rta Covid-19: UK death toll overtakes Italy’s to become worst in Europe By feeds.bmj.com Published On :: Wednesday, May 6, 2020 - 13:37 Full Article
rta Russia’s Uncertain Regime Transformation By feedproxy.google.com Published On :: Wed, 11 Mar 2020 15:47:58 +0000 11 March 2020 Professor Nikolai Petrov Senior Research Fellow, Russia and Eurasia Programme, Chatham House Google Scholar Dr Ben Noble Lecturer in Russian Politics, University College London; Senior Research Fellow, HSE, Moscow Despite the drama, Vladimir Putin’s announcement endorsing a constitutional change allowing him to remain president from 2024 does surprisingly little to change the status quo. 2020-03-11-Putin-Constitution.jpg Russian President Vladimir Putin addresses lawmakers debating on the second reading of the constitutional reform bill during a session of the State Duma, Russia's lower house of parliament March 10, 2020. Photo by ALEXANDER NEMENOV/AFP via Getty Images. With Putin’s current term as head of state due to run out in 2024, the question everybody has been asking is what he will do to remain in power. The Russian president’s recent speech, made in person in the State Duma during the second reading of his own constitutional reform bill, has been interpreted by many as a clear answer. Summaries such as “Putin forever” and “perpetual Putin” abound. But the reality is not so clear.Putin has not committed to standing for re-election in 2024, never mind staying in power until 2036, when two additional six-year terms from 2024 would run out. What he has done is provide the constitutional grounds to retain power as president. It creates a highly credible option without committing him to it.And the uncertainty matters. Because as long as members of the elite are unsure whether Putin will take up the option to remain president, they are kept in check.Broader constitutional reformWith the flurry of interest around Putin’s announcement, we should not lose sight of his moves to further strengthen the presidency. As part of the broader constitutional reform package, Russia’s existing “super-presidency” will gain additional powers, such as the authority to fire top-tier judges and to block legislation when the legislature has overridden a presidential veto (in other words, a “super-veto”).The proposals also put the autonomy of local self-government at risk, with Moscow and regional executives gaining the constitutional power to hire and fire officials who are not even technically part of the state. And the president now has a formalised role as “general leader” of the government. Putin is creating the “Great Presidency”.However, the majority of constitutional changes do not relate to the presidency – they have different purposes. Firstly, to revitalise support for the regime which took a hit following unpopular pension reforms in 2018. Secondly, to distract or appease those worried by Putin remaining in a strengthened presidency. And perhaps most significantly, to boost turnout in the nationwide vote on reforms.This desire to re-energise popular support becomes apparent as the changes – some of which will have to be inserted rather awkwardly into the constitution’s structure – focus on three elements aimed squarely at improving the regime’s appeal: increased material support from the state for citizens, including indexing state pensions; an emphasis on “traditional values”, including a declaration that marriage can only be a union between a man and a woman; and increased Russian sovereignty, including a “nationalisation” of the elite, with a constitutional ban on top-level officials having bank accounts abroad. Constitutional reform is, moreover, the most visible part of a broader political transformation already underway, including a major propaganda drive. Putin has promised a significant increase in resources for its “maternity capital” programme, putting more money in the pockets of young Russian families.And he has instructed Prime Minister Mikhail Mishustin’s government to focus on delivering his “national projects” – goals aimed at improving Russians’ lives across a range of areas, from infrastructure to education and healthcare.Taking advantage of several imminent historical milestones is also on the cards. It has been reported Putin will sign the constitutional reform bill on March 18 – the anniversary of