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As More Migrants from Africa and Asia Arrive in Latin America, Governments Seek Orderly and Controlled Pathways

Growing numbers of African and Asian migrants are moving through Latin America, many hoping to reach the United States or Canada after expensive, arduous, and often dangerous journeys that can take months or even years. As more extracontinental migrants transit through South and Central America, Colombia, Panama, and Costa Rica have developed the most comprehensive policies to manage these flows, sometimes working in coordination with the U.S. government.




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Efficacy and Safety of Dapagliflozin in the Elderly: Analysis From the DECLARE-TIMI 58 Study

OBJECTIVE

Data regarding the effects of sodium–glucose cotransporter 2 inhibitors in the elderly (age ≥65 years) and very elderly (age ≥75 years) are limited.

RESEARCH DESIGN AND METHODS

The Dapagliflozin Effect on Cardiovascular Events (DECLARE)–TIMI 58 assessed cardiac and renal outcomes of dapagliflozin versus placebo in patients with type 2 diabetes. Efficacy and safety outcomes were studied within age subgroups for treatment effect and age-based treatment interaction.

RESULTS

Of the 17,160 patients, 9,253 were <65 years of age, 6,811 ≥65 to <75 years, and 1,096 ≥75 years. Dapagliflozin reduced the composite of cardiovascular death or hospitalization for heart failure consistently, with a hazard ratio (HR) of 0.88 (95% CI 0.72, 1.07), 0.77 (0.63, 0.94), and 0.94 (0.65, 1.36) in age-groups <65, ≥65 to <75, and ≥75 years, respectively (interaction P value 0.5277). Overall, dapagliflozin did not significantly decrease the rates of major adverse cardiovascular events, with HR 0.93 (95% CI 0.81, 1.08), 0.97 (0.83, 1.13), and 0.84 (0.61, 1.15) in age-groups <65, ≥65 to <75, and ≥75 years, respectively (interaction P value 0.7352). The relative risk reduction for the secondary prespecified cardiorenal composite outcome ranged from 18% to 28% in the different age-groups with no heterogeneity. Major hypoglycemia was less frequent with dapagliflozin versus placebo, with HR 0.97 (95% CI 0.58, 1.64), 0.50 (0.29, 0.84), and 0.68 (0.29, 1.57) in age-groups <65, ≥65 to <75, and ≥75 years, respectively (interaction P value 0.2107). Safety outcomes, including fractures, volume depletion, cancer, urinary tract infections, and amputations were balanced with dapagliflozin versus placebo, and acute kidney injury was reduced, all regardless of age. Genital infections that were serious or led to discontinuation of the study drug and diabetic ketoacidosis were uncommon, yet more frequent with dapagliflozin versus placebo, without heterogeneity (interaction P values 0.1058 and 0.8433, respectively).

CONCLUSIONS

The overall efficacy and safety of dapagliflozin are consistent regardless of age.




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Myocardial Ischemic Burden and Differences in Prognosis Among Patients With and Without Diabetes: Results From the Multicenter International REFINE SPECT Registry

OBJECTIVE

Prevalence and prognostic impact of cardiovascular disease differ between patients with or without diabetes. We aimed to explore differences in the prevalence and prognosis of myocardial ischemia by automated quantification of total perfusion deficit (TPD) among patients with and without diabetes.

RESEARCH DESIGN AND METHODS

Of 20,418 individuals who underwent single-photon emission computed tomography myocardial perfusion imaging, 2,951 patients with diabetes were matched to 2,951 patients without diabetes based on risk factors using propensity score. TPD was categorized as TPD = 0%, 0% < TPD < 1%, 1% ≤ TPD < 5%, 5% ≤ TPD ≤ 10%, and TPD >10%. Major adverse cardiovascular events (MACE) were defined as a composite of all-cause mortality, myocardial infarction, unstable angina, or late revascularization.

