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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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Association Between the Use of Antidepressants and the Risk of Type 2 Diabetes: A Large, Population-Based Cohort Study in Japan

OBJECTIVE

This study aimed to reveal the associations between the risk of new-onset type 2 diabetes and the duration of antidepressant use and the antidepressant dose, and between antidepressant use after diabetes onset and clinical outcomes.

RESEARCH DESIGN AND METHODS

In this large-scale retrospective cohort study in Japan, new users of antidepressants (exposure group) and nonusers (nonexposure group), aged 20–79 years, were included between 1 April 2006 and 31 May 2015. Patients with a history of diabetes or receipt of antidiabetes treatment were excluded. Covariates were adjusted by using propensity score matching; the associations were analyzed between risk of new-onset type 2 diabetes and the duration of antidepressant use/dose of antidepressant in the exposure and nonexposure groups by using Cox proportional hazards models. Changes in glycated hemoglobin (HbA1c) level were examined in groups with continuous use, discontinuation, or a reduction in the dose of antidepressants.

RESULTS

Of 90,530 subjects, 45,265 were in both the exposure and the nonexposure group after propensity score matching; 5,225 patients (5.8%) developed diabetes. Antidepressant use was associated with the risk of diabetes onset in a time- and dose-dependent manner. The adjusted hazard ratio was 1.27 (95% CI 1.16–1.39) for short-term low-dose and 3.95 (95% CI 3.31–4.72) for long-term high-dose antidepressant use. HbA1c levels were lower in patients who discontinued or reduced the dose of antidepressants (F[2,49] = 8.17; P < 0.001).

CONCLUSIONS

Long-term antidepressant use increased the risk of type 2 diabetes onset in a time- and dose-dependent manner. Glucose tolerance improved when antidepressants were discontinued or the dose was reduced after diabetes onset.




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Seasonal Worker Programs in Europe: Lessons Learned and Ways Forward

As the European Union prepares to review the implementation of its Seasonal Workers Directive, as well as countries such as the United Kingdom continue to explore new approaches to selecting seasonal workers, this webinar features findings from a policy brief on the topic. 




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Diabetes and Back Pain: Markers of Diabetes Disease Progression Are Associated With Chronic Back Pain

Lorenzo Rinaldo
Jul 1, 2017; 35:126-131
Feature Articles




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Diabetes Self-management Education and Support in Type 2 Diabetes: A Joint Position Statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics

Margaret A. Powers
Apr 1, 2016; 34:70-80
Position Statements




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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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Professorship in decision making at Wharton, Operations, Information and Decisions (OID), University of Pennsylvania

APPLICATION DEADLINE OCTOBER 15, 2019 The Operations, Information and Decisions Department at the Wharton School is seeking applicants for a full-time, tenure track, Assistant Professor faculty position in the area of decision-making. Our decision-making faculty is comprised of scholars with a diverse set of backgrounds and interests, and we encourage applicants with degrees in economics, […]

The post Professorship in decision making at Wharton, Operations, Information and Decisions (OID), University of Pennsylvania appeared first on Decision Science News.




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Educators Who Ran for Office Share Their Lessons Learned (Video)

Watch a discussion between three educators who ran for their state legislatures about their experiences on the campaign trail.




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Educators Who Ran for Office Share Their Lessons Learned (Video)

Watch a discussion between three educators who ran for their state legislatures about their experiences on the campaign trail.




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Missouri teachers virtually educate students about pandemic




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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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For Students in Coal Country, the Census Is a Hands-On Civics Lesson

In rural communities with shrinking populations, schools are enlisting students to help prevent the U.S. Census Bureau from undercounting them next year.




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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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Schools Are Required to Teach Mental-Health Lessons This Fall in Two States. And That's a First.

Students returning to schools in Virginia and New York this fall will be required to participate in mental-health education as part of their health and physical education courses.




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Missouri teachers virtually educate students about pandemic




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Open Enrollment Has Drained One District. It's Looking to Dissolve

Wisconsin’s Palmyra-Eagle district has lost more than half its students in the last decade, sparking a fiscal crisis. A special board is deciding whether the district should be allowed to dissolve.




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Verdict Looms on Whether Insolvent Wisconsin District Can Dissolve

Palmyra-Eagle, a mostly rural school district in Southeast Wisconsin, lost more than half its students to surrounding districts and then taxpayers voted to dissolve the district.




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Why Don't Struggling K-12 Districts Just Dissolve?

Emotions remain raw as educators and residents in a rural Wisconsin district dig for solutions after being denied the option of dissolving.




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Panel Rejects Wisconsin District's Request to Dissolve

Members of the special state panel felt the Palmyra-Eagle district needs more time to explore options to stay alive, though many residents, including the local school board, believe the district faces a fiscal cliff.




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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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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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With ESSA Passage, Delaware Offers Lessons

Paul Herdman of the Rodel Foundation of Delaware checks in where his state is after RTTT and how the state's education plan can serve as a model for other states responding to ESSA's reduction of federal oversight.




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Kansas, Missouri renew Border War with 4-game football set

Kansas and Missouri are resuming their bitter Border War in football after the former Big 12 rivals agreed to a four-game series in which each school will play two home games beginning in September 2025. The fourth-longest rivalry in college football dates to 1891, but it has been on hiatus since Missouri departed for the Southeastern Conference. The schools recently announced a six-game series in men's basketball beginning with the upcoming season that includes two games on each campus and two in Kansas City, Missouri.