Russia’s annexation of Crimea. And May 9 is the 75th anniversary of the end of the Great Patriotic War (the Russian term for the Second World War), with foreign dignitaries invited to attend events in Moscow.Putin has also been filling the airwaves with a high-production-values series called “20 Questions for Vladimir Putin”, as well as holding public meetings with citizens in provinces such as Cherepovets and Ivanovo. There is a clear aim to demonstrate the president is not only still in control, but also concerned with the well-being of everyday Russians.With parliamentary elections scheduled for September 2021 the Kremlin knows that, to maintain its control of a super-majority of seats in the State Duma, its ratings-raising drive has to work – even if it does always have the option of using manifestly authoritarian methods for realising desired election results. A proposal to call early State Duma elections was made during the second reading of Putin’s reform bill, but was quickly withdrawn after Putin spoke out against the idea.Russia’s complex architecture of “power”Throughout this transformation, maintaining control of the elite – particularly of the siloviki – is key for Putin. A reshuffling and removal of senior officials in the Procuracy has seen Yury Chaika replaced as general prosecutor by Ivan Krasnov, previously a deputy chair of the Investigative Committee, which is widely seen as a rival structure in Russia’s complex architecture of “power” bodies.When considered alongside the constitutional changes giving the president broader powers in appointing regional prosecutors, this is textbook “divide and rule”. Power balancing is also on display with the Security Council, as the job description for Dmitry Medvedev’s new role as its deputy chair could provide fertile ground for clashes with the body’s secretary, Nikolai Patrushev.Pitting rival patronal networks against each other means Putin can keep rivals in check within the broader structure of the “Great Presidency”, while staying firmly in control himself.The prospect of Putin remaining president is unlikely to be popular. According to data from independent Russian polling agency the Levada Centre, only 27 per cent of Russians want Putin to stay in the post after 2024. This figure could, of course, change in either direction as the prospect becomes more real for Russians. But if Putin’s announcement galvanises mass opposition, the authorities may well use responses to the COVID-19 outbreak to keep protesters at bay – something already on display in Moscow.What this all means for Russia is that, despite the drama, considerable uncertainty remains following Putin’s announcement. What we can say for certain, however, is that it dashes hopes of serious political change any time soon. Full Article
rta The smell of new curtains By kolembo.wordpress.com Published On :: Sun, 23 Oct 2016 20:12:31 +0000 It came from the right side like God, or a deer, a Migraine warning; Chemotherapy strikes at any time. Where am I going wrong? Under community skies and red roofed buildings, immaculate And unfinished, Holding on for next week’s rent, Even if you were alive, I’d not have listened, Missing a father to say […] Full Article Poetry cancer friendship hope internet relationships love
rta Marvia Providence ‘Anointed’ for ministry - Offers ‘Bible pull up and come again’ entertainment to gospel audiences By jamaica-gleaner.com Published On :: Sun, 03 May 2020 00:23:57 -0500 Just the mention of the name Marvia Providence sends a tingle to the toes and, immediately, feet start tapping and bodies begin swaying. Before you know it, all the ‘warriors’ – prayer and otherwise – are in full flight. That’s the effect of the... Full Article
rta Is place of death important to patients? By feeds.bmj.com Published On :: Mon, 12 Oct 2015 13:41:39 +0000 The current orthodoxy is that home is the best and preferred place of death for most people, but in this podcast, Kristian Pollock a sociologist from Nottingham University questions these assumptions and calls for greater attention to improving the experience of dying in hospital and elsewhere. Read the full... Full Article