RESULTS

MACE risk was increased in patients with diabetes compared with patients without diabetes at each level of TPD above 0 (P < 0.001 for interaction). In patients with TPD >10%, patients with diabetes had greater than twice the MACE risk compared with patients without diabetes (annualized MACE rate 9.4 [95% CI 6.7–11.6] and 3.9 [95% CI 2.8–5.6], respectively, P < 0.001). Patients with diabetes with even very minimal TPD (0% < TPD < 1%) experienced a higher risk for MACE than those with 0% TPD (hazard ratio 2.05 [95% CI 1.21–3.47], P = 0.007). Patients with diabetes with a TPD of 0.5% had a similar MACE risk as patients without diabetes with a TPD of 8%.

CONCLUSIONS

For every level of TPD >0%, even a very minimal deficit of 0% < TPD < 1%, the MACE risk was higher in the patients with diabetes compared with patients without diabetes. Patients with diabetes with minimal ischemia had comparable MACE risk as patients without diabetes with significant ischemia.




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Microvascular and Cardiovascular Outcomes According to Renal Function in Patients Treated With Once-Weekly Exenatide: Insights From the EXSCEL Trial

OBJECTIVE

To evaluate the impact of once-weekly exenatide (EQW) on microvascular and cardiovascular (CV) outcomes by baseline renal function in the Exenatide Study of Cardiovascular Event Lowering (EXSCEL).

RESEARCH DESIGN AND METHODS

Least squares mean difference (LSMD) in estimated glomerular filtration rate (eGFR) from baseline between the EQW and placebo groups was calculated for 13,844 participants. Cox regression models were used to estimate effects by group on incident macroalbuminuria, retinopathy, and major adverse CV events (MACE). Interval-censored time-to-event models estimated effects on renal composite 1 (40% eGFR decline, renal replacement, or renal death) and renal composite 2 (composite 1 variables plus macroalbuminuria).

RESULTS

EQW did not change eGFR significantly (LSMD 0.21 mL/min/1.73 m2 [95% CI –0.27 to 0.70]). Macroalbuminuria occurred in 2.2% of patients in the EQW group and in 2.5% of those in the placebo group (hazard ratio [HR] 0.87 [95% CI 0.70–1.07]). Neither renal composite was reduced with EQW in unadjusted analyses, but renal composite 2 was reduced after adjustment (HR 0.85 [95% CI 0.74–0.98]). Retinopathy rates did not differ by treatment group or in the HbA1c-lowering or prior retinopathy subgroups. CV outcomes in those with eGFR <60 mL/min/1.73 m2 did not differ by group. Those with eGFR ≥60 mL/min/1.73 m2 had nominal risk reductions for MACE, all-cause mortality, and CV death, but interactions by renal function group were significant for only stroke (HR 0.74 [95% CI 0.58–0.93]; P for interaction = 0.035) and CV death (HR 1.08 [95% CI 0.85–1.38]; P for interaction = 0.031).

CONCLUSIONS

EQW had no impact on unadjusted retinopathy or renal outcomes. CV risk was modestly reduced only in those with eGFR ≥60 mL/min/1.73 m2 in analyses unadjusted for multiplicity.




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Glycated Hemoglobin, Prediabetes, and the Links to Cardiovascular Disease: Data From UK Biobank

OBJECTIVE

HbA1c levels are increasingly measured in screening for diabetes; we investigated whether HbA1c may simultaneously improve cardiovascular disease (CVD) risk assessment, using QRISK3, American College of Cardiology/American Heart Association (ACC/AHA), and Systematic COronary Risk Evaluation (SCORE) scoring systems.

RESEARCH DESIGN AND METHODS

UK Biobank participants without baseline CVD or known diabetes (n = 357,833) were included. Associations of HbA1c with CVD was assessed using Cox models adjusting for classical risk factors. Predictive utility was determined by the C-index and net reclassification index (NRI). A separate analysis was conducted in 16,596 participants with known baseline diabetes.

