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Using the BRAVO Risk Engine to Predict Cardiovascular Outcomes in Clinical Trials With Sodium-Glucose Transporter 2 Inhibitors

OBJECTIVE

This study evaluated the ability of the Building, Relating, Assessing, and Validating Outcomes (BRAVO) risk engine to accurately project cardiovascular outcomes in three major clinical trials—BI 10773 (Empagliflozin) Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients (EMPA-REG OUTCOME), Canagliflozin Cardiovascular Assessment Study (CANVAS), and Dapagliflozin Effect on Cardiovascular Events–Thrombolysis in Myocardial Infarction (DECLARE-TIMI 58) trial—on sodium–glucose cotransporter 2 inhibitors (SGLT2is) to treat patients with type 2 diabetes.

RESEARCH DESIGN AND METHODS

Baseline data from the publications of the three trials were obtained and entered into the BRAVO model to predict cardiovascular outcomes. Projected benefits of reducing risk factors of interest (A1C, systolic blood pressure [SBP], LDL, or BMI) on cardiovascular events were evaluated, and simulated outcomes were compared with those observed in each trial.

RESULTS

BRAVO achieved the best prediction accuracy when simulating outcomes of the CANVAS and DECLARE-TIMI 58 trials. For the EMPA-REG OUTCOME trial, a mild bias was observed (~20%) in the prediction of mortality and angina. The effect of risk reduction on outcomes in treatment versus placebo groups predicted by the BRAVO model strongly correlated with the observed effect of risk reduction on the trial outcomes as published. Finally, the BRAVO engine revealed that most of the clinical benefits associated with SGLT2i treatment are through A1C control, although reductions in SBP and BMI explain a proportion of the observed decline in cardiovascular events.

CONCLUSIONS

The BRAVO risk engine was effective in predicting the benefits of SGLT2is on cardiovascular health through improvements in commonly measured risk factors, including A1C, SBP, and BMI. Since these benefits are individually small, the use of the complex, dynamic BRAVO model is ideal to explain the cardiovascular outcome trial results.




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Support for ADHD in the Schools

Penny Williams from A Mom's view of ADHD and I decided to join forces this month in an attempt to reach more people through our blogs. I believe that many of my readers would find her blog helpful and I also felt that I could offer some insight into the school perspective to her readers. Penny wrote Make Homework Routine a few weeks ago. If you found that helpful, check out her blog full of more strategies! A Mom's View of ADHD is an excellent resource for parents of children with ADHD. It's written from by a parent going through it and provides excellent insight and strategies. I highly recommend it as a place for parents to go to connect and gain support.

Be sure to check out my article, Support for ADHD in the Schools. I discussed the options available for receiving support in the schools for ADHD such as an IEP or a 504 Plan.





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New map highlights China's export-driven CO2 emissions

China produces a whole lot of stuff -- stuff that gets bought by the rest of the world. In 2019, China exported approximately $2.5 trillion dollars worth of goods.




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Ask Ariely: On Team Tragedy, Airport Anxiety, and Grumpy Gift-wrapping

Here’s my Q&A column from the WSJ this week — and if you have any questions for me, you can tweet them to @danariely with the hashtag #askariely, post a comment on my Ask Ariely Facebook page, or email them to AskAriely@wsj.com. ___________________________________________________ Hi Dan, I have a hard time watching...




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USS Montgomery, USNS Cesar Chavez enter South China Sea to support drill ship

The USS Montgomery and the USNS Cesar Chavez sailed into the South China Sea this week in support of the West Capella drill ship, according to U.S. Indo-Pacific Command.




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[ Yahoo Answers ] Open Question : Nowadays many of legit questions are getting removed without notice. There's no appeal options also. How can I report about these mistakes?

*my legit questions




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[ Politics ] Open Question : Trump supporters: Do you watch Disney and Pixar movies even though they carry hidden liberal agendas?

Do you let your kids watch Disney and Pixar movies? They're all created by liberals.




