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The Contemporary Prevalence of Diabetic Neuropathy in Type 1 Diabetes: Findings From the T1D Exchange

OBJECTIVE

To evaluate the contemporary prevalence of diabetic peripheral neuropathy (DPN) in participants with type 1 diabetes in the T1D Exchange Clinic Registry throughout the U.S.

RESEARCH DESIGN AND METHODS

DPN was assessed with the Michigan Neuropathy Screening Instrument Questionnaire (MNSIQ) in adults with ≥5 years of type 1 diabetes duration. A score of ≥4 defined DPN. Associations of demographic, clinical, and laboratory factors with DPN were assessed.

RESULTS

Among 5,936 T1D Exchange participants (mean ± SD age 39 ± 18 years, median type 1 diabetes duration 18 years [interquartile range 11, 31], 55% female, 88% non-Hispanic white, mean glycated hemoglobin [HbA1c] 8.1 ± 1.6% [65.3 ± 17.5 mmol/mol]), DPN prevalence was 11%. Compared with those without DPN, DPN participants were older, had higher HbA1c, had longer duration of diabetes, were more likely to be female, and were less likely to have a college education and private insurance (all P < 0.001). DPN participants also were more likely to have cardiovascular disease (CVD) (P < 0.001), worse CVD risk factors of smoking (P = 0.008), hypertriglyceridemia (P = 0.002), higher BMI (P = 0.009), retinopathy (P = 0.004), reduced estimated glomerular filtration rate (P = 0.02), and Charcot neuroarthropathy (P = 0.002). There were no differences in insulin pump or continuous glucose monitor use, although DPN participants were more likely to have had severe hypoglycemia (P = 0.04) and/or diabetic ketoacidosis (P < 0.001) in the past 3 months.

CONCLUSIONS

The prevalence of DPN in this national cohort with type 1 diabetes is lower than in prior published reports but is reflective of current clinical care practices. These data also highlight that nonglycemic risk factors, such as CVD risk factors, severe hypoglycemia, diabetic ketoacidosis, and lower socioeconomic status, may also play a role in DPN development.




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Immigrants from New Origin Countries in the United States

The national origins of new arrivals to the United States are shifting, in ways not always fully appreciated. Recent newcomers are more likely to come from Asia, Central America, and Africa, and less likely to be from Mexico. This article offers key demographic information about the 15 immigrant groups that have experienced the largest growth since 2010, including Indians, Chinese, Colombians, Nigerians, and Bangladeshis.




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“Cubicle Activism”: Companies Face Growing Demands from Workers to Cut Ties with ICE and Others in Immigration Arena

From online petitions to organized walkouts, corporate America is facing increasing employee activism over its business involvement with agencies implementing the federal government's immigration policies. This "cubicle activism," seen at companies ranging from Amazon and Google to Bank of America and Wayfair, has garnered mixed success to date, forcing divestiture from private prison contractors but fewer results in other contexts, as this article explores.




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Interlocking Set of Trump Administration Policies at the U.S.-Mexico Border Bars Virtually All from Asylum

Through a set of interlocking policies, the Trump administration has walled off the asylum system at the U.S.-Mexico border, guaranteeing that only a miniscule few can successfully gain protection. While the Migrant Protection Protocols, more commonly known as Remain in Mexico, have been a key part of throttling asylum applications, two newer, far less visible programs hold the potential to complete the job, as this article explores.




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Soluciones estratégicas para afrontar la crisis migratoria en Estados Unidos y México

Dado el incremento de los flujos migratorios provenientes de Centroamérica, el pasado mes de junio de 2019, los Estados Unidos y México acordaron tomar una serie de medidas para reducir los flujos irregulares. Sin embargo, será muy difícil mantener estos esfuerzos de corto plazo, debido a una debilidad institucional crónica y a estructuras de política pública poco planificadas en ambos países. Este comentario ofrece cinco recomendaciones a ambos países considerando soluciones de mediano y largo plazo para disuadir la migración irregular y, al mismo tiempo, garantizar que aquellos que busquen protección tengan un proceso justo.




