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Protection in Crisis: Forced Migration and Protection in a Global Era

More than 51 million people worldwide are forcibly displaced today as refugees, asylum seekers, or internally displaced persons. This report details the increasing mismatch between the legal and normative frameworks that define the existing protection regime and the contemporary patterns of forced displacement.




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Spiraling Violence and Drought Drive Refugee Crisis in South Sudan

Nearly 4 million South Sudanese have been driven from their homes by violence or food insecurity since late 2013, roughly half seeking refuge in neighboring countries. Drought and conflict have converged in the young country to fuel one of the world's most severe humanitarian emergencies. This article examines refugee flows from South Sudan, underlying drivers, and regional and international responses to the crisis.




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When Disaster Strikes: Responding to Migrants Caught in Crises

Migrants displaced by crisis do not benefit from international protection the way that refugees do. This article examines the experiences of labor migrants amid manmade and natural disasters in the Central African Republic, Côte d’Ivoire, Lebanon, Libya, South Africa, and Thailand, as well as stakeholder responses. Research demonstrates the agency and resilience of migrants, who develop flexible solutions in the face of crisis.




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As Lesvos Battles Migration Crisis Fatigue, the Value of Centralized Migration Decision-Making Is Questioned

As Greece's Aegean islands continue to grapple with migrants arriving on their shores, decisions regarding the needs of newcomers are negotiated in Brussels and Athens, far removed from the situation on the ground. Meanwhile, local communities have had successes in hosting migrants, as this article drawing on observations from the hospitality center and refugee camp on Lesvos explores.




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Superior Long-term Survival for Simultaneous Pancreas-Kidney Transplantation as Renal Replacement Therapy: 30-Year Follow-up of a Nationwide Cohort

OBJECTIVE

In patients with type 1 diabetes and end-stage renal disease, it is controversial whether a simultaneous pancreas-kidney (SPK) transplantation improves survival compared with kidney transplantation alone. We compared long-term survival in SPK and living- or deceased-donor kidney transplant recipients.

RESEARCH DESIGN AND METHODS

We included all 2,796 patients with type 1 diabetes in the Netherlands who started renal replacement therapy between 1986 and 2016. We used multivariable Cox regression analyses adjusted for recipient age and sex, dialysis modality and vintage, transplantation era, and donor age to compare all-cause mortality between deceased- or living-donor kidney and SPK transplant recipients. Separately, we analyzed mortality between regions where SPK transplant was the preferred intervention (80% SPK) versus regions where a kidney transplant alone was favored (30% SPK).

RESULTS

Of 996 transplanted patients, 42%, 16%, and 42% received a deceased- or living-donor kidney or SPK transplant, respectively. Mean (SD) age at transplantation was 50 (11), 48 (11), and 42 (8) years, respectively. Median (95% CI) survival time was 7.3 (6.2; 8.3), 10.5 (7.2; 13.7), and 16.5 (15.1; 17.9) years, respectively. SPK recipients with a functioning pancreas graft at 1 year (91%) had the highest survival (median 17.4 years). Compared with deceased-donor kidney transplant recipients, adjusted hazard ratios (95% CI) for 10- and 20-year all-cause mortality were 0.79 (0.49; 1.29) and 0.98 (0.69; 1.39) for living-donor kidney and 0.67 (0.46; 0.98) and 0.79 (0.60; 1.05) for SPK recipients, respectively. A treatment strategy favoring SPK over kidney transplantation alone showed 10- and 20-year mortality hazard ratios of 0.56 (0.40; 0.78) and 0.69 (0.52; 0.90), respectively.

CONCLUSIONS

Compared with living- or deceased-donor kidney transplantation, SPK transplant was associated with improved patient survival, especially in recipients with a long-term functioning pancreatic graft, and resulted in an almost twofold lower 10-year mortality rate.




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Screening for Glucose Perturbations and Risk Factor Management in Dysglycemic Patients With Coronary Artery Disease--A Persistent Challenge in Need of Substantial Improvement: A Report From ESC EORP EUROASPIRE V

OBJECTIVE

Dysglycemia, in this survey defined as impaired glucose tolerance (IGT) or type 2 diabetes, is common in patients with coronary artery disease (CAD) and associated with an unfavorable prognosis. This European survey investigated dysglycemia screening and risk factor management of patients with CAD in relation to standards of European guidelines for cardiovascular subjects.