rta Unexpected findings, with uncertain implications, in research imaging By feeds.bmj.com Published On :: Fri, 13 Nov 2015 16:20:27 +0000 When healthy volunteers are scanned as part of a research project, unexpected findings, with uncertain implications, can be thrown up. Joanna Wardlaw, professor of applied neuroimaging and honorary consultant neuroradiologist at the University of Edinburgh, joins us to discuss how her group deals with these incidental findings, and what... Full Article
rta Nutritional science - Is quality more important than quantity? By feeds.bmj.com Published On :: Fri, 07 Sep 2018 17:39:13 +0000 We at The BMJ care about food, and if our listener stats are to be believed, so do you. In this podcast we’re looking at quality as an important driver of a good diet. At our recent food conference - Food For Thought - hosted in Zurich by Swiss Re we brought researchers in many fields of nutritional science together. We asked people with... Full Article
rta UK children are drinking less and the importance of a publicly provided NHS By feeds.bmj.com Published On :: Fri, 28 Sep 2018 18:36:43 +0000 Brits have a reputation as Europe’s boozers - and for good reason, with alcohol consumption higher than much of the rest of the continent. That reputation is extended to our young people too - but is it still deserved? Joanna Inchley, senior research fellow at the University of St Andrews, explains new research on decreasing drinking -... Full Article
rta What caused the drop in stroke mortality in the UK By feeds.bmj.com Published On :: Thu, 23 May 2019 10:12:07 +0000 Stroke mortality rates have been declining in almost every country, and that reduction could result from a decline in disease occurrence or a decline in case fatality, or both. Broadly - is that decline down to better treatment or better prevention. Olena Seminog, a researcher, and and Mike Rayner, professor of population health, both from the... Full Article
rta Physical activity and mortality - "The least active quartile did less than 5 minute per day" By feeds.bmj.com Published On :: Fri, 23 Aug 2019 14:29:32 +0000 We know that exercise is good for you - the WHO recommends at least 150 minutes of moderate intensity or 75 minutes of vigorous intensity aerobic physical activity each week. That recommendation is built on evidence that relied on self reporting that may underestimate the amount of lower intensity exercise those people were doing, and at the... Full Article
rta Brexit - Planning for medicine shortages By feeds.bmj.com Published On :: Fri, 13 Sep 2019 18:22:17 +0000 This week we saw the release of the much awaited Yellowhammer documents from the government, documents which outline some of the risks involved with Britain’s sudden departure from the EU. The documents themselves outline that there are risks to the supply of medicines - but do not set out the detail of how those risks have been mitigated, and... Full Article
rta David Williams - everyday discrimination is an independent predictor of mortality By feeds.bmj.com Published On :: Thu, 13 Feb 2020 12:44:12 +0000 There comes a tipping point in all campaigns when the evidence is overwhelming and the only way to proceed is with action. According to David Williams, it’s time to tackle the disproportionate effects of race on patients in the UK. David Williams, from Harvard University, developed the Everyday Discrimination Scale that, in 1997, launched a new... Full Article
rta Talk Evidence Covid-19 update - Confused symptoms, fatality rate uncertainty, Iceland's testing By feeds.bmj.com Published On :: Fri, 27 Mar 2020 16:14:17 +0000 For the next few months Talk Evidence is going to focus on the new corona virus pandemic. There is an enormous amount of uncertainty about the disease, what the symptoms are, fatality rate, treatment options, things we shouldn't be doing. We're going to try to get away from the headlines and talk about what we need to know - to hopefully give... Full Article
rta Morbidity and Mortality in Diabetics In the Framingham Population: Sixteen Year Follow-up Study By diabetes.diabetesjournals.org Published On :: 1974-02-01 Mariano J GarciaFeb 1, 1974; 23:105-111Original Contribution Full Article