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From high school student to dentist, Give Kids A Smile volunteer continues commitment

Dr. Theressa Eliscar-Hewett began volunteering at the Nassau County Give Kids A Smile event in Long Island, New York, as a high school student. More than 10 years later, she continues to volunteer, only now as a dentist.




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ADA provides suggestions to help protect dentists from employee theft

Nearly 49% of responding dental practices have experienced employee theft, and nearly 46% of those have experienced theft or embezzlement more than once, according to a survey conducted by the ADA Council on Dental Practice.




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ADA provides suggestions to help protect dentists from employee theft




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Phishing email claims to be from ADA president

At least one American Dental Association member has reported receiving a phishing email appearing to come from an address containing ADA President Chad P. Gehani's name and including a link to "view member's details."




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ADA seeks clarification from HHS regarding chief dental officer

The American Dental Association is applauding the U.S. Department of Health and Human Services’ decision to appoint a chief dental officer at the Centers for Medicare & Medicaid but would like to confirm the position is exclusive to CMS.




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ADA adds frequently asked questions from dentists to coronavirus resources

With the coronavirus disease now deemed a pandemic by the World Health Organization, the American Dental Association updated its webpage on the disease March 11 to include a link to frequently asked questions from member dentists covering topics such as personal protective equipment and patient communications.




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Infection control webinar from ADA, OSAP available late March 20

On March 20, the ADA will release an on-demand webinar offering answers to frequently asked questions about infection control protocol and procedures related to COVID-19.




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ADA urges CDC to provide ‘immediate guidance’ on protecting dental patients, staff from COVID-19 during emergency treatments

The American Dental Association is urging the Centers for Disease Control and Prevention to provide immediate guidance on the best way to protect dental patients and staff from the transmission of COVID-19 during emergency and urgent care situations.




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ADA offers free e-books on professional risk, OSHA from April 1-7

As part of its ongoing efforts to support dentists during the COVID-19 pandemic, the ADA is offering members two free e-books the week of April 1-7: “Managing Professional Risks: Best Practices” and “The ADA Practical Guide to OSHA Training: Compliance for Dental Professionals.”




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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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Crude prices rise after positive news from China

Oil prices rose early Tuesday, after Monday declines, possibly helped by some positive news from China -- but doubts remain as to whether that direction will hold.




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Cancer patients on Medicaid might not benefit from experimental treatments, study finds

Cancer patients on Medicaid or who don't have insurance benefit less from experimental treatments, even if they get into clinical trials, a study published Thursday by JAMA Network Open has found.




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U.S. rural areas soon might be on front lines in COVID-19 pandemic

The COVID-19 pandemic has left a path of destruction in urban centers throughout the northeastern United States, but the next outbreak hotspots could have even deadlier effects in rural areas.




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Exploring New Legal Migration Pathways: Lessons from Pilot Projects

As European countries launch ambitious new legal migration partnerships with several origin and transit countries in Africa, this report takes stock of the long and mixed history of such projects. To make the most of their potential to encourage skills development and fill pressing labor gaps, policymakers will need to think carefully about the partners and sectors they choose, among other key considerations.




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Social Innovation for Refugee Inclusion: From Bright Spots to System Change

In the three years since the European migration and refugee crisis vividly captured public attention, a wave of innovative initiatives has emerged to help newcomers settle into receiving societies. Now, as the sense of crisis abates, this report explores what these initiatives will need to do to outlast the hype and produce lasting change on key integration issues such as housing, economic inclusion, and community building.




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Renal and Cardiovascular Outcomes After Weight Loss From Gastric Bypass Surgery in Type 2 Diabetes: Cardiorenal Risk Reductions Exceed Atherosclerotic Benefits

OBJECTIVE

We examined detailed renal and cardiovascular (CV) outcomes after gastric bypass (GBP) surgery in people with obesity and type 2 diabetes mellitus (T2DM), across several renal function categories, in a nationwide cohort study.