RESEARCH DESIGN AND METHODS

The European Society of Cardiology’s European Observational Research Programme (ESC EORP) European Action on Secondary and Primary Prevention by Intervention to Reduce Events (EUROASPIRE) V (2016–2017) included 8,261 CAD patients, aged 18–80 years, from 27 countries. If the glycemic state was unknown, patients underwent an oral glucose tolerance test (OGTT) and measurement of glycated hemoglobin A1c. Lifestyle, risk factors, and pharmacological management were investigated.

RESULTS

A total of 2,452 patients (29.7%) had known diabetes. OGTT was performed in 4,440 patients with unknown glycemic state, of whom 41.1% were dysglycemic. Without the OGTT, 30% of patients with type 2 diabetes and 70% of those with IGT would not have been detected. The presence of dysglycemia almost doubled from that self-reported to the true proportion after screening. Only approximately one-third of all coronary patients had completely normal glucose metabolism. Of patients with known diabetes, 31% had been advised to attend a diabetes clinic, and only 24% attended. Only 58% of dysglycemic patients were prescribed all cardioprotective drugs, and use of sodium–glucose cotransporter 2 inhibitors (3%) or glucagon-like peptide 1 receptor agonists (1%) was small.

CONCLUSIONS

Urgent action is required for both screening and management of patients with CAD and dysglycemia, in the expectation of a substantial reduction in risk of further cardiovascular events and in complications of diabetes, as well as longer life expectancy.




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Targeting CXCR1/2 Does Not Improve Insulin Secretion After Pancreatic Islet Transplantation: A Phase 3, Double-Blind, Randomized, Placebo-Controlled Trial in Type 1 Diabetes

OBJECTIVE

Reparixin is an inhibitor of CXCR1/2 chemokine receptor shown to be an effective anti-inflammatory adjuvant in a pilot clinical trial in allotransplant recipients.

RESEARCH DESIGN AND METHODS

A phase 3, multicenter, randomized, double-blind, parallel-assignment study (NCT01817959) was conducted in recipients of islet allotransplants randomized (2:1) to reparixin or placebo in addition to immunosuppression. Primary outcome was the area under the curve (AUC) for C-peptide during the mixed-meal tolerance test at day 75 ± 5 after the first and day 365 ± 14 after the last transplant. Secondary end points included insulin independence and standard measures of glycemic control.

RESULTS

The intention-to-treat analysis did not show a significant difference in C-peptide AUC at both day 75 (27 on reparixin vs. 18 on placebo, P = 0.99) and day 365 (24 on reparixin vs. 15 on placebo, P = 0.71). There was no statistically significant difference between treatment groups at any time point for any secondary variable. Analysis of patient subsets showed a trend for a higher percentage of subjects retaining insulin independence for 1 year after a single islet infusion in patients receiving reparixin as compared with patients receiving placebo (26.7% vs. 0%, P = 0.09) when antithymocyte globulin was used as induction immunosuppression.

CONCLUSIONS

In this first double-blind randomized trial, islet transplantation data obtained with reparixin do not support a role of CXCR1/2 inhibition in preventing islet inflammation-mediated damage.




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Microvascular and Macrovascular Complications of Diabetes

Michael J. Fowler
Apr 1, 2008; 26:77-82
Diabetes Foundation




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Men take Guinness record for ping pong ball catches in shaving cream

A pair of Idaho men tackled an unusual Guinness World Record by most table tennis balls caught in shaving foam on the head in 30 seconds (team of 2).




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Migration, Development, and Global Governance: From Crisis toward Consolidation

Migration and development policy discussions have edged closer to each other on the international stage. The adoption of the Global Compact for Migration in December 2018 marks an important milestone. As all eyes turn toward the compact’s implementation, this brief examines some of the key topics states have pledged to work more closely on—from labor migration and migrants’ rights, to returns and reintegration.