rta Clinical and Molecular Prevalence of Lipodystrophy in an Unascertained Large Clinical Care Cohort By diabetes.diabetesjournals.org Published On :: 2020-01-20T12:00:26-08:00 Lipodystrophies are a group of disorders characterized by absence or loss of adipose tissue and abnormal fat distribution, commonly accompanied by metabolic dysregulation. Although considered rare disorders, their prevalence in the general population is not well understood. We aimed to evaluate the clinical and genetic prevalence of lipodystrophy disorders in a large clinical care cohort. We interrogated the electronic health record (EHR) information of >1.3 million adults from the Geisinger Health System for lipodystrophy diagnostic codes. We estimate a clinical prevalence of disease of 1 in 20,000 individuals. We performed genetic analyses in individuals with available genomic data to identify variants associated with inherited lipodystrophies and examined their EHR for comorbidities associated with lipodystrophy. We identified 16 individuals carrying the p.R482Q pathogenic variant in LMNA associated with Dunnigan familial partial lipodystrophy. Four had a clinical diagnosis of lipodystrophy, whereas the remaining had no documented clinical diagnosis despite having accompanying metabolic abnormalities. We observed a lipodystrophy-associated variant carrier frequency of 1 in 3,082 individuals in our cohort with substantial burden of metabolic dysregulation. We estimate a genetic prevalence of disease of ~1 in 7,000 in the general population. Partial lipodystrophy is an underdiagnosed condition. and its prevalence, as defined molecularly, is higher than previously reported. Genetically guided stratification of patients with common metabolic disorders, like diabetes and dyslipidemia, is an important step toward precision medicine. Full Article
rta Importance of creative industries By jamaica-gleaner.com Published On :: Sun, 05 Apr 2020 00:25:33 -0500 In 2020, when information is literally glued to our fingertips, technological innovations fill the stratosphere, the economy is reeling. Under the catastrophic effects of the coronavirus pandemic, one has no choice but to be creative – be creative... Full Article
rta Opioid agonist treatment and risk of mortality during opioid overdose public health emergency: population based retrospective cohort study By feeds.bmj.com Published On :: Tuesday, March 31, 2020 - 09:36 Full Article
rta Facing forex shortage, productive sector appeals to BOJ for help By jamaica-gleaner.com Published On :: Fri, 08 May 2020 00:17:12 -0500 WITH THE productive sector experiencing a shortage of foreign exchange for the past two months, the Jamaican Manufacturers and Exporters Association, JMEA, says it has appealed to the Bank of Jamaica, BOJ, for direct access to US currency for three... Full Article
rta RCP warns over shortage of stroke physicians By feeds.bmj.com Published On :: Tuesday, November 29, 2016 - 06:30 Full Article
rta Covid-19: UK death toll overtakes Italy’s to become worst in Europe By feeds.bmj.com Published On :: Wednesday, May 6, 2020 - 13:37 Full Article
rta Revving Up the Deportation Machinery: Enforcement under Trump and the Pushback By www.migrationpolicy.org Published On :: Tue, 24 Apr 2018 14:19:32 -0400 The Trump administration has significantly cranked up the immigration enforcement machinery in the U.S. interior. Yet even as arrests and deportations are up in the early Trump months, they remain less than half their peaks. This report demonstrates how pushback from California and other "sanctuary" locations makes it quite unlikely that ICE will be able to match record enforcement levels. Full Article
rta Targeted Enforcement: Projecting the Effects of Executive Action on Deportations By www.migrationpolicy.org Published On :: Thu, 23 Jul 2015 16:15:50 -0400 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. Full Article
rta Mortality Implications of Prediabetes and Diabetes in Older Adults By care.diabetesjournals.org Published On :: 2020-01-20T12:00:30-08:00 OBJECTIVE Diabetes in older age is heterogeneous, and the treatment approach varies by patient characteristics. We characterized the short-term all-cause and cardiovascular mortality risk associated with hyperglycemia in older age. RESEARCH DESIGN AND METHODS We included 5,791 older adults in the Atherosclerosis Risk in Communities Study who attended visit 5 (2011–2013; ages 66–90 years). We compared prediabetes (HbA1c 5.7% to <6.5%), newly diagnosed diabetes (HbA1c ≥6.5%, prior diagnosis <1 year, or taking antihyperglycemic medications <1 year), short-duration diabetes (duration ≥1 year but <10 years [median]), and