pro

Self-protection: how NHS doctors are sourcing their own PPE




pro

Proline-rich 11 (PRR11) drives F-actin assembly by recruiting the actin-related protein 2/3 complex in human non-small cell lung carcinoma [DNA and Chromosomes]

The actin cytoskeleton is extremely dynamic and supports diverse cellular functions in many physiological and pathological processes, including tumorigenesis. However, the mechanisms that regulate the actin-related protein 2/3 (ARP2/3) complex and thereby promote actin polymerization and organization in cancer cells are not well-understood. We previously implicated the proline-rich 11 (PRR11) protein in lung cancer development. In this study, using immunofluorescence staining, actin polymerization assays, and siRNA-mediated gene silencing, we uncovered that cytoplasmic PRR11 is involved in F-actin polymerization and organization. We found that dysregulation of PRR11 expression results in F-actin rearrangement and nuclear instability in non-small cell lung cancer cells. Results from molecular mechanistic experiments indicated that PRR11 associates with and recruits the ARP2/3 complex, facilitates F-actin polymerization, and thereby disrupts the F-actin cytoskeleton, leading to abnormal nuclear lamina assembly and chromatin reorganization. Inhibition of the ARP2/3 complex activity abolished irregular F-actin polymerization, lamina assembly, and chromatin reorganization due to PRR11 overexpression. Notably, experiments with truncated PRR11 variants revealed that PRR11 regulates F-actin through different regions. We found that deletion of either the N or C terminus of PRR11 abrogates its effects on F-actin polymerization and nuclear instability and that deletion of amino acid residues 100–184 or 100–200 strongly induces an F-actin structure called the actin comet tail, not observed with WT PRR11. Our findings indicate that cytoplasmic PRR11 plays an essential role in regulating F-actin assembly and nuclear stability by recruiting the ARP2/3 complex in human non-small cell lung carcinoma cells.




pro

Safe or Sorry? Prospects for Britons in the European Union after Brexit

Amid ongoing Brexit negotiations, much remains uncertain for the roughly 1 million UK citizens living elsewhere in the European Union. This report offers a demographic profile of these Brexpats, considering what form an EU-UK deal on citizens’ rights might take and identifying key challenges many Britons are likely to face—including difficulty securing legal status and accessing labor markets, social security, and health-care systems.




pro

Embarking on the Next Journey: Innovations in Predeparture Orientation Programs for Refugees

This MPI Europe webinar examines innovative ways to better design and implement predeparture orientation programs for resetttling refugees. The discussion features observations from a refugee who went through an orientation program before being resettled in the Netherlands, and a resettlement agency official in Norway.




pro

On the Wrong Path? Protecting the European Union’s External Border in the Western Balkans

With thousands more migrants potentially traveling through the Western Balkans this year, this MPI Europe webinar explores the implications of the buttressed EU border on the bloc’s neighbors, including the issues of outsourcing migration control, EU support for addressing irregular migration in neighboring countries, and considerations for EU policymakers.




pro

On the Wrong Path? Protecting the European Union’s External Border in the Western Balkans

With thousands migrants potentially traveling through the Western Balkans this year, this MPI Europe webinar explores the implications of the buttressed EU border on the bloc’s neighbors, the migrants transiting these routes, and the local communities. Experts also explored how the European Union can support efforts to address irregular migration in neighboring countries, and what are the tradeoffs and considerations that policymakers must weigh. 




pro

The Trump Immigration Plan: A Lopsided Proposal

The White House immigration plan offered as a solution to resolve the fate of DREAMers seeks legal immigration cuts unlike any seen since 1924. In addition to a decrease of up to 40 percent in family-sponsored immigration, the proposal demands vast increases in enforcement and a retrenchment in protections for those seeking humanitarian relief. In exchange, one-sixth of the unauthorized population could gain legal status.