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The International Migration System: Reflections on the Challenges and Opportunities Ahead

A reflection by MPI's co-founder, Demetrios Papademetriou, as he takes leave from his day-to-day role at MPI on the challenges and opportunities ahead for international migration systems over the next few decades. After opening remarks, Papademetriou engages in a conversation with incoming MPI President Andrew Selee about the trends and realities confronting policymakers and publics.




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Quality for Whom? Supporting Diverse Children and Workers in Early Childhood Quality Rating and Improvement Systems

For children in U.S. homes where a language other than English is spoken, early childhood programs that are responsive to their needs can be key to later academic success. But as states refine their Quality Rating and Improvement Systems (QRIS) to assess such programs, immigrant early childhood workers with in-demand language and cultural skills may be left behind. This report examines the challenges these workers face and promising practices to serve diverse communities.




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New Opportunities? ESSA and Its Implications for Dual Language Learners and ECEC Workforce Development

Enactment of the Every Student Succeeds Act (ESSA) in 2015 introduced opportunities to use federal funds to strengthen the early childhood education and care (ECEC) workforce as a means of better meeting the needs of the growing and increasingly diverse young child population.




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Best Supporting? Maybe Not.

Let's say someone stuck a microphone in your face and gave you 45 seconds to say something meaningful to a billion people. Let's say, moreover, that this is the only chance you will ever have to directly address the entire world.




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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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Building an Evidence Base to Support Refugee Resettlement

Marking the release of an MPI Europe report commissioned as part of the EU-FRANK project, this webinar examines critical gaps in the research and evaluation of refugee resettlement programs and recommendations for improving evidence gathering and knowledge sharing between resettlement countries. 




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Scaling up Refugee Resettlement in Europe: The Role of Institutional Peer Support

With pressure mounting on EU Member States to create and scale up refugee resettlement programs, many have turned to peers in other countries for information, advice, and operational support. This report maps the many forms resettlement-focused peer-support initiatives take and discusses common stumbling blocks and strategies for policymakers and program designers looking to make the most of these critical exchanges.




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Social Innovation for Refugee Inclusion Conference Report: Maintaining Momentum and Creating Lasting Change

Fostering the social and economic inclusion of refugees has long been the domain of governments and NGOs. In the wake of the 2015–16 European migration and refugee crisis, however, new actors have emerged and taken on important roles in integrating newcomers. This report describes key discussions and takeaways from an MPI Europe conference on these developments.




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Money Wise: Improving How EU Funds Support Migration and Integration Policy Objectives

European policymakers are negotiating the blueprint for the next EU funding cycle—a plan that will determine how much money is available for migration and integration aims, what it can be used for, and who can access it. This policy brief explores some of the limitations of EU funds, as well as strategies that could help them more effectively serve migration and integration policy goals.




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Investing in the Neighborhood: Changing Mexico-U.S. Migration Patterns and Opportunities for Sustainable Cooperation

Migration between Mexico and the United States has changed dramatically in recent years, but policies and political rhetoric in both countries have not always kept up. This report, which draws from discussions of a high-level Mexico-U.S. study group convened by MPI and El Colegio de México, explores this new migration reality and how the two governments could work more closely together to address shared policy challenges.




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Invertir en el vecindario: Cambios en los patrones de migración entre México y Estados Unidos y oportunidades para una cooperación sostenible

La migración entre México y Estados Unidos ha cambiado dramáticamente en los últimos años, pero las políticas y la retórica política en ambos países no se han actualizado a este contexto a la misma velocidad. Este reporte explora esta nueva realidad migratoria y cómo los dos gobiernos podrían trabajar juntos para abordar los desafíos de políticas públicas que tienen en común.