long-standing diabetes (duration ≥10 years). Outcomes were all-cause and cardiovascular mortality (median follow-up of 5.6 years). RESULTS Participants were 58% female, and 24% had prevalent cardiovascular disease. All-cause mortality rates, per 1,000 person-years, were 21.2 (95% CI 18.7, 24.1) among those without diabetes, 23.7 (95% CI 20.8, 27.1) for those with prediabetes, 33.8 (95% CI 25.2, 45.5) among those with recently diagnosed diabetes, 29.6 (95% CI 25.0, 35.1) for those with diabetes of short duration, and 48.6 (95% CI 42.4, 55.7) for those with long-standing diabetes. Cardiovascular mortality rates, per 1,000 person-years, were 5.8 (95% CI 4.6, 7.4) among those without diabetes, 6.6 (95% CI 5.2, 8.5) for those with prediabetes, 11.5 (95% CI 7.0, 19.1) among those with recently diagnosed diabetes, 8.2 (95% CI 5.9, 11.3) for those with diabetes of short duration, and 17.3 (95% CI 13.8, 21.7) for those with long-standing diabetes. After adjustment for other cardiovascular risk factors, prediabetes and newly diagnosed diabetes were not significantly associated with a higher risk of all-cause mortality (hazard ratio [HR] 1.03 [95% CI 0.85, 1.23] and HR 1.31 [95% CI 0.94, 1.82], respectively) or cardiovascular mortality (HR 1.00 [95% CI 0.70, 1.43] and HR 1.35 [95% CI 0.74, 2.49], respectively). Excess mortality risk was primarily concentrated among those with long-standing diabetes (all-cause: HR 1.71 [95% CI 1.40, 2.10]; cardiovascular: HR 1.72 [95% CI 1.18, 2.51]). CONCLUSIONS In older adults, long-standing diabetes has a substantial and independent effect on short-term mortality. Older individuals with prediabetes remained at low mortality risk over a median 5.6 years of follow-up. Full Article
rta After Deportation, Some Congolese Returnees Face Detention and Extortion By www.migrationpolicy.org Published On :: Wed, 22 May 2019 17:22:03 -0400 This article explores post-deportation dynamics and challenges returnees face in the Democratic Republic of the Congo (DRC). Even as European countries focus on increasing returns of migrants deemed not to have a right to stay, little attention has been given to conditions at return—even to a country such as the DRC where allegations of serious human-rights violations against returned migrants have been reported for years. Full Article
rta Loss of Incretin Effect Is a Specific, Important, and Early Characteristic of Type 2 Diabetes By care.diabetesjournals.org Published On :: 2011-05-01 Jens J. HolstMay 1, 2011; 34:S251-S257Diabetes Treatments Full Article
rta Coronary Heart Disease Incidence and Cardiovascular Mortality in Busselton with Reference to Glucose and Insulin Concentrations By care.diabetesjournals.org Published On :: 1979-03-01 T A WelbornMar 1, 1979; 2:154-160Proceedings of the Kroc Foundation International Conference on Epidemiology of Diabetes and its Macrovascular Complications Full Article
rta Association of Urine Haptoglobin With Risk of All-Cause and Cause-Specific Mortality in Individuals With Type 2 Diabetes: A Transethnic Collaborative Work By care.diabetesjournals.org Published On :: 2020-02-20T11:55:30-08:00 OBJECTIVE Haptoglobin is an acute-phase reactant with pleiotropic functions. We aimed to study whether urine haptoglobin may predict risk of mortality in people with type 2 diabetes. RESEARCH DESIGN AND METHODS We employed a transethnic approach with a cohort of Asian origin (Singapore) (N = 2,061) and a cohort of European origin (France) (N = 1,438) included in the study. We used survival analyses to study the association of urine haptoglobin with risk of all-cause and cause-specific mortality. RESULTS A total of 365 and 525 deaths were registered in the Singapore cohort (median follow-up 7.5 years [interquartile range 3.5–12.8]) and French SURDIAGENE cohort (median follow-up 6.8 years [interquartile range 4.3–10.5], respectively. Singapore participants with urine haptoglobin in quartiles 2 to 4 had higher risk for all-cause mortality compared with quartile 1 (unadjusted hazard ratio [HR] 1.47 [95% CI 1.02–2.11], 2.28 [1.62–3.21], and 4.64 [3.39–6.35], respectively). The association remained significant in quartile 4 after multiple adjustments (1.68 [1.15–2.45]). Similarly, participants in the French cohort with haptoglobin in quartile 4 had significantly higher hazards for all-cause mortality compared with quartile 1 (unadjusted HR 2.67 [2.09–3.42] and adjusted HR 1.49 [1.14–1.96]). In both cohorts, participants in quartile 4 had a higher risk of mortality attributable to cardiovascular disease and infection but not malignant tumor. CONCLUSIONS Urine haptoglobin predicts risk of mortality independent of traditional risk factors, suggesting that it may potentially be a novel biomarker for risk of mortality in patients with type 2 diabetes. Full Article