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Democrats Under Pressure: Political Calendar Exposes Ideological Differences on Immigration

Ideological differences in the Democratic Party over immigration that were once masked by unity against President Trump’s border wall and immigration agenda are now being exposed as Democratic presidential candidates seek to stand out in a crowded field and amid controversy over an emergency border spending bill. As the 2020 electoral calendar accelerates, how the party navigates the gulf between its most liberal and conservative wings will become a greater challenge for its leaders.




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From Control to Crisis: Changing Trends and Policies Reshaping U.S.-Mexico Border Enforcement

How did the U.S. border enforcement picture go in the span of two years from the lowest levels of illegal immigration since 1971 to a spiraling border security and humanitarian crisis? This report draws on enforcement and other data as well as analysis of changing migration trends and policies to tell this story. The authors outline key elements for a new strategy that can succeed over the long term.




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Crisis in the Courts: Is the Backlogged U.S. Immigration Court System at Its Breaking Point?

With a backlog of more than 1 million removal cases, the U.S. immigration court system is in crisis. Pressure from external forces, internal challenges, and lagging resources for the courts at a time of massive increases in spending on immigration enforcement have contributed to the backlog. This article explores how the system got to the breaking point, and what opportunities for reform exist.




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Metabolic Effects of Dietary Sucrose in Type II Diabetic Subjects

John P Bantle
Sep 1, 1993; 16:1301-1305
Short Report




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Loss of Incretin Effect Is a Specific, Important, and Early Characteristic of Type 2 Diabetes

Jens J. Holst
May 1, 2011; 34:S251-S257
Diabetes Treatments




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Day and Night Home Closed-Loop Insulin Delivery in Adults With Type 1 Diabetes: Three-Center Randomized Crossover Study

Lalantha Leelarathna
Jul 1, 2014; 37:1931-1937
Emerging Technologies and Therapeutics




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Feasibility of Outpatient Fully Integrated Closed-Loop Control: First studies of wearable artificial pancreas

Boris P. Kovatchev
Jul 1, 2013; 36:1851-1858
Diabetes Care Symposium




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A Low-Glycemic Load Diet Facilitates Greater Weight Loss in Overweight Adults With High Insulin Secretion but Not in Overweight Adults With Low Insulin Secretion in the CALERIE Trial

Anastassios G. Pittas
Dec 1, 2005; 28:2939-2941
BR Clinical Care/Education/Nutrition




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Increased Carotid Intima-Media Thickness and Stiffness in Obese Children

Arcangelo Iannuzzi
Oct 1, 2004; 27:2506-2508
Brief Reports




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Dietary Sugar and Body Weight: Have We Reached a Crisis in the Epidemic of Obesity and Diabetes?: Health Be Damned! Pour on the Sugar

George A. Bray
Apr 1, 2014; 37:950-956
Current Concepts of Type 2 Diabetes Prevention




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Standardizing Clinically Meaningful Outcome Measures Beyond HbA1c for Type 1 Diabetes: A Consensus Report of the American Association of Clinical Endocrinologists, the American Association of Diabetes Educators, the American Diabetes Association, the Endo

Gina Agiostratidou
Dec 1, 2017; 40:1622-1630
Continuous Glucose Monitoring and Risk of Hypoglycemia




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Staging Presymptomatic Type 1 Diabetes: A Scientific Statement of JDRF, the Endocrine Society, and the American Diabetes Association

Richard A. Insel
Oct 1, 2015; 38:1964-1974
Scientific Statement




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Impact of Recent Increase in Incidence on Future Diabetes Burden: U.S., 2005-2050

K.M. Venkat Narayan
Sep 1, 2006; 29:2114-2116
BR Epidemiology/Health Services/Psychosocial Research




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Hyperglycemie and Microvascular and Macrovascular Disease in Diabetes

Ronald Klein
Feb 1, 1995; 18:258-268
Kelly West Lecture 1994




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Hypoglycemia and Diabetes: A Report of a Workgroup of the American Diabetes Association and The Endocrine Society

Elizabeth R. Seaquist
May 1, 2013; 36:1384-1395
Scientific Statement




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Boeing presents first Loyal Wingman drone aircraft to Australia

Boeing announced Tuesday has presented its first unmanned aircraft to the Royal Australian Air Force.