pro

A Wall Cannot Fix Problems at Border; Smart Solutions for Asylum Crisis Can

What President Trump calls a border crisis is in fact a crisis in the asylum system—one worsened at every turn by his administration’s harsh policies and rhetoric. Rather than spend $5.7 billion on a wall, it would be far more effective to use the money to retool an overwhelmed asylum system, adapt outmatched border enforcement infrastructure to respond to the changing composition of arrivals, and work cooperatively with Mexico to tackle the factors propelling Central Americans to flee.




pro

A Path to Citizenship for 1.8 Million DREAMERs? Despite Talk, No Proposal Would Do So

Even as the 1.8 million number swirls in the discussion of how many DREAMers would be placed on a path to citizenship, proposals debated in the Senate in February 2018 would have resulted in the legalization of smaller numbers, as this commentary explains. It offers estimates of potential beneficiaries of several Senate proposals, including one backed by the White House, and analysis of key criteria.




pro

Trump Administration Rescinds DACA, Fueling Renewed Push in Congress and the Courts to Protect DREAMers

The Trump administration’s decision to terminate the Deferred Action for Childhood Arrivals (DACA) deportation-relief program launched in 2012 has sparked new urgency to find a longer-term fix for "DREAMers," the unauthorized immigrants brought to the United States as children. This Policy Beat article examines movement in the courts and in Congress on the DREAM Act and similar proposals, exploring likely paths forward.




pro

Spike in Unaccompanied Child Arrivals at U.S.-Mexico Border Proves Enduring Challenge; Citizenship Question on 2020 Census in Doubt

Approximately 11,500 unaccompanied children were apprehended at the U.S.-Mexico border in May, putting this year on track to exceed 2014's surge. As the U.S. government struggles to care for these child migrants, with public outrage mounting over reports of unsafe, filthy conditions in initial Border Patrol custody, the failure of the executive branch and Congress to plan for increased shelter and care demands are increasingly apparent, as this article explores.




pro

A Profile of U.S. Children with Unauthorized Immigrant Parents

Growing up with unauthorized immigrant parents puts children—nearly 80 percent of whom were born in the United States—at a disadvantage, with lower preschool enrollment, reduced socioeconomic progress, and higher rates of linguistic isolation and poverty. This fact sheet examines the number, characteristics, and socioeconomic status of children, both U.S.-citizen and noncitizen, who have unauthorized immigrant parents.




pro

Immigration to the Heartland: A Profile of Immigrants in the Kansas City Region

The immigrant population in the Kansas City region has grown rapidly over the past 25 years, contributing to overall population growth in the area. This fact sheet describes immigrants in the metro area, examining their origins, industries of employment, income and poverty levels, English proficiency, educational attainment, and more.




pro

Dual Language Learners: A National Demographic and Policy Profile

As the share of U.S. children under age 8 who are Dual Language Learners (DLLs) increases, state policies have an important role to play in ensuring all young learners are able to get their education off to a good start. These fact sheets compare key characteristics of DLLs and their peers nationwide and in 30 states, and identify state policies that support equitable access to high-quality early childhood education and care programs.




pro

Spheres of Exploitation: Thwarting Actors Who Profit from Illegal Labor, Domestic Servitude, and Sex Work

This report analyzes the exploitation of migrants in three spheres: the domestic care sector, the labor market, and the sex industry. It details several obstacles governments face in their efforts to weaken the "bad actors" that profit from exploitation, and shows how one of the biggest challenges facing law enforcement is that serious criminals and lawbreakers often operate on the edge of legality and exploit legal routes wherever possible.




pro

Targeted Enforcement: Projecting the Effects of Executive Action on Deportations

Marking the release of an MPI report, this briefing explores the effects of recent revisions in DHS immigration enforcement priorities on deportations within the U.S. interior.




pro

Improving the Governance of International Migration

This volume from MPI's Transatlantic Council on Migration aims to fill the analytical gap regarding the question of what greater global cooperation on governing the flow of international migrants could achieve. The book focuses on a set of fundamental questions: What are the key steps to building a better, more cooperative system of governance? What are the goals that can be achieved through greater international cooperation? And, most fundamentally, who (or what) is to be governed?