RESEARCH DESIGN AND METHODS

We linked data from the National Diabetes Register and the Scandinavian Obesity Surgery Register with four national databases holding information on socioeconomic variables, medications, hospitalizations, and causes of death and matched 5,321 individuals with T2DM who had undergone GBP with 5,321 who had not (age 18–65 years, mean BMI >40 kg/m2, mean follow-up >4.5 years). The risks of postoperative outcomes were assessed with Cox regression models.

RESULTS

During the first years postsurgery, there were small reductions in creatinine and albuminuria and stable estimated glomerular filtration rate (eGFR) in the GBP group. The incidence rates of most outcomes relating to renal function, CV disease, and mortality were lower after GBP, being particularly marked for heart failure (hazard ratio [HR] 0.33 [95% CI 0.24, 0.46]) and CV mortality (HR 0.36 [(95% CI 0.22, 0.58]). The risk of a composite of severe renal disease or halved eGFR was 0.56 (95% CI 0.44, 0.71), whereas nonfatal CV risk was lowered less (HR 0.82 [95% CI 0.70, 0.97]) after GBP. Risks for key outcomes were generally lower after GBP in all eGFR strata, including in individuals with eGFR <30 mL/min/1.73 m2.

CONCLUSIONS

Our data suggest robust benefits for renal outcomes, heart failure, and CV mortality after GBP in individuals with obesity and T2DM. These results suggest that marked weight loss yields important benefits, particularly on the cardiorenal axis (including slowing progression to end-stage renal disease), whatever the baseline renal function status.




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Obstructive Sleep Apnea, a Risk Factor for Cardiovascular and Microvascular Disease in Patients With Type 2 Diabetes: Findings From a Population-Based Cohort Study

OBJECTIVE

To determine the risk of cardiovascular disease (CVD), microvascular complications, and mortality in patients with type 2 diabetes who subsequently develop obstructive sleep apnea (OSA) compared with patients with type 2 diabetes without a diagnosis of OSA.

RESEARCH DESIGN AND METHODS

This age-, sex-, BMI-, and diabetes duration–matched cohort study used data from a U.K. primary care database from 1 January 2005 to 17 January 2018. Participants aged ≥16 years with type 2 diabetes were included. Exposed participants were those who developed OSA after their diabetes diagnosis; unexposed participants were those without diagnosed OSA. Outcomes were composite CVD (ischemic heart disease [IHD], stroke/transient ischemic attack [TIA], heart failure [HF]), peripheral vascular disease (PVD), atrial fibrillation (AF), peripheral neuropathy (PN), diabetes-related foot disease (DFD), referable retinopathy, chronic kidney disease (CKD), and all-cause mortality. The same outcomes were explored in patients with preexisting OSA before a diagnosis of type 2 diabetes versus diabetes without diagnosed OSA.

RESULTS

A total of 3,667 exposed participants and 10,450 matched control participants were included. Adjusted hazard ratios for the outcomes were as follows: composite CVD 1.54 (95% CI 1.32, 1.79), IHD 1.55 (1.26, 1.90), HF 1.67 (1.35, 2.06), stroke/TIA 1.57 (1.27, 1.94), PVD 1.10 (0.91, 1.32), AF 1.53 (1.28, 1.83), PN 1.32 (1.14, 1.51), DFD 1.42 (1.16, 1.74), referable retinopathy 0.99 (0.82, 1.21), CKD (stage 3–5) 1.18 (1.02, 1.36), albuminuria 1.11 (1.01, 1.22), and all-cause mortality 1.24 (1.10, 1.40). In the prevalent OSA cohort, the results were similar, but some associations were not observed.

CONCLUSIONS

Patients with type 2 diabetes who develop OSA are at increased risk of CVD, AF, PN, DFD, CKD, and all-cause mortality compared with patients without diagnosed OSA. Patients with type 2 diabetes who develop OSA are a high-risk population, and strategies to detect OSA and prevent cardiovascular and microvascular complications should be implemented.




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Dietary Manganese, Plasma Markers of Inflammation, and the Development of Type 2 Diabetes in Postmenopausal Women: Findings From the Womens Health Initiative

OBJECTIVE

To examine the association between manganese intake and the risk of type 2 diabetes in postmenopausal women and determine whether this association is mediated by circulating markers of inflammation.