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3M inks $126M deal with DoD to increase N95 mask production in October

3M has signed a $126 million deal with the Pentagon to increase its production of N95 masks to 26 million per month beginning in October 2020.




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Defense officials criticize Ligado's 5G proposal at Senate hearing

Top Pentagon officials told lawmakers Wednesday that a proposed nationwide network to provide 5G and internet-of-things services was "too risky to be worth it."




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Staging Presymptomatic Type 1 Diabetes: A Scientific Statement of JDRF, the Endocrine Society, and the American Diabetes Association

Richard A. Insel
Oct 1, 2015; 38:1964-1974
Scientific Statement




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Dietary Sugar and Body Weight: Have We Reached a Crisis in the Epidemic of Obesity and Diabetes?: Health Be Damned! Pour on the Sugar

George A. Bray
Apr 1, 2014; 37:950-956
Current Concepts of Type 2 Diabetes Prevention




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Genetic Discrimination Between LADA and Childhood-Onset Type 1 Diabetes Within the MHC

OBJECTIVE

The MHC region harbors the strongest loci for latent autoimmune diabetes in adults (LADA); however, the strength of association is likely attenuated compared with that for childhood-onset type 1 diabetes. In this study, we recapitulate independent effects in the MHC class I region in a population with type 1 diabetes and then determine whether such conditioning in LADA yields potential genetic discriminators between the two subtypes within this region.

RESEARCH DESIGN AND METHODS

Chromosome 6 was imputed using SNP2HLA, with conditional analysis performed in type 1 diabetes case subjects (n = 1,985) and control subjects (n = 2,219). The same approach was applied to a LADA cohort (n = 1,428) using population-based control subjects (n = 2,850) and in a separate replication cohort (656 type 1 diabetes case, 823 LADA case, and 3,218 control subjects).

RESULTS

The strongest associations in the MHC class II region (rs3957146, β [SE] = 1.44 [0.05]), as well as the independent effect of MHC class I genes, on type 1 diabetes risk, particularly HLA-B*39 (β [SE] = 1.36 [0.17]), were confirmed. The conditional analysis in LADA versus control subjects showed significant association in the MHC class II region (rs3957146, β [SE] = 1.14 [0.06]); however, we did not observe significant independent effects of MHC class I alleles in LADA.

CONCLUSIONS

In LADA, the independent effects of MHC class I observed in type 1 diabetes were not observed after conditioning on the leading MHC class II associations, suggesting that the MHC class I association may be a genetic discriminator between LADA and childhood-onset type 1 diabetes.




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Effects of Gender-Affirming Hormone Therapy on Insulin Sensitivity and Incretin Responses in Transgender People

OBJECTIVE

The long-term influences of sex hormone administration on insulin sensitivity and incretin hormones are controversial. We investigated these effects in 35 transgender men (TM) and 55 transgender women (TW) from the European Network for the Investigation of Gender Incongruence (ENIGI) study.

RESEARCH DESIGN AND METHODS

Before and after 1 year of gender-affirming hormone therapy, body composition and oral glucose tolerance tests (OGTTs) were evaluated.

RESULTS

In TM, body weight (2.8 ± 1.0 kg; P < 0.01), fat-free mass (FFM) (3.1 ± 0.9 kg; P < 0.01), and waist-to-hip ratio (–0.03 ± 0.01; P < 0.01) increased. Fasting insulin (–1.4 ± 0.8 mU/L; P = 0.08) and HOMA of insulin resistance (HOMA-IR) (2.2 ± 0.3 vs. 1.8 ± 0.2; P = 0.06) tended to decrease, whereas fasting glucose (–1.6 ± 1.6 mg/dL), glucose-dependent insulinotropic polypeptide (GIP) (–1.8 ± 1.0 pmol/L), and glucagon-like peptide 1 (GLP-1) (–0.2 ± 1.1 pmol/L) were statistically unchanged. Post-OGTT areas under the curve (AUCs) for GIP (2,068 ± 1,134 vs. 2,645 ± 1,248 [pmol/L] x min; P < 0.01) and GLP-1 (2,352 ± 796 vs. 2,712 ± 1,015 [pmol/L] x min; P < 0.01) increased. In TW, body weight tended to increase (1.4 ± 0.8 kg; P = 0.07) with decreasing FFM (–2.3 ± 0.4 kg; P < 0.01) and waist-to-hip ratio (–0.03 ± 0.01; P < 0.01). Insulin (3.4 ± 0.8 mU/L; P < 0.01) and HOMA-IR (1.7 ± 0.1 vs. 2.4 ± 0.2; P < 0.01) rose, fasting GIP (–1.4 ± 0.8 pmol/L; P < 0.01) and AUC GIP dropped (2,524 ± 178 vs. 1,911 ± 162 [pmol/L] x min; P < 0.01), but fasting glucose (–0.3 ± 1.4 mg/dL), GLP-1 (1.3 ± 0.8 pmol/L), and AUC GLP-1 (2,956 ± 180 vs. 2,864 ± 93 [pmol/L] x min) remained unchanged.

