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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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An Uneven Landscape: The Differing State Approaches to English Learner Policies under ESSA

Experts share how states have approached Every Student Succeeds Act (ESSA) implementation, areas where the law and state efforts to support English Learners can be improved, and findings from the compendium, The Patchy Landscape of State English Learner Policies under ESSA




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Cutaneous Manifestations of Diabetes Mellitus

Michelle Duff
Jan 1, 2015; 33:40-48
Practical Pointers




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Clarifying the Role of Insulin in Type 2 Diabetes Management

John R. White
Jan 1, 2003; 21:
Feature Articles




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PROactive: A Sad Tale of Inappropriate Analysis and Unjustified Interpretation

Jay S. Skyler
Apr 1, 2006; 24:63-65
Commentary




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Cardiac Manifestations of Congenital Generalized Lipodystrophy

Vani P. Sanon
Oct 1, 2016; 34:181-186
Feature Articles




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Jabberwocky. Or: Grand Unified Theory of Uncertainty???


Jabberwocky, Lewis Carroll's whimsical nonsense poem, uses made-up words to create an atmosphere and to tell a story. "Billig", "frumious", "vorpal" and "uffish" have no lexical meaning, but they could have. The poem demonstrates that the realm of imagination exceeds the bounds of reality just as the set of possible words and meanings exceeds its real lexical counterpart.

Uncertainty thrives in the realm of imagination, incongruity, and contradiction. Uncertainty falls in the realm of science fiction as much as in the realm of science. People have struggled with uncertainty for ages and many theories of uncertainty have appeared over time. How many uncertainty theories do we need? Lots, and forever. Would we say that of physics? No, at least not forever.

Can you think inconsistent, incoherent, or erroneous thoughts? I can. (I do it quite often, usually without noticing.) For those unaccustomed to thinking incongruous thoughts, and who need a bit of help to get started, I can recommend thinking of "two meanings packed into one word like a portmanteau," like 'fuming' and 'furious' to get 'frumious' or 'snake' and 'shark' to get 'snark'.

Portmanteau words are a start. Our task now is portmanteau thoughts. Take for instance the idea of a 'thingk':

When I think a thing I've thought,
I have often felt I ought
To call this thing I think a "Thingk",
Which ought to save a lot of ink.

The participle is written "thingking",
(Which is where we save on inking,)
Because "thingking" says in just one word:
"Thinking of a thought thing." Absurd!

All this shows high-power abstraction.
(That highly touted human contraption.)
Using symbols with subtle feint,
To stand for something which they ain't.

Now that wasn't difficult: two thoughts at once. Now let those thoughts be contradictory. To use a prosaic example: thinking the unthinkable, which I suppose is 'unthingkable'. There! You did it. You are on your way to a rich and full life of thinking incongruities, fallacies and contradictions. We can hold in our minds thoughts of 4-sided triangles, parallel lines that intersect, and endless other seeming impossibilities from super-girls like Pippi Longstockings to life on Mars (some of which may actually be true, or at least possible).

Scientists, logicians, and saints are in the business of dispelling all such incongruities, errors and contradictions. Banishing inconsistency is possible in science because (or if) there is only one coherent world. Belief in one coherent world and one grand unified theory is the modern secular version of the ancient monotheistic intuition of one universal God (in which saints tend to believe). Uncertainty thrives in the realm in which scientists and saints have not yet completed their tasks (perhaps because they are incompletable). For instance, we must entertain a wide range of conflicting conceptions when we do not yet know how (or whether) quantum mechanics can be reconciled with general relativity, or Pippi's strength reconciled with the limitations of physiology. As Henry Adams wrote:

"Images are not arguments, rarely even lead to proof, but the mind craves them, and, of late more than ever, the keenest experimenters find twenty images better than one, especially if contradictory; since the human mind has already learned to deal in contradictions."

The very idea of a rigorously logical theory of uncertainty is startling and implausible because the realm of the uncertain is inherently incoherent and contradictory. Indeed, the first uncertainty theory - probability - emerged many centuries after the invention of the axiomatic method in mathematics. Today we have many theories of uncertainty: probability, imprecise probability, information theory, generalized information theory, fuzzy logic, Dempster-Shafer theory, info-gap theory, and more (the list is a bit uncertain). Why such a long and diverse list? It seems that in constructing a logically consistent theory of the logically inconsistent domain of uncertainty, one cannot capture the whole beast all at once (though I'm uncertain about this).

A theory, in order to be scientific, must exclude something. A scientific theory makes statements such as "This happens; that doesn't happen." Karl Popper explained that a scientific theory must contain statements that are at risk of being wrong, statements that could be falsified. Deborah Mayo demonstrated how science grows by discovering and recovering from error.