RESULTS

Incident fatal or nonfatal CVD, as defined in the QRISK3 prediction model, occurred in 12,877 participants over 8.9 years. Of participants, 3.3% (n = 11,665) had prediabetes (42.0–47.9 mmol/mol [6.0–6.4%]) and 0.7% (n = 2,573) had undiagnosed diabetes (≥48.0 mmol/mol [≥6.5%]). In unadjusted models, compared with the reference group (<42.0 mmol/mol [<6.0%]), those with prediabetes and undiagnosed diabetes were at higher CVD risk: hazard ratio (HR) 1.83 (95% CI 1.69–1.97) and 2.26 (95% CI 1.96–2.60), respectively. After adjustment for classical risk factors, these attenuated to HR 1.11 (95% CI 1.03–1.20) and 1.20 (1.04–1.38), respectively. Adding HbA1c to the QRISK3 CVD risk prediction model (C-index 0.7392) yielded a small improvement in discrimination (C-index increase of 0.0004 [95% CI 0.0001–0.0007]). The NRI showed no improvement. Results were similar for models based on the ACC/AHA and SCORE risk models.

CONCLUSIONS

The near twofold higher unadjusted risk for CVD in people with prediabetes is driven mainly by abnormal levels of conventional CVD risk factors. While HbA1c adds minimally to cardiovascular risk prediction, those with prediabetes should have their conventional cardiovascular risk factors appropriately measured and managed.




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Confirming the Bidirectional Nature of the Association Between Severe Hypoglycemic and Cardiovascular Events in Type 2 Diabetes: Insights From EXSCEL

OBJECTIVE

We sought to confirm a bidirectional association between severe hypoglycemic events (SHEs) and cardiovascular (CV) event risk and to characterize individuals at dual risk.

RESEARCH DESIGN AND METHODS

In a post hoc analysis of 14,752 Exenatide Study of Cardiovascular Event Lowering (EXSCEL) participants, we examined time-dependent associations between SHEs and subsequent major adverse cardiac events (CV death, nonfatal myocardial infarction [MI] or stroke), fatal/nonfatal MI, fatal/nonfatal stroke, hospitalization for acute coronary syndrome (hACS), hospitalization for heart failure (hHF), and all-cause mortality (ACM), as well as time-dependent associations between nonfatal CV events and subsequent SHEs.

RESULTS

SHEs were uncommon and not associated with once-weekly exenatide therapy (hazard ratio 1.13 [95% CI 0.94–1.36], P = 0.179). In fully adjusted models, SHEs were associated with an increased risk of subsequent ACM (1.83 [1.38–2.42], P < 0.001), CV death (1.60 [1.11–2.30], P = 0.012), and hHF (2.09 [1.37–3.17], P = 0.001), while nonfatal MI (2.02 [1.35–3.01], P = 0.001), nonfatal stroke (2.30 [1.25–4.23], P = 0.007), hACS (2.00 [1.39–2.90], P < 0.001), and hHF (3.24 [1.98–5.30], P < 0.001) were all associated with a subsequent increased risk of SHEs. The elevated bidirectional time-dependent hazards linking SHEs and a composite of all CV events were approximately constant over time, with those individuals at dual risk showing higher comorbidity scores compared with those without.

CONCLUSIONS

These findings, showing greater risk of SHEs after CV events as well as greater risk of CV events after SHEs, validate a bidirectional relationship between CV events and SHEs in patients with high comorbidity scores.