CONCLUSIONS

In this cohort of transgender persons, insulin sensitivity but also post-OGTT incretin responses tend to increase with masculinization and to decrease with feminization.




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Vasodilatory Actions of Glucagon-Like Peptide 1 Are Preserved in Skeletal and Cardiac Muscle Microvasculature but Not in Conduit Artery in Obese Humans With Vascular Insulin Resistance

OBJECTIVE

Obesity is associated with microvascular insulin resistance, which is characterized by impaired insulin-mediated microvascular recruitment. Glucagon-like peptide 1 (GLP-1) recruits skeletal and cardiac muscle microvasculature, and this action is preserved in insulin-resistant rodents. We aimed to examine whether GLP-1 recruits microvasculature and improves the action of insulin in obese humans.

RESEARCH DESIGN AND METHODS

Fifteen obese adults received intravenous infusion of either saline or GLP-1 (1.2 pmol/kg/min) for 150 min with or without a euglycemic insulin clamp (1 mU/kg/min) superimposed over the last 120 min. Skeletal and cardiac muscle microvascular blood volume (MBV), flow velocity and blood flow, brachial artery diameter and blood flow, and pulse wave velocity (PWV) were determined.

RESULTS

Insulin failed to change MBV or flow in either skeletal or cardiac muscle, confirming the presence of microvascular insulin resistance. GLP-1 infusion alone increased MBV by ~30% and ~40% in skeletal and cardiac muscle, respectively, with no change in flow velocity, leading to a significant increase in microvascular blood flow in both skeletal and cardiac muscle. Superimposition of insulin to GLP-1 infusion did not further increase MBV or flow in either skeletal or cardiac muscle but raised the steady-state glucose infusion rate by ~20%. Insulin, GLP-1, and GLP-1 + insulin infusion did not alter brachial artery diameter and blood flow or PWV. The vasodilatory actions of GLP-1 are preserved in both skeletal and cardiac muscle microvasculature, which may contribute to improving metabolic insulin responses and cardiovascular outcomes.

CONCLUSIONS

In obese humans with microvascular insulin resistance, GLP-1’s vasodilatory actions are preserved in both skeletal and cardiac muscle microvasculature, which may contribute to improving metabolic insulin responses and cardiovascular outcomes.




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Amid an Unfolding Humanitarian Crisis in Syria, the European Union Faces the Perils of Devolving Migration Management to Turkey

The high-stakes gambit taken by Turkish President Recep Tayyip Erdoğan to allow tens of thousands of asylum seekers and migrants free movement to the Greek border demonstrated the fragility of the EU-Turkey deal and the European Union's broader approach to outsource migration management to third countries. This article examines the causes for the tensions, the EU approach to external partnerships, and a hardening European attitude towards unwanted arrivals.




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International Experience Suggests Safe Third-Country Agreement Would Not Solve the U.S.-Mexico Border Crisis

While safe third-country agreements appear to hold the potential of deterring new asylum claims, experience suggests this may be a false promise. As the Trump administration explores the possibility of such agreements with Mexico and Guatemala, this commentary examines the evidence of safe third-country arrangements in Europe, finding them difficult to enforce and playing little role in deterring new claims.