rta Alliance of the ADA offers education, entertainment at Conference 2020 By www.ada.org Published On :: Tue, 21 Jan 2020 10:14:00 -0600 From courses on burnout, vaping and more to golf and a low-country boil, the Alliance of the American Dental Association's upcoming Conference 2020 in Charleston, South Carolina, will offer a variety of educational and entertainment opportunities. Full Article
rta ADA council affirms importance of code of ethics during COVID-19 pandemic By www.ada.org Published On :: Thu, 09 Apr 2020 14:34:00 -0500 The ADA Council on Ethics, Bylaws and Judicial Affairs’ ethics subcommittee authored an online essay as part of its Ethical Moment series in the May issue of The Journal of the American Dental Association, affirming that the ADA Principles of Ethics and Code of Professional Conduct is just as important as ever when making the difficult decisions they encounter on a daily basis. Full Article
rta ADA, recovery task force seek to address PPE shortages By www.ada.org Published On :: Wed, 22 Apr 2020 11:31:00 -0500 Association staff and members of the ADA Advisory Task Force on Dental Practice Recovery are aware and working diligently in addressing members’ concerns over the limited availability of certain personal protective equipment items. Full Article
rta Refineries, investors fear crude shortages over possible Venezuela sanctions By www.upi.com Published On :: Thu, 24 Jan 2019 10:54:11 -0500 An unexpected rise in U.S. crude inventories offset fears of potential risk to Venezuelan crude supply because of possible U.S. sanctions. Full Article
rta Patient portals need proxy options for better privacy protection, study finds By www.upi.com Published On :: Mon, 04 May 2020 15:27:49 -0400 More patient portals and electronic health records should enable users to create "proxy" accounts for nurses and home aids to prevent unintentional sharing of personal health details, researchers said Monday. Full Article
rta Performance of High-Sensitivity Cardiac Troponin Assays To Reflect Comorbidity Burden and Improve Mortality Risk Stratification in Older Adults With Diabetes By care.diabetesjournals.org Published On :: 2020-03-11T14:49:52-07:00 OBJECTIVEIncorporation of comorbidity burden to inform diabetes management in older adults remains challenging. High-sensitivity cardiac troponins are objective, quantifiable biomarkers that may improve risk monitoring in older adults. We assessed the associations of elevations in high-sensitivity cardiac troponin I (hs-cTnI) and T (hs-cTnT) with comorbidities and improvements in mortality risk stratification.RESEARCH DESIGN AND METHODSWe used logistic regression to examine associations of comorbidities with elevations in either troponin (≥85th percentile) among 1,835 participants in the Atherosclerosis Risk in Communities (ARIC) Study with diabetes (ages 67–89 years, 43% male, 31% black) at visit 5 (2011–2013). We used Cox models to compare associations of high cardiac troponins with mortality across comorbidity levels.RESULTSElevations in either troponin (≥9.4 ng/L for hs-cTnI, ≥25 ng/L for hs-cTnT) were associated with prevalent coronary heart disease, heart failure, chronic kidney disease, pulmonary disease, hypoglycemia, hypertension, dementia, and frailty. Over a median follow-up of 6.2 years (418 deaths), both high hs-cTnI and high hs-cTnT further stratified mortality risk beyond comorbidity levels; those with a high hs-cTnI or hs-cTnT and high comorbidity were at highest mortality risk. Even among those with low comorbidity, a high hs-cTnI (hazard ratio [HR] 3.0 [95% CI 1.7, 5.4]) or hs-cTnT (HR 3.3 [95% CI 1.8, 6.2]) was associated with elevated mortality. CONCLUSIONS Many comorbidities were reflected by both hs-cTnI and hs-cTnT; elevations in either of the troponins were associated with higher mortality risk beyond comorbidity burden. High-sensitivity cardiac troponins may identify older adults at high mortality risk and be useful in guiding clinical care of older adults with diabetes. Full Article