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Can a Company be pro-regulation and pro-commerce? Gregg Renfrew from Beautycounter thinks so

It’s the middle of an election year and, according to the Pew Research Center, the country hasn’t been this polarized since the Civil War. In such a climate, it would seem to be an oxymoron for a company to push for both financial growth and tighter regulations. Gregg Renfrew, CEO & Founder of Beautycounter, wouldn’t […]




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Thinking with AND: Insights from KIND’s story

“I’m a confused Mexican Jew.” So says Daniel Lubetzky, Founder and CEO of KIND Snack, in his very personal interview with Columbia faculty member David Rogers at BRITE ’16. Their discussion touched on the many ideas behind KIND Snacks, from the beginnings of the company, to the strategic thinking that forces Lubetzky to stay away […]




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10 Examples of Heroism Arising From the COVID-19 Pandemic

By Scott T. Allison In any tragedy or crisis, you will see many people standing out and stepping up to save lives and make the world a better place. These heroic individuals can range from leaders of nations to ordinary citizens who rise to the occasion to help others in need. During this COVID-19 pandemic, … Continue reading 10 Examples of Heroism Arising From the COVID-19 Pandemic




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No-Failure Design and Disaster Recovery: Lessons from Fukushima

One of the striking aspects of the early stages of the nuclear accident at Fukushima-Daiichi last March was the nearly total absence of disaster recovery capability. For instance, while Japan is a super-power of robotic technology, the nuclear authorities had to import robots from France for probing the damaged nuclear plants. Fukushima can teach us an important lesson about technology.

The failure of critical technologies can be disastrous. The crash of a civilian airliner can cause hundreds of deaths. The meltdown of a nuclear reactor can release highly toxic isotopes. Failure of flood protection systems can result in vast death and damage. Society therefore insists that critical technologies be designed, operated and maintained to extremely high levels of reliability. We benefit from technology, but we also insist that the designers and operators "do their best" to protect us from their dangers.

Industries and government agencies who provide critical technologies almost invariably act in good faith for a range of reasons. Morality dictates responsible behavior, liability legislation establishes sanctions for irresponsible behavior, and economic or political self-interest makes continuous safe operation desirable.

The language of performance-optimization  not only doing our best, but also achieving the best  may tend to undermine the successful management of technological danger. A probability of severe failure of one in a million per device per year is exceedingly  and very reassuringly  small. When we honestly believe that we have designed and implemented a technology to have vanishingly small probability of catastrophe, we can honestly ignore the need for disaster recovery.

Or can we?

Let's contrast this with an ethos that is consistent with a thorough awareness of the potential for adverse surprise. We now acknowledge that our predictions are uncertain, perhaps highly uncertain on some specific points. We attempt to achieve very demanding outcomes  for instance vanishingly small probabilities of catastrophe  but we recognize that our ability to reliably calculate such small probabilities is compromised by the deficiency of our knowledge and understanding. We robustify ourselves against those deficiencies by choosing a design which would be acceptable over a wide range of deviations from our current best understanding. (This is called "robust-satisficing".) Not only does "vanishingly small probability of failure" still entail the possibility of failure, but our predictions of that probability may err.

Acknowledging the need for disaster recovery capability (DRC) is awkward and uncomfortable for designers and advocates of a technology. We would much rather believe that DRC is not needed, that we have in fact made catastrophe negligible. But let's not conflate good-faith attempts to deal with complex uncertainties, with guaranteed outcomes based on full knowledge. Our best models are in part wrong, so we robustify against the designer's bounded rationality. But robustness cannot guarantee success. The design and implementation of DRC is a necessary part of the design of any critical technology, and is consistent with the strategy of robust satisficing.

One final point: moral hazard and its dilemma. The design of any critical technology entails two distinct and essential elements: failure prevention and disaster recovery. What economists call a `moral hazard' exists since the failure prevention team might rely on the disaster-recovery team, and vice versa. Each team might, at least implicitly, depend on the capabilities of the other team, and thereby relinquish some of its own responsibility. Institutional provisions are needed to manage this conflict.

The alleviation of this moral hazard entails a dilemma. Considerations of failure prevention and disaster recovery must be combined in the design process. The design teams must be aware of each other, and even collaborate, because a single coherent system must emerge. But we don't want either team to relinquish any responsibility. On the one hand we want the failure prevention team to work as though there is no disaster recovery, and the disaster recovery team should presume that failures will occur. On the other hand, we want these teams to collaborate on the design.