The realm of uncertainty contains contradictions (ostensible or real) such as the pair of statements: "Nine year old girls can lift horses" and "Muscle fiber generates tension through the action of actin and myosin cross-bridge cycling". A logically consistent theory of uncertainty can handle improbabilities, as can scientific theories like quantum mechanics. But a logical theory cannot encompass outright contradictions. Science investigates a domain: the natural and physical worlds. Those worlds, by virtue of their existence, are perhaps coherent in a way that can be reflected in a unified logical theory. Theories of uncertainty are directed at a larger domain: the natural and physical worlds and all imaginable (and unimaginable) other worlds. That larger domain is definitely not coherent, and a unified logical theory would seem to be unattainable. Hence many theories of uncertainty are needed.

Scientific theories are good to have, and we do well to encourage the scientists. But it is a mistake to think that the scientific paradigm is suitable to all domains, in particular, to the study of uncertainty. Logic is a powerful tool and the axiomatic method assures the logical consistency of a theory. For instance, Leonard Savage argued that personal probability is a "code of consistency" for choosing one's behavior. Jim March compares the rigorous logic of mathematical theories of decision to strict religious morality. Consistency between values and actions is commendable says March, but he notes that one sometimes needs to deviate from perfect morality. While "[s]tandard notions of intelligent choice are theories of strict morality ... saints are a luxury to be encouraged only in small numbers." Logical consistency is a merit of any single theory, including a theory of uncertainty. However, insisting that the same logical consistency apply over the entire domain of uncertainty is like asking reality and saintliness to make peace.




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Review Article – Within a single lifetime: Recent writings on autism

AHP readers will be interested in a review article now available online from History of the Human Sciences “Within a single lifetime: Recent writings on autism.” Written by Gregory Hollin the piece reviews five recent books on autism.




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Sex and Psychology Podcast: Maintaining a Healthy Intimate Life During Lockdown and Social Distancing

These are unprecedented times. Much of the world is currently living under lockdown conditions and practicing social distancing in order to curb the spread of the COVID-19 coronavirus. So how is this affecting people’s intimate lives? How are our sex lives and relationships holding up, and is there anything we can do to more effectively navigate this complex and challenging situation? For the answers to these questions, I spoke to Dr. Lori Brotto, a Professor at the University of British Columbia, a practicing psychologist, and author of the book Better Sex Through Mindfulness. I asked Dr. Brotto what she has been seeing in her clinical practice since the pandemic began and how it’s different from usual.




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The beautiful, mysterious science of how you hear | Jim Hudspeth

Have you ever wondered how your ears work? In this delightful and fascinating talk, biophysicist Jim Hudspeth demonstrates the wonderfully simple yet astonishingly powerful mechanics of hair cells, the microscopic powerhouses that make hearing possible -- and explains how, when it's really quiet, your ears will begin to beam out a spectrum of sounds unique to you.




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In uncertain times, think like a mother | Yifat Susskind

There's a simple and powerful way to confront the world's most pressing crises, says women's rights activist Yifat Susskind: think like a mother. As she puts it: "When you think like a mother, you prioritize the needs of the many, not the whims of the few." Follow along as she shares moving stories of people around the world who embody this mindset -- and shows how it can also help you see beyond suffering and act to build a better world.




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How to spark your curiosity, scientifically | Nadya Mason

Curious how stuff works? Do a hands-on experiment at home, says physicist Nadya Mason. She shows how you can demystify the world around you by tapping into your scientific curiosity -- and performs a few onstage experiments of her own using magnets, dollar bills, dry ice and more.




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How to shift your mindset and choose your future | Tom Rivett-Carnac

When it comes to big life problems, we often stand at a crossroads: either believe we're powerless against great change, or we rise to meet the challenge. In an urgent call to action, political strategist Tom Rivett-Carnac makes the case for adopting a mindset of "stubborn optimism" to confront climate change -- or whatever crisis may come our way -- and sustain the action needed to build a regenerative future. As he puts it: "Stubborn optimism can fill our lives with meaning and purpose."




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How visualizing inferential uncertainty can mislead readers about treatment effects in scientific results

STANDARD ERRORS VS STANDARD DEVIATIONS Click to enlarge There’s an ancient haiku that goes: People confuse a well-estimated mean with a certain outcome Ok, that’s not true. But Jake Hofman, Dan Goldstein, and Jessica Hullman have a new paper (recently accepted at CHI 2020) about this. They bet you’ll think the results of their paper […]

The post How visualizing inferential uncertainty can mislead readers about treatment effects in scientific results appeared first on Decision Science News.