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Immigrant Workers: Vital to the U.S. COVID-19 Response, Disproportionately Vulnerable

Six million immigrant workers are at the frontlines of keeping U.S. residents healthy and fed during the COVID-19 pandemic, representing disproportionate shares of physicians, home health aides, and retail-store pharmacists, for example. They also are over-represented in sectors most immediately devastated by mass layoffs, yet many will have limited access to safety-net systems and to federal relief, as this fact sheet details.




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Supporting DLLs in Superdiverse PreK-3 Programs: Findings from Two Studies

Marking the release of two research reports that highlight promising, effective approaches to teaching and learning for Dual Language Learners in multilingual, multicultural classrooms, report authors present their findings on this webinar and discuss key implications for policy and practice.




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State Sociodemographic Portraits of Immigrant and U.S.-Born Parents of Young Children

These fact sheets provide a sociodemographic sketch of parents with children ages 0 to 8 in the 30 states with the largest number of immigrant families, offering data and analysis of some of the key parental characteristics to help stakeholders identify populations that could be targets for early childhood and parent-focused programs working to improve child and parent outcomes.




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English Plus Integration: Shifting the Instructional Paradigm for Immigrant Adult Learners to Support Integration Success

To successfully integrate, immigrants and refugees need a variety of skills and knowledge—from English proficiency to understanding how school systems and local services work. Yet the adult education programs in place to support them have narrowed in scope. This policy brief proposes a new instructional model, English Plus Integration, to help states more comprehensively meet the diverse needs of their adult immigrant learners.




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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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Immigrant Workers Are Vital to the U.S. Coronavirus Pandemic Response, But Disproportionately Vulnerable

WASHINGTON — Six million immigrant workers are at the frontlines of keeping U.S. residents healthy, safe and fed during the COVID-19 pandemic, according to a Migration Policy Institute (MPI) analysis of U.S. Census Bureau data issued today. While the foreign born represented 17 percent of the 156 million civilians working in 2018, they account for larger shares in pandemic-response frontline occupations: 29 percent of all physicians in the United States, 38 percent of home health aides and 23 percent of retail-store pharmacists, for example.




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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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Is a U.S. Immigration System Rebuilt after 9/11 Prepared to Tackle Ever-Evolving Security Threats, Including Pandemics? Report Assesses Successes, Gaps

WASHINGTON — The U.S. immigration system was dramatically reshaped by the terrorist attacks of September 11, 2001, which shone a harsh spotlight on weaknesses in visa and immigration screening processes. From the creation of the Department of Homeland Security (DHS) to expanded national security protections in immigration and tourism policies, countless changes in the immigration arena have unfolded over the past 19 years.




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Which English Learners Count When? Understanding State EL Subgroup Definitions in ESSA Reporting

States publish a wealth of data about their English Learner students’ academic achievement and other outcomes such as graduation rates. But the answer to the question “Who is an EL?” is not always the same. This brief explains how the EL subgroup varies across states and types of data, and why it is important to understand these differences when making decisions about how ELs and schools are faring.




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Arroz de Marisco (Portugeuse rice dish)

The Portuguese have a double gene for flavours. They keep it simple, they rely on extremely good produce. This dish has such a unique flavour. It's ideal with all wines. A good Lisbon paste is the trick!




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Roast Christmas Duck with Port and Cherry sauce

Getting in early with my Christmas recipe to inspire you to move away from the traditional Turkey . Not one for sweet tasting sauces with meat however his works extremely well against the rich sometimes games flavour and the sweet sour notes from the cherry sauce.




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Start-Up Visas: A Passport for Innovation and Growth?

Over the last decade, a number of governments have launched start-up visa programs in the hopes of attracting talented immigrant entrepreneurs with innovative business ideas. With the track record for these programs a mixed one, this report explains how embedding start-up visas within a broader innovation strategy could lead to greater success.




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Refugee Sponsorship Programs: A Global State of Play and Opportunities for Investment

From Argentina to New Zealand and points beyond, a growing number of countries have begun exploring refugee sponsorship as a way to expand protection capacity at a time of rising need, involving individuals and communities more directly in resettlement. This brief takes stock of what both new and well-established programs need to succeed, and outlines opportunities for private philanthropic actors to support them.