This moral hazard and its dilemma do not obviate the need for both elements of the design. Fukushima has taught us an important lesson by highlighting the special challenge of high-risk critical technologies: design so failure cannot occur, and prepare to respond to the unanticipated.





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

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




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5 Secrets to Increase Your Sexual Satisfaction: Tips From a Sex Therapist

As a practicing sex therapist, I often see two partners legitimately trying to bridge a satisfaction gap between each other, but they can’t seem to get the moves just right. If left unchecked, this can lead to resentment and conflict; however, couples who figure out how to speak to each other sexually (both verbally and nonverbally) have the highest success in terms of finding something that works for both of them. Making an environment conducive to this sort of positive growth requires a little bit of effort and the ability to listen. Drawing on my clinical experience, here are my top tips for increasing sexual satisfaction:



  • Sexual Problems and Solutions

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Have You Reached Out to or Heard From an Ex During the Pandemic? You're Not Alone

Anecdotally, I’ve heard from a lot of people who have said that they reached out to (or heard from) and ex-partner since the COVID-19 coronavirus pandemic began. But just how many people have done so? And what motivated them to reconnect? Some of my colleagues and I at The Kinsey Institute are currently in the midst of researching how this pandemic is affecting people’s intimate lives (click here if you’d like to participate and learn more about the study), and our preliminary data suggest that reaching out to an ex isn’t a rare occurrence.




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What the world can learn from China's response to the coronavirus | Gary Liu

From Hong Kong, South China Morning Post CEO Gary Liu tracks China's response to the coronavirus pandemic -- from the initial outbreak in Wuhan to the shutdown of Hubei province and the containment measures taken across its major cities. Sharing insights into how the culture in places like Hong Kong and South Korea contributed to fast action against the virus, Liu identifies lessons people across the world can use to stop its spread. (This virtual conversation is part of the TED Connects series, hosted by head of TED Chris Anderson and current affairs curator Whitney Pennington Rodgers. Recorded March 25, 2020)




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What's missing from the American immigrant narrative | Elizabeth Camarillo Gutierrez

Recounting her story of finding opportunity and stability in the US, Elizabeth Camarillo Gutierrez examines the flaws in narratives that simplify and idealize the immigrant experience -- and shares hard-earned wisdom on the best way to help those around us. "Our world is one that flourishes when different voices come together," she says.




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Massachusetts Moves Equity to Forefront of Aspiring Superintendent Program

The state's "Influence 100" project includes a leadership development program that will give aspiring district leaders a hands-on opportunity to work through an equity issue in their home districts.




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Online Charter Schools in North Carolina Petition to Go From Pilot to Permanent

The state's two virtual charter schools have earned poor marks from the state's accountability system in the few years they've been operating.




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Staff Email Addresses Removed From District Websites to Improve Cybersecurity

Some district technology leaders say having staff email addresses publicly available opens the door for phishing scams and potential hacks.




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How Schools Will Overcome the 'Coronavirus Slide:' Ideas From 5 Superintendents

With many school buildings closed for the rest of the academic year—and more to follow—district leaders turn their attention to making up for what may be deep learning losses.




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How Schools Will Overcome the 'Coronavirus Slide:' Ideas From 5 Superintendents

With many school buildings closed for the rest of the academic year—and more to follow—district leaders turn their attention to making up for what may be deep learning losses.




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Accreditor frowns on Georgia school system's board troubles




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Gay teacher ousted from Catholic school after 23 years




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A New Worry From the COVID-19 Crisis: Paying for College

Fewer students are filing financial aid applications this year, as the pandemic continues to disrupt college plans for high school seniors nationwide.




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Judge blocks Tennessee from implementing voucher program




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North Dakota, Wyoming Move Away From Smarter Balanced Tests

North Dakota and Wyoming state superintendents said this week that they will soon hire new testing vendors.