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USCIS Fee Increase Proposed Rule Could Represent the Latest Step in Reshaping Immigration to United States

While much attention has been given to the move by U.S. Citizenship and Immigration Services to raise its application fees—including an 83 percent hike to apply for U.S. citizenship—the policy changes embedded in the proposed rule have been less scrutinized. The changes, including the elimination of most fee waivers for lower-income applicants, would likely reduce the number and shift the profile of those getting a green card or other immigration status.




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Coronavirus Is Spreading across Borders, But It Is Not a Migration Problem

Travel bans, border closures, and other migration management tools did not prove effective at blocking COVID-19 from spreading across international borders. Yet as governments have shifted from containment to mitigation with the coronavirus now in community transmission in many countries, these restrictions are a logical part of the policy toolkit in the context of social distancing and restricting all forms of human movement, as this commentary explores.




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A Proxy War on Minorities? India Crafts Citizenship and Refugee Policies through the Lens of Religion

The Modi government's push for a Citizenship Amendment Act and National Register of Citizens sparked deadly riots and chilled India's 200 million Muslims, who fear being relegated to second-class citizenship—and for some, even statelessness. This article explores actions by Modi's Bharatiya Janata Party, the significance of Bangladeshi illegal immigration as a driver, and what a register of citizens in Assam might mean for India.




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A New Migration Policy for A New Era: A Conversation with Mexico&#039;s Interior Secretary Olga Sánchez Cordero

On her first official trip to Washington, DC, Secretary of the Interior Olga Sánchez Cordero offered a public address on Mexico’s new approach to migration policy at MPI. Her remarks and the event discussion were mostly conducted in Spanish, and this recording is of the simultaneous English interpretation. 




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Una nueva política migratoria para una nueva era: Una conversación con la Secretaria de Gobernación Olga Sánchez Cordero

Durante su primera visita oficial a Washington, DC, la Secretaria de Gobierno Olga Sánchez Cordero presento un discurso público sobre la nueva política migratoria de México en el Instituto de Políticas Migratorias.




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Policy Solutions to Address Crisis at Border Exist, But Require Will and Staying Power to Execute

Closing the U.S.-Mexico border and cutting off aid to Central America would only feed the crisis unfolding at key points along the U.S.-Mexico border. This commentary outlines a range of immediate and long-term policy responses that would more effectively address the complex mix of factors fueling rising Central American migration to the United States.




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Strategic Solutions for the United States and Mexico to Manage the Migration Crisis

Amid surging migration from Central America, the United States and Mexico in June 2019 agreed to a series of enforcement measures. Yet these near-term efforts will be difficult to maintain given chronic institutional weaknesses and poorly thought-out policy structures in both countries. This commentary, by the presidents of MPI and El Colegio de México, offers a set of long-term, collaborative solutions to dissuade illegal migration while ensuring fairness to those seeking protection.




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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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Nonprofit recruiting dentists to volunteer in Puerto Rico

The U.S.-based International Medical Relief is sponsoring outreach trips to Puerto Rico in response to the earthquakes that have devastated the region.




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Dental schools, industry team up to create innovation centers

The Center for Research & Education in Technology is encouraging dental schools to find out how to participate in its program and learn about the benefits to the school and its students.




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Global Dental Relief recruiting volunteers

Global Dental Relief, a nonprofit organization that has delivered free dental care to children around the globe since 2001, is seeking clinical volunteers for upcoming humanitarian missions in Nepal and Guatemala.




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NIDCR seeks comments on research proposal

The National Institute of Dental and Craniofacial Research is seeking comments on a proposed research initiative on dental fear and anxiety.




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ADA urges Congress to increase relief for small businesses, dentist owners

As Congress works on a third legislation package in response to the coronavirus pandemic, the ADA is asking lawmakers to include provisions on how to assist dental practices and other small businesses facing economic burdens.




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ADA Member Advantage ends Chase endorsement for credit card processing

ADA Member Advantage announced April 1 it ended its endorsement relationship with Chase for credit card processing.




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IRS publishes Employee Retention Credit FAQ

The Internal Revenue Service has published an FAQ on the Employee Retention Credit in regards to the Coronavirus Aid, Relief, and Economic Security Act.