RESEARCH DESIGN AND METHODS

We included 84,285 postmenopausal women without a history of diabetes from the national Women’s Health Initiative Observational Study (WHI-OS). Replication analysis was then conducted among 62,338 women who participated in the WHI-Clinical Trial (WHI-CT). Additionally, data from a case-control study of 3,749 women nested in the WHI-OS with information on biomarkers of inflammation and endothelial dysfunction were examined using mediation analysis to determine the relative contributions of these known biomarkers by which manganese affects type 2 diabetes risk.

RESULTS

Compared with the lowest quintile of energy-adjusted dietary manganese, WHI-OS participants in the highest quintile had a 30% lower risk of type 2 diabetes (hazard ratio [HR] 0.70 [95% CI 0.65, 0.76]). A consistent association was also confirmed in the WHI-CT (HR 0.79 [95% CI 0.73, 0.85]). In the nested case-control study, higher energy-adjusted dietary manganese was associated with lower circulating levels of inflammatory biomarkers that significantly mediated the association between dietary manganese and type 2 diabetes risk. Specifically, 19% and 12% of type 2 diabetes risk due to manganese were mediated through interleukin 6 and hs-CRP, respectively.

CONCLUSIONS

Higher intake of manganese was directly associated with a lower type 2 diabetes risk independent of known risk factors. This association may be partially mediated by inflammatory biomarkers.




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microRNA-21/PDCD4 Proapoptotic Signaling From Circulating CD34+ Cells to Vascular Endothelial Cells: A Potential Contributor to Adverse Cardiovascular Outcomes in Patients With Critical Limb Ischemia

OBJECTIVE

In patients with type 2 diabetes (T2D) and critical limb ischemia (CLI), migration of circulating CD34+ cells predicted cardiovascular mortality at 18 months after revascularization. This study aimed to provide long-term validation and mechanistic understanding of the biomarker.

RESEARCH DESIGN AND METHODS

The association between CD34+ cell migration and cardiovascular mortality was reassessed at 6 years after revascularization. In a new series of T2D-CLI and control subjects, immuno-sorted bone marrow CD34+ cells were profiled for miRNA expression and assessed for apoptosis and angiogenesis activity. The differentially regulated miRNA-21 and its proapoptotic target, PDCD4, were titrated to verify their contribution in transferring damaging signals from CD34+ cells to endothelial cells.

RESULTS

Multivariable regression analysis confirmed that CD34+ cell migration forecasts long-term cardiovascular mortality. CD34+ cells from T2D-CLI patients were more apoptotic and less proangiogenic than control subjects and featured miRNA-21 downregulation, modulation of several long noncoding RNAs acting as miRNA-21 sponges, and upregulation of the miRNA-21 proapoptotic target PDCD4. Silencing miR-21 in control subject CD34+ cells phenocopied the T2D-CLI cell behavior. In coculture, T2D-CLI CD34+ cells imprinted naïve endothelial cells, increasing apoptosis, reducing network formation, and modulating the TUG1 sponge/miRNA-21/PDCD4 axis. Silencing PDCD4 or scavenging reactive oxygen species protected endothelial cells from the negative influence of T2D-CLI CD34+ cells.

CONCLUSIONS

Migration of CD34+ cells predicts long-term cardiovascular mortality in T2D-CLI patients. An altered paracrine signaling conveys antiangiogenic and proapoptotic features from CD34+ cells to the endothelium. This damaging interaction may increase the risk for life-threatening complications.




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Top 5 Questions about ADHD- From Everyday Health

Everyday Health is gathering the responses of several professionals of the top 5 questions they get regarding ADHD. They asked me to participate. The following are the questions and my answers. Check in with Everyday Health next week to see the compilation of responses.

1. Why are there so many theories about the causes of ADHD? What are the most common?

Any disorder that does not have a known cause is open to a number of theories. People naturally want to know why or want to feel as if it can be prevented in the future. Heredity is believed to be the most commonly accepted cause.