pro

Central American Development: Two Decades of Progress and Challenges for the Future

This report summarizes the economic and social development policy achievements of Central American countries over the past 20 years, as well as the notable obstacles to development that remain. The author identifies long-term challenges and outlines how they can be incorporated into a new development agenda.




pro

Migration and Environmental Change: Assessing the Developing European Approach

This policy brief explores the relationship between environmental change and migration to Europe in light of recent scholarship challenging the notion that environmental change triggers mass migration. It presents an overview of European policy response in this area and summarizes the spectrum of proposed solutions.




pro

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.




pro

A New Era in Refugee Protection and Migration Management? Looking Forward After UN Summit on Refugees and Migrants

MPI experts discuss the outcomes from the UN Summit on Large Movements of Refugees and Migrants and President Obama's Leaders Summit on the Global Refugee Crisis and what it means for international cooperation on refugee protection and management of migration flows.




pro

Indonesia: A Country Grappling with Migrant Protection at Home and Abroad

Indonesia, which has a long history as a major origin for migrant labor in the Asia-Pacific and beyond, more recently has reluctantly found itself a transit and destination country, including for asylum seekers. Still, policymakers remain focused on protection of its nationals abroad rather than on assuring the status of Chinese and other foreigners in the country. This country profile explores Indonesia's rich migration history. 

 




pro

Firing Up Regional Brain Networks: The Promise of Brain Circulation in the ASEAN Economic Community

Given diverging demographics, rising educational attainment and wide variation in economic opportunities, countries in the Association of Southeast Asian Nations are poised to see an expansion of both the demand for and supply of skilled migrants willing and able to move. The convergence of these megatrends represents unique opportunities for human-capital development and brain circulation, as this report explores.




pro

The Long Road Ahead: Status Report on the Implementation of the ASEAN MRAs on Professional Services

While it has been years since the Association of Southeast Asian Nations signed accords to facilitate the movement of professionals in seven occupations, implementation of these Mutual Recognition Arrangements remains "painfully slow and uneven across countries." This final report in an MPI-Asian Development Bank series explores MRA implementation by sector, and offers recommendations to help achieve the goal of greater skill mobility in Southeast Asia.




pro

Regional Enforcement: A Profile of Migrants Deported from the United States and Mexico to the Northern Triangle

Marking the release of an MPI report, speakers on this webinar present an overview of regional immigration enforcement trends, including U.S. and Mexican apprehensions and deportations of both children and adults, along with a demographic, socioeconomic, and criminal profile of child and adult deportees.




pro

Migrants Deported from the United States and Mexico to the Northern Triangle: A Statistical and Socioeconomic Profile

This report examines the rising numbers of apprehensions and deportations of Central American children and adults by the United States and Mexico, and provides a demographic, socioeconomic, and criminal profile of deportees to El Salvador, Guatemala, and Honduras. The report traces how rising Mexican enforcement is reshaping regional dynamics and perhaps ushering in changes to long-lasting trends in apprehensions.




pro

Regional Enforcement: A Profile of Migrants Deported from the United States and Mexico to the Northern Triangle

This webinar includes an overview of regional immigration enforcement trends, including U.S. and Mexican apprehensions and deportations of Central American migrants, along with a demographic, socioeconomic, and criminal profile of child and adult deportees.




pro

Exploring Innovative Ideas to Strengthen the Global Protection System

A discussion, including the former United Nations Deputy High Commissioner for Refugees, examining the huge strains on the global protection system and how it can better respond to protracted refugee situations and other long-term displacement, focusing on the conclusions of the Transatlantic Council on Migration's recent meeting, Beyond Asylum: Rethinking Protection Policies to Meet Sharply Escalating Needs.