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Knowledge sharing for the development of learning resources : theory, method, process and application for schools, communities and the workplace : a UNESCO-PNIEVE resource / by John E. Harrington, Professor Emeritis.

The Knowledge Sharing for the Development of Learning Resources tutorial provides a professional step forward, a learning experience that leads to recognition that your leadership is well founded as well as ensuring that participants in the development of learning resources recognize they are contributing to an exceptional achievement.




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PPSA update (Family Law) / presented by Associate Professor David Brown, University of Adelaide.




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Forum 2019 : 3C Lessons for practitioners from 5 years as Commissioner : slides / presented by Greg May, Legal Profession Conduct Commissioner.




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Developing tailored study plans for the new higher education environment : 'Letting go of control' : final report / Professor Joe Shapter, National Teaching Fellow, Flinders University ; Associate Professor Ingo Koeper, College of Science and Engi

"It is timely that the higher education sector examines paths forward to address and indeed engage in the new environment in which it will work in the future. This fellowship explored two approaches to engage students more deeply in their education. The first approach is generally termed 'interdisciplinary studies' where students define their own program of study; the second approach focuses on topic structure where students are given a wide range of choice and in effect can build a topic that suits their interests."--Page iv.




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Engaging men who use violence : invitational narrative approaches / Professor Sarah Wendt, Dr Kate Seymour, Fiona Buchanan, Chris Dolman, Dr Natalie Greenland.

"This study contributes to the limited evidence available on how invitational narrative approaches are used in the domestic and family violence field. It focused on invitational narrative ways of engaging and working with men who perpetrate domestic and family violence. Focusing on the processes and skills of practice embedded in invitational narrative ideas enabled the examination of different ways of engaging men that have the potential to lead to sustained change. Accordingly, the main aim of this study was to explore invitational narrative ways of working in order to build an understanding of the processes and skills that engage men and enable behavioural and attitudinal change." --Executive summary (page 6).




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Shell / Kristina Olsson.

Utzon, Jorn, 1918-2008 -- Fiction.




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Treasure palaces : great writers visit great museums / foreword by Nicholas Serota ; edited by Maggie Fergusson.

Museums.




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Fermentation : how to make your own sauerkraut, kimchi, brine pickles, kefir, kombucha, vegan dairy, and more / Åsa Simonsson.

Fermented foods.




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The Australian musical : from the beginning / Peter Pinne and Peter Wyllie Johnston ; foreword by John Kotzas, CEO Queensland Performing Arts Centre ; introduction by Mark Madama, Associate Professor of Musical Theatre, University of Michigan.

Lyricists -- Australia -- Biography.




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On the end of privacy : dissolving boundaries in a screen-centric world / Richard E. Miller.

Clementi, Tyler.




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Defrosting ancient microbes : emerging genomes in a warmer world / Scott O. Rogers, Professor of Molecular Biology and Evolution, Department of Biological Sciences, Bowling Green State University ; John D. Castello, Professor Emeritus of Microbiology and

Microorganisms -- History.




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Newsreel. 29, December 1963 Professor A. F. Huxley.

1963.




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Farewell dinner to Professor C. Lovatt Evans 1 July 1949.

1949.




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Association for Science Education

The Association for Science Education's online website. The Wellcome Library subscribes to selected titles only.




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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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Des vésanies, ou maladies mentales / par J.-R. Jacquelin-Dubuisson.

Paris : chez l'auteur, 1816.




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A description of the genus Cinchona, comprehending the various species of vegetables from which the Peruvian and other barks of a similar quality are taken. Illustrated by figures of all the species hitherto discovered. To which is prefixed Professor Vahl

London : printed for B. and J. White, 1797.




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Descriptive anatomy of the horse and domestic animals / chiefly compiled from the manuscripts of Thomas Strangeways and Professor Goodsir by J. Wilson Johnston and T.J. Call.

Edinburgh : MacLachlan and Stewart, 1870.




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Dictionnaire de médecine, de chirurgie, de pharmacie, des sciences accessoires et de l'art vétérinaire / de P.-H. Nysten.

Londres : J.-B. Baillière, 1855.




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Die accessorischen Geschlechtsdrusen der Wirbeltiere, mit besonderer Berucksichtigung des Menschen / von Rudolf Disselhorst.

Wiesbaden : J.F. Bergmann, 1897.




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Die Anatomie der menschlichem Rückenmarks-Nerven für Studierende und Ärzte / von Professor Dr. Rüdinger.

Stuttgart : J.G. Cotta, 1870.




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Die Behandlung der crouposen Lungenentzundung : nach den Grundsatzen des Professors von Jurgensen in Tubingen / von H. Wehberg.

Berlin : Heuser, 1889.




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Die Bekämpfung der Infectionskrankheiten : Hygienischer Theil / von Oberingenieur Brix, Professor Dr. Pfuhl und Hafenarzt Dr. Nocht ; herausgegeben von Stabsarzt Professor Dr. Behring.

Leipzig : G. Thieme, 1894.




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Die Diagnostik des Pulses in Bezug auf die localen Veränderungen desselben / von A. Mosso.

Leipzig : Veit, 1879.




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Die Ermudung / von A. Mosso ; aus dem Italienischen übers. von I. Glinzer.

Leipzig : S. Hirzel, 1892.