2. How can you explain the value of treatment to resistant parents? For example, “I survived my childhood with ADHD --and I was never diagnosed or treated. Why does my child need ADHD treatment?”

Often children with ADHD have gaps in their education. As they are in and out of focus each day, they miss key points in instruction. As new skills build upon old skills, it can be more and more difficult to learn new tasks where there are gaps in the foundation. This difficulty can make focusing even more difficult, further compounding the problem. Treatment can help reduce or prevent this cycle.

3. What role does a child’s school have in helping him or her with ADHD?

The school can help by providing support and accommodations specific to the particular needs of your child IF it can be determined that the symptoms of ADHD are significantly impacting his or her education. Of course, each school has different criteria for determining if there is a significant impact.

4. Are the medications recommended for ADHD safe for children? What are the potential dangers?

There is not a lot of solid research yet on this topic. While the medications are believed to be safe, they have not been around long enough to fully study long term effects. There are also side effects that may make the medications not worth the benefits in some children. All of that being said, I've seen kids who are finally able to focus after starting medication. Taking the medication improves learning, grades, and self esteem, which has numerous positive long term benefits. Medication is not something to take lightly. Parents must think very carefully weigh the unknown risks of taking the medications verses the possible risks of refusing the medications. There is not one answer that fits all children.

5. What are the most common side effects of ADHD meds?

Weight loss, behavioral changes, and headaches are possible side effects.




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House probe: Trump admin failed to adequately screen travelers from South Korea, Italy for COVID-19

The Trump administration failed to conduct effective screening of passengers from South Korea and Italy for the coronavirus when those countries were experiencing rapid expansion in COVID-19 cases.




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

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




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Astronomers find black hole just 1,000 light-years from Earth

Scientists have discovered the closest black hole to Earth, located just 1,000 light-years away.




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Televangelist Jim Bakker recovering from stroke

Televangelist Jim Bakker is recovering at his North Carolina home after having a stroke, his wife said Friday.




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Watch: Gwyneth Paltrow, Ben Schwartz read texts from their moms on 'Kimmel'

Gwyneth Paltrow, Ben Schwartz and other celebrities read text messages from their mothers on "Jimmy Kimmel Live" in honor of Mother's Day.




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Princess Love files for divorce from Ray J

Princess Love filed for divorce from Ray J, her husband and "Love & Hip Hop: Hollywood" co-star, after nearly four years of marriage.





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How to Stay Sane While Staying Home: Advice from an Introvert

For loners, recluses, and other solitary types such as myself, sheltering-in-place feels natural and normal. However scary other aspects of this pandemic might be, for us, this aspect isn’t. Working...




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[ Credit ] Open Question : I'm 23 with a 536 credit score because I was stupid from ages 18-20. Is there any way to make it higher? ?

I have 2500 worth of debt and most of it has been turned over into collections 




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[ Religion & Spirituality ] Open Question : My mother keeps turning water into wine, walking on water and resurrecting from the dead. Is she a witch?




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[ Politics ] Open Question : IF Cons rewrote the Constitution of the United States would it have less laws, more liberty, & move power from DC to the State Capitals?

Oh would that 'less laws/more liberty/more state capital power' look anything like Mike Pence's Religious Freedom Restoration Act or in other words the 'we Conservative Republican Christians are such oppressed persecuted victims WAAAAA WAAAA' Bill. https://www.youtube.com/watch?v=KIikqPmbgvI 




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From Emigration to Asylum Destination, Italy Navigates Shifting Migration Tides

Long a country of emigration—13 million Italians went abroad between 1880 and 1915—Italy has also experienced significant inflows of Middle Eastern and sub-Saharan African workers in recent decades. Italy has also been on the frontlines of Europe's refugee crisis. This country profile examines Italy's shifting migration patterns, policy responses over time, and debates.




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Vanishing Frontiers: The Forces Driving Mexico and the United States Together

Wall or no wall, deeply intertwined social, economic, business, cultural, and personal relationships mean the U.S.-Mexico border is more like a seam than a barrier, weaving together two economies and cultures, as MPI President Andrew Selee sketches in this book, which draws from his travels and discussions with people from all walks of life in Mexico and the United States.