pro

Temporary Protected Status at Risk: Implications for Central America and U.S. Policy

As the Trump administration weighs the future of Temporary Protected Status (TPS) for Salvadorans, this teleconference focuses on the legal framework for TPS (particularly for Hondurans and Salvadorans) and profile of current TPS holders; the capacity of El Salvador and Honduras to receive and meaningfully reintegrate returnees; and the implications of TPS termination for broader U.S. policy goals in Central America.




pro

Promising Strategies for Reintegration of Migrants Returning to Mexico and Central America

Authors of a year-long study of reception and reintegration services in Mexico and the Northern Triangle discuss the findings of their fieldwork, including the differing reintegration needs of individual migrant groups, promising reception and reintegration programs, ongoing challenges for origin communities, and policy recommendations to improve reintegration strategies. 




pro

Diabetes INSIDE: Improving Population HbA1c Testing and Targets in Primary Care With a Quality Initiative

OBJECTIVE

To improve outcomes of patients with adult type 2 diabetes by decreasing HbA1c undertesting, reducing the proportion of patients with poor glycemic control, and lowering mean HbA1c levels using a quality improvement (QI) program.

RESEARCH DESIGN AND METHODS

Six years of outpatient electronic health record (EHR) data were analyzed for care gaps before and 2 years after implementing a QI initiative in an urban academic medical center. QI strategies included 1) individual provider and departmental outcome reports, 2) patient outreach programs to address timely follow-up care, 3) a patient awareness campaign to improve understanding of achieving clinical goals, 4) improving EHR data capture to improve population monitoring, and 5) professional education.

RESULTS

Analysis (January 2010 to May 2018) of 7,798 patients from Tulane Medical Center (mean age 61 years, 57% female, 62% black, 97% insured) with 136,004 visits showed target improvements. A Cox proportional hazards model controlling for age, sex, race, and HbA1c level showed a statistically significant reduction in HbA1c undertesting >6 months (hazard ratio 1.20 ± 0.07). Statistical process control charts showed 15.5% relative improvement in the patient proportion with HbA1c >9% (75 mmol/mol) from 13% to 11% (P < 10–6) following QI interventions and a 2.1% improvement of population mean HbA1c from 7.4% (57 mmol/mol) to 7.2% (55 mmol/mol) (P < 10–6).

CONCLUSIONS

Multidisciplinary QI teams using EHR data to design interventions for providers and patients produced statistically significant improvements in both care process and clinical outcome goals.




pro

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.




pro

Glucosamine Use, Inflammation, and Genetic Susceptibility, and Incidence of Type 2 Diabetes: A Prospective Study in UK Biobank

OBJECTIVE

Glucosamine is a widely used supplement typically taken for osteoarthritis and joint pain. Emerging evidence suggests potential links of glucosamine with glucose metabolism, inflammation, and cardiometabolic risk. We prospectively analyzed the association of habitual glucosamine use with risk of type 2 diabetes (T2D) and assessed whether genetic susceptibility and inflammation status might modify the association.

RESEARCH DESIGN AND METHODS

This study analyzed 404,508 participants from the UK Biobank who were free of diabetes, cancer, or cardiovascular disease at baseline and completed the questionnaire on supplement use. Cox proportional hazards models were used to evaluate the association between habitual use of glucosamine and risk of incident T2D.

RESULTS

During a median of 8.1 years of follow-up, 7,228 incident cases of T2D were documented. Glucosamine use was associated with a significantly lower risk of T2D (hazard ratio 0.83, 95% CI 0.78–0.89) after adjustment for age, sex, BMI, race, center, Townsend deprivation index, lifestyle factors, history of disease, and other supplement use. This inverse association was more pronounced in participants with a higher blood level of baseline C-reactive protein than in those with a lower level of this inflammation marker (P-interaction = 0.02). A genetic risk score for T2D did not modify this association (P-interaction = 0.99).