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DeVos Visits Kentucky School Recovering From Shooting

U.S. Secretary of Education Betsy DeVos on Wednesday visited a Kentucky high school that is recovering from a 2018 shooting to award additional grant money meant to aid its recovery efforts.




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How Schools Will Overcome the 'Coronavirus Slide:' Ideas From 5 Superintendents

With many school buildings closed for the rest of the academic year—and more to follow—district leaders turn their attention to making up for what may be deep learning losses.




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Lessons From a 'Hidden Gem' in Alabama

A rural Southern school with a predominantly Native American population engages the whole community in its continued quest for improvement.




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Rapid Deployment of Remote Learning: Lessons From 4 Districts

Chief technology officers are facing an unprecedented test of digital preparedness due to the coronavirus pandemic, struggling with shortfalls of available learning devices and huge Wi-Fi access challenges.




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New York Leap-Frogs ESSA With Its Own Financial Transparency Rule

New York will require some districts next year to have their school-by-school spending amounts approved by the state, an effort to assure that state funds are being distributed as intended.




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New York Takes Final Step to Separate State Test Scores From Teacher Evaluations

The New York state legislature passed a bill that would make the use of state test scores in these evaluations optional, leaving the decision up to districts and making it subject to collective bargaining.




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Court Bars Tennessee From Starting School Voucher Program

A court said legislators violated the state's constitution when they passed a law that targeted specific areas to be included in the program without local consent.




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Judge blocks Tennessee from implementing voucher program




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Accreditor frowns on Georgia school system's board troubles




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Gay teacher ousted from Catholic school after 23 years




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A New Worry From the COVID-19 Crisis: Paying for College

Fewer students are filing financial aid applications this year, as the pandemic continues to disrupt college plans for high school seniors nationwide.




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Judge blocks Tennessee from implementing voucher program




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What This Superintendent Learns From Teaching a High School Course

The leader of a Montana school district spends up to two hours each day grading assignments from students in an online English credit recovery program.




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In Response to Federal Feedback, N.J. Seeks Testing Waiver From ESSA

The state wants to test its middle school students in the mathematics courses in which they're enrolled, rather than with the state tests created for that each student's particular grade.




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How Schools Will Overcome the 'Coronavirus Slide:' Ideas From 5 Superintendents

With many school buildings closed for the rest of the academic year—and more to follow—district leaders turn their attention to making up for what may be deep learning losses.




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Utah Will Ask for Test Participation Waiver From ESSA

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




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Hacked and Cut Off From the Public: This Is School Board Business in the Coronavirus Crisis

Social distancing is forcing school business to be conducted virtually, putting school boards in the difficult spot of making crucial decisions on spending and other issues without the same level of public input.




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Accreditor frowns on Georgia school system's board troubles




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Rapid Deployment of Remote Learning: Lessons From 4 Districts

Chief technology officers are facing an unprecedented test of digital preparedness due to the coronavirus pandemic, struggling with shortfalls of available learning devices and huge Wi-Fi access challenges.




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Oregon State lands big commitment from 4-star ILB Easton Mascarenas

Coach Smith is doing a fine job Building the Dam




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Jets sign Lamar Jackson (the undrafted DB from Nebraska)

The Jets announced on Wednesday that they have signed Lamar Jackson, but no one start frantically wondering what they missed regarding the 2019 NFL MVP. The Lamar Jackson that the Jets signed is an undrafted defensive back from Nebraska rather than the Ravens quarterback. The Jets' Jackson was second-team All-Big Ten last season after recording [more]




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Why Oregon Football is one year away from winning a College Football Playoff

Geoff Schwartz joins the latest Talkin' Ducks Podcast with host Jordan Kent




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Seeking Their Due From Court Ruling, Washington State Teachers Strike

Classrooms across Washington state sat empty last week, as teachers in seven districts went on strike when negotiations over salaries and benefits failed to result in contracts by the first day of school.




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Just a girl from Crewe / Janice Madden.