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Vulnerable to COVID-19 and in Frontline Jobs, Immigrants Are Mostly Shut Out of U.S. Relief

On the frontlines of responding to the COVID-19 pandemic yet also more disproportionately affected by the virus and with reduced health care access, immigrants in the United States have largely found themselves blocked from federal economic relief. As states and philanthropic groups seek to plug the gap, this article examines conditions and changing policies around immigration and the coronavirus response.




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Under Lockdown Amid COVID-19 Pandemic, Europe Feels the Pinch from Slowed Intra-EU Labor Mobility

Border closures and lockdowns amid the COVID-19 pandemic have put a chill on intra-EU labor mobility, most immediately with the difficulty for European farmers to gain access to much-needed seasonal workers and for health-care institutions to get care workers. This article explores how these workers, who often face difficult situations, may be more vulnerable now. It also takes on implications for intra-EU labor mobility post-pandemic.




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Tapping the Talents of Highly Skilled Immigrants in the United States: Takeaways from Experts Summit

Economists project a shortage of 5 million U.S. workers with postsecondary education and training by 2020. Yet 2 million immigrant college graduates in the United States are either unemployed or work in jobs that require no more than a high school degree. How can this skill underutilization, known as "brain waste," be remedied? MPI asked the experts, and this report summarizes their discussion and recommendations.




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'Attraction Effect' Helps Voters Pick From the Pack

Some years ago, a political scientist conducted an interesting experiment that speaks to the fractured race for the Republican presidential nomination, which now has six candidates, five issues, and four potential front-runners.




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What Obama Might Learn From Emily Dickinson

Tell all the Truth but tell it slant/Success in Circuit lies/Too bright for our infirm Delight/The Truth's superb surprise . . .





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After the Storm: Learning from the EU Response to the Migration Crisis

As maritime arrivals climbed in 2015, EU policymakers struggled to mount a coordinated response. A range of ad hoc crisis-response tools emerged, but many officials worry that if another migration emergency were to hit Europe, the European Union may still be unprepared. This report traces the evolution of the EU response to the 2015–16 crisis and lays out recommendations to lock in progress and shore up weaknesses.




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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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Reducing Integration Barriers Facing Foreign-Trained Immigrants: Policy and Practice Lessons from Across the United States

Marking the release of an MPI report, researchers and practitioners on this webinar discuss brain waste among college-educated immigrants and initiatives that ease the barriers foreign-educated newcomers confront with regards to credential recognition, employment, and relicensure, as well as recent policy developments and ongoing challenges in the field.




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Reducing Integration Barriers Facing Foreign-Trained Immigrants: Policy and Practice Lessons from Across the United States

Marking the release of a report on the barriers foreign-trained high-skilled immigrants face in the United States, this webinar examines programs and initiatives that assist with credential recognition, employment, and relicensure, as well as recent policy developments. Discussants review recommendations for community-based organizations, employers, and policymakers to expand successful efforts aimed at preventing brain waste. 




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As Millions Are Pushed from Jobs amid Pandemic, the Loss of Employer Health Coverage &amp; Limited Access to Public Coverage for Many Immigrants Hold Major Implications for Them – and U.S. Overall

WASHINGTON – As more than 33 million U.S. workers have lost their jobs since March amid the pandemic-induced economic crisis, immigrants are among the most vulnerable: They are more likely than the U.S. born to be laid off and to live in communities with high COVID-19 infection rates, and less likely to have health insurance coverage and access to a doctor or other usual source of health care.




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Italian tomato, saffron and mozzarella arancini

1/2 cup chicken stock 1 pinch of saffron olive oil, for cooking 1 small brown onion, diced 1 tbsp. tomato paste 150 g Carnaroli rice or Arborio rice Himalayan salt and freshly ground black pepper 100 ml white wine 60 g grated parmesan finely grated zest of 1 lemon 100 g grated mozzarella 3 eggs 125 ml (1/2 cup) milk 50 g plain flour 160 g panko breadcrumbs (see Note) vegetable oil, for deep-frying