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Teenagers Who Believe They Are Particularly Intelligent Tend To Be More Narcissistic And Happier With Life

By Emily Reynolds. But self-assessed intelligence was not actually related to objective measures of intelligence




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California Governor Says Schools May Restart in Late July

California classrooms could reopen with modifications as soon as late July, California Gov. Gavin Newsom said Tuesday, bringing a new wave of anxiety for parents, teachers, and students.




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Florida sheriff defends keeping childhood shooting a secret




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State offficials to review complaint against Florida sheriff




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Ex-Florida sheriff's removal lawsuit dismissed




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California doom: Staggering $54 billion budget deficit looms




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Pointillism in 1st Grade? Teachers Use Unfamiliar Lessons to Mine for Giftedness

Some districts are using new “response lessons” to identify the talented students that traditional assessments miss.




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Mining for Gifted Students in Untapped Places

An internationally known gifted-education center is scouting—and helping to develop—gifted students in after-school programs and pullout classes in one of Maryland’s most challenged school districts.




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School Closures May Go Into the Fall If Coronavirus Resurges, State Chiefs Warn

Schools may have to continue closures in the fall if the coronavirus resurges, state schools chiefs in Maryland and Washington said. The warnings came the same week thata key federal official predicted schools would be able to reopen for the 2020-21 school year.




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New York Poised to Revamp Certification Exams

A task force is recommending that the state lowers the score required on the controversial national edTPA exam.




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New York Proposes Increased Flexibility to Teacher Certification Process

To give districts more flexibility in the face of teacher shortages, New York's education department is proposing to modify its regulations on teacher certifications.




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Florida sheriff defends keeping childhood shooting a secret




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State offficials to review complaint against Florida sheriff




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Ex-Florida sheriff's removal lawsuit dismissed




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California doom: Staggering $54 billion budget deficit looms




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Undergraduate Education Degrees Again Permitted in California

Aspiring teachers in California will now be able to major in education as undergraduates, which has been forbidden for more than five decades under an unusual state law.




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The PACE Perspective on the 'The California Way'

Policy Analysis for California Education has been a premier ed policy organization for three decades. As Daisy Gonzales writes, it is in the forefront of shaping current reforms and interpreting them for audiences such as 'On California.'




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'On California' Is on Vacation

The blessings of season to you all! We will be back in the New Year. Christmas thoughts follow.




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STEM Blossoms in California Salad Bowl

Along with winter vegetables, STEM is blooming in Imperial County. Dennis and Daniel Gibbs are growing young scientists by transplanting the scientific method to the second grade.




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Teachers' Union Victory in California

Teachers unions are scapegoats for low student performance.




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School Revolution in California

What's taking place in California is nothing less than a quiet revolution in education.




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California Reforms Accountability

California just made school accountability much more complicated. And that's good.




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California




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Where Are the Arts in California Schools?

California joins a growing number of cities and states hoping to spotlight which students do and do not have access to high-quality arts education.




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2018 Election Will Rock California Education

Next year's California election will be both a referendum on the massive changes in education finance and testing enacted during Jerry Brown governorship and a test of the political coalition that made those changes possible.




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The California Testing-Funding Paradox

As the number of charter schools continues to grow, voters in California will be forced to examine their largess.




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'California, Trump on Collision Course'

A read of California's news outlets makes clear that the state is not going to accept President-elect Donald Trump's policies without a fight, particularly those on immigration.




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Charter Advocates Dealt Loss in California Chief's Election

State Assembly member Tony Thurmond ultimately prevailed over former charter school executive Marshall Tuck in a contest that drew more than $50 million in outside campaign spending.




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California Teachers Challenge Union's Collection of Dues

Five California educators last week filed a lawsuit seeking to stop the state's top teachers' union from collecting dues through mandatory paycheck deductions.




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Incoming California Governor to Seek Nearly $2 Billion in Early-Childhood Funding

Democrat Gavin Newsom, who takes office Jan. 7, plans to expand full-day kindergarten and child-care offerings in the state, according to media reports.




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Educational Opportunities and Performance in California

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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Showdown in California Over Proposed Charter School Curbs

Lawmakers are considering legislation that would put limits on the state’s charter school sector and give districts broader discretion to deny applications.




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Paid Maternity Leave for Teachers? California's Governor Says No Once Again

The bill would have given public school teachers at least six weeks of paid maternity leave.




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Educational Opportunities and Performance in California

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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California schools will look very different when they reopen




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What if Hawaii's False Alarm Had Happened on a School Day?

Hawaii's schools are prepared to respond to ballistic missile threats, education officials wrote in a letter to parents after Saturday's false alarm.