CONCLUSIONS

Our findings indicate that glucosamine use is associated with a lower risk of incident T2D.




pro

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.




pro

What math professors and k-12 teachers think of each other

By Michael Pershan, St. Ann’s School I. What do primary/secondary math educators think of the teaching that happens in colleges? And — the other way around — what do mathematics professors think of primary and secondary math teaching? I’m nearing … Continue reading




pro

Soccer: Germany's Bundesliga approved to return in mid-May

The Bundesliga -- Germany's top soccer league -- will be allowed to resume in May after German Chancellor Angela Merkel lifted some lockdown restrictions in the country on Wednesday amid the coronavirus pandemic.




pro

NFL lays out protocols for reopening of team facilities

The NFL outlined protocols Wednesday for the gradual reopening of team facilities amid the coronavirus pandemic.




pro

Michigan coach Jim Harbaugh proposes major changes to NFL Draft eligibility rules

Michigan coach Jim Harbaugh is urging the NFL and NCAA to amend their rules and provide flexibility to college football players who consider making the jump to the next level.




pro

New Orleans Saints release Pro Bowl OL Larry Warford

The New Orleans Saints released Pro Bowl offensive lineman Larry Warford after three seasons, the team announced Friday.




pro

Glucose, Advanced Glycation End Products, and Diabetes Complications: What Is New and What Works

Melpomeni Peppa
Oct 1, 2003; 21:
Council's Voice




pro

Insulin Therapy: A Personal Approach

Mayer B. Davidson
Jul 1, 2015; 33:123-135
Feature Articles




pro

Improving Patient Adherence

Alan M. Delamater
Apr 1, 2006; 24:71-77
Feature Articles




pro

Treatment Approach to Patients With Severe Insulin Resistance

Timothy J. Church
Apr 1, 2016; 34:97-104
Feature Articles




pro

Standards of Medical Care in Diabetes--2018 Abridged for Primary Care Providers

American Diabetes Association
Jan 1, 2018; 36:14-37
Position Statements




pro

Standards of Medical Care in Diabetes--2019 Abridged for Primary Care Providers

American Diabetes Association
Jan 1, 2019; 37:11-34
Position Statements




pro

Standards of Medical Care in Diabetes--2020 Abridged for Primary Care Providers

American Diabetes Association
Jan 1, 2020; 38:10-38
Standards of Care




pro

Plasma and Dietary Linoleic Acid and 3-Year Risk of Type 2 Diabetes After Myocardial Infarction: A Prospective Analysis in the Alpha Omega Cohort

OBJECTIVE

To study plasma and dietary linoleic acid (LA) in relation to type 2 diabetes risk in post–myocardial infarction (MI) patients.

RESEARCH DESIGN AND METHODS

We included 3,257 patients aged 60–80 years (80% male) with a median time since MI of 3.5 years from the Alpha Omega Cohort and who were initially free of type 2 diabetes. At baseline (2002–2006), plasma LA was measured in cholesteryl esters, and dietary LA was estimated with a 203-item food-frequency questionnaire. Incident type 2 diabetes was ascertained through self-reported physician diagnosis and medication use. Hazard ratios (with 95% CIs) were calculated by Cox regressions, in which dietary LA isocalorically replaced the sum of saturated (SFA) and trans fatty acids (TFA).

RESULTS

Mean ± SD circulating and dietary LA was 50.1 ± 4.9% and 5.9 ± 2.1% energy, respectively. Plasma and dietary LA were weakly correlated (Spearman r = 0.13, P < 0.001). During a median follow-up of 41 months, 171 patients developed type 2 diabetes. Plasma LA was inversely associated with type 2 diabetes risk (quintile [Q]5 vs. Q1: 0.44 [0.26, 0.75]; per 5%: 0.73 [0.62, 0.86]). Substitution of dietary LA for SFA+TFA showed no association with type 2 diabetes risk (Q5 vs. Q1: 0.78 [0.36, 1.72]; per 5% energy: 1.18 [0.59, 2.35]). Adjustment for markers of de novo lipogenesis attenuated plasma LA associations.