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Inoreader mobile apps updated to support Automatic Night Mode, Microblogs, Sort by Magic and popularity indicators.

Hey, it’s been quite some time without updates on this front, but our latest updates to our Android and iOS…




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Expert Podcast: Understanding How English Learners Count in ESSA Reporting

This podcast features a discussion between MPI's Margie McHugh and Julie Sugarman about how to understand the varying composition of states' English Learner (EL) subgroup under ESSA, and why understanding these technical differences matters when making decisions about how ELs and schools are faring. They also talk about different groups of ELs: newcomers, students with interrupted formal education, and long-term ELs, and data collection around these different cohorts.




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Diabetes Self-management Education and Support in Type 2 Diabetes: A Joint Position Statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics

Margaret A. Powers
Apr 1, 2016; 34:70-80
Position Statements




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Opportunities and Challenges for Biosimilars: What's on the Horizon in the Global Insulin Market?

Lisa S. Rotenstein
Oct 1, 2012; 30:138-150
Features




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Crisis support for the world, one text away | Nancy Lublin

What if we could help people in crisis anytime, anywhere with a simple text message? That's the idea behind Crisis Text Line, a free 24-hour service that connects people in need with trained, volunteer crisis counselors -- "strangers helping strangers around the world, like a giant global love machine," as cofounder and CEO Nancy Lublin puts it. Learn more about their big plans to expand to four new languages, providing a third of the globe with crucial, life-saving support. (This ambitious plan is a part of the Audacious Project, TED's initiative to inspire and fund global change.)




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Educational Opportunities and Performance in Massachusetts

This Quality Counts 2019 Highlights Report captures all the data you need to assess your state's performance on key educational outcomes.




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Massachusetts Ranks Second on Quality Counts Annual Report Card

The state, which earned a B-plus, led the nation in K-12 achievement rankings and outperformed other states in several key academic indicators, but fell short on funding equity.




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Educational Opportunities and Performance in Massachusetts

This Quality Counts 2020 Highlights Report captures all the data you need to assess your state's performance on key educational outcomes.




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Educational Opportunities and Performance in North Carolina

This Quality Counts 2020 Highlights Report captures all the data you need to assess your state's performance on key educational outcomes.




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Educational Opportunities and Performance in West Virginia

This Quality Counts 2019 Highlights Report captures all the data you need to assess your state's performance on key educational outcomes.




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Educational Opportunities and Performance in Virginia

This Quality Counts 2019 Highlights Report captures all the data you need to assess your state's performance on key educational outcomes.




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Educational Opportunities and Performance in West Virginia

This Quality Counts 2020 Highlights Report captures all the data you need to assess your state's performance on key educational outcomes.




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Educational Opportunities and Performance in Virginia

This Quality Counts 2020 Highlights Report captures all the data you need to assess your state's performance on key educational outcomes.




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Educational Opportunities and Performance in Maine

This Quality Counts 2019 Highlights Report captures all the data you need to assess your state's performance on key educational outcomes.




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Educational Opportunities and Performance in Maine

This Quality Counts 2020 Highlights Report captures all the data you need to assess your state's performance on key educational outcomes.




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Educational Opportunities and Performance in Ohio

This Quality Counts 2019 Highlights Report captures all the data you need to assess your state's performance on key educational outcomes.




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Educational Opportunities and Performance in Ohio

This Quality Counts 2020 Highlights Report captures all the data you need to assess your state's performance on key educational outcomes.




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Educational Opportunities and Performance in Oklahoma

This Quality Counts 2019 Highlights Report captures all the data you need to assess your state's performance on key educational outcomes.




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Oklahoma Ranks 49th on Quality Counts Annual Report Card

The state, which earned a D-plus, has struggled with school finance issues and endured teacher strikes and battles over pay, but also earned B-plus for funding equity.