CONCLUSIONS

In our cohort of post-MI patients, plasma LA was inversely related to type 2 diabetes risk, whereas dietary LA was not related. Further research is needed to assess whether plasma LA indicates metabolic state rather than dietary LA in these patients.




pro

Redesigning Primary Care to Improve Diabetes Outcomes (the UNITED Study)

OBJECTIVE

The effective redesign of primary care delivery systems to improve diabetes care requires an understanding of which particular components of delivery consistently lead to better clinical outcomes. We identified associations between common systems of care management (SysCMs) and the frequency of meeting standardized performance targets for Optimal Diabetes Care (NQF#0729) in primary care practices.

RESEARCH DESIGN AND METHODS

A validated survey of 585 eligible family or general internal medicine practices seeing ≥30 adult patients with diabetes in or near Minnesota during 2017 evaluated the presence of 62 SysCMs. From 419 (72%) practices completing the survey, NQF#0729 was determined in 396 (95%) from electronic health records, including 215,842 patients with type 1 or type 2 diabetes.

RESULTS

Three SysCMs were associated with higher rates of meeting performance targets across all practices: 1) a systematic process for shared decision making with patients (P = 0.001), 2) checklists of tests or interventions needed for prevention or monitoring of diabetes (P = 0.002), and 3) physician reminders of guideline-based age-appropriate risk assessments due at the patient visit (P = 0.002). When all three were in place, an additional 10.8% of the population achieved recommended performance measures. In subgroup analysis, 15 additional SysCMs were associated with better care in particular types of practices.

CONCLUSIONS

Diabetes care outcomes are better in primary care settings that use a patient-centered approach to systematically engage patients in decision making, remind physicians of age-appropriate risk assessments, and provide checklists for recommended diabetes interventions. Practice size and location are important considerations when redesigning delivery systems to improve performance.




pro

Impact of a Telephonic Intervention to Improve Diabetes Control on Health Care Utilization and Cost for Adults in South Bronx, New York

OBJECTIVE

Self-management education and support are essential for improved diabetes control. A 1-year randomized telephonic diabetes self-management intervention (Bronx A1C) among a predominantly Latino and African American population in New York City was found effective in improving blood glucose control. To further those findings, this current study assessed the intervention’s impact in reducing health care utilization and costs over 4 years.

RESEARCH DESIGN AND METHODS

We measured inpatient (n = 816) health care utilization for Bronx A1C participants using an administrative data set containing all hospital discharges for New York State from 2006 to 2014. Multilevel mixed modeling was used to assess changes in health care utilization and costs between the telephonic diabetes intervention (Tele/Pr) arm and print-only (PrO) control arm.

RESULTS

During follow-up, excess relative reductions in all-cause hospitalizations for the Tele/Pr arm compared with PrO arm were statistically significant for odds of hospital use (odds ratio [OR] 0.89; 95% CI 0.82, 0.97; P < 0.01), number of hospital stays (rate ratio [RR] 0.90; 95% CI 0.81, 0.99; P = 0.04), and hospital costs (RR 0.90; 95% CI 0.84, 0.98; P = 0.01). Reductions in hospital use and costs were even stronger for diabetes-related hospitalizations. These outcomes were not significantly related to changes observed in hemoglobin A1c during individuals’ participation in the 1-year intervention.

CONCLUSIONS

These results indicate that the impact of the Bronx A1C intervention was not just on short-term improvements in glycemic control but also on long-term health care utilization. This finding is important because it suggests the benefits of the intervention were long-lasting with the potential to not only reduce hospitalizations but also to lower hospital-associated costs.




pro

Peacock protecting duck nest in patio area of Oregon bar

Employees at an Oregon restaurant said a peacock has taken on the role of protector for a mother duck and the eggs she laid in the closed patio area.