rta Continuous Glucose Monitoring in Pregnancy: Importance of Analysing Temporal Profiles to Understand Clinical Outcomes By care.diabetesjournals.org Published On :: 2020-03-24T15:44:44-07:00 OBJECTIVETo determine if temporal glucose profiles differed between 1) women who were randomized to real-time continuous glucose monitoring (RT-CGM) or self-monitored blood glucose (SMBG), 2) women who used insulin pumps or multiple daily insulin injections (MDIs), and 3) women whose infants were born large for gestational age (LGA) or not, by assessing CGM data obtained from the Continuous Glucose Monitoring in Women With Type 1 Diabetes in Pregnancy Trial (CONCEPTT).RESEARCH DESIGN AND METHODSStandard summary metrics and functional data analysis (FDA) were applied to CGM data from the CONCEPTT trial (RT-CGM, n = 100; SMBG, n = 100) taken at baseline and at 24- and 34-weeks gestation. Multivariable regression analysis determined if temporal differences in 24-h glucose profiles occurred between comparators in each of the three groups.RESULTSFDA revealed that women using RT-CGM had significantly lower glucose (0.4–0.8 mmol/L [7–14 mg/dL]) for 7 h/day (0800 h–1200 h and 1600 h–1900 h) compared with those with SMBG. Women using pumps had significantly higher glucose (0.4–0.9 mmol/L [7–16 mg/dL]) for 12 h/day (0300 h to 0600 h, 1300 h to 1800 h, and 2030 h to 0030 h) at 24 weeks with no difference at 34 weeks compared with MDI. Women who had an LGA infant ran a significantly higher glucose by 0.4–0.7 mmol/L (7–13 mg/dL) for 4.5 h/day at baseline; by 0.4–0.9 mmol/L (7–16 mg/dL) for 16 h/day at 24 weeks; and by 0.4–0.7 mmol/L (7–13 mg/dL) for 14 h/day at 34 weeks.CONCLUSIONSFDA of temporal glucose profiles gives important information about differences in glucose control and its timing, which are undetectable by standard summary metrics. Women using RT-CGM were able to achieve better daytime glucose control, reducing fetal exposure to maternal glucose. Full Article
rta Prognostic Significance of Long-term HbA1c Variability for All-Cause Mortality in the ACCORD Trial By care.diabetesjournals.org Published On :: 2020-03-30T13:26:58-07:00 OBJECTIVEThe association between high glycemic variability and all-cause mortality has been widely investigated in epidemiological studies but rarely validated in glucose-lowering clinical trials. We aimed to identify the prognostic significance of visit-to-visit HbA1c variability in treated patients in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial population.RESEARCH DESIGN AND METHODSWe studied the risk of all-cause mortality in relation to long-term visit-to-visit HbA1c variability, expressed as coefficient of variation (CV), variability independent of the mean (VIM), and average real variability (ARV), from the 8th month to the transition. Multivariable Cox proportional hazards models were used to estimate adjusted hazard ratio (HR) and 95% CI.RESULTSCompared with the standard therapy group (n = 4,728), the intensive therapy group (n = 4,755) had significantly lower mean HbA1c (6.6% [49 mmol/mol] vs. 7.7% [61 mmol/mol], P < 0.0001) and lower CV, VIM, and ARV (P < 0.0001). In multivariate adjusted analysis, all three HbA1c variability indices were significantly associated with total mortality in all patients as well as in the standard- and intensive-therapy groups analyzed separately. The hazard ratios for a 1-SD increase in HbA1c variability indices for the all-cause mortality were 1.19 and 1.23 in intensive and standard therapy, respectively. Cross-tabulation analysis showed the third tertile of HbA1c mean and VIM had significantly higher all-cause mortality (HR 2.05; 95% CI, 1.17–3.61; P < 0.01) only in the intensive-therapy group.CONCLUSIONSLong-term visit-to-visit HbA1c variability was a strong predictor of all-cause mortality. HbA1c VIM combined with HbA1c mean conferred an increased risk for all-cause mortality in the intensive-therapy group. Full Article
rta Risk of Major Adverse Cardiovascular Events, Severe Hypoglycemia, and All-Cause Mortality for Widely Used Antihyperglycemic Dual and Triple Therapies for Type 2 Diabetes Management: A Cohort Study of All Danish Users By care.diabetesjournals.org Published On :: 2020-04-01T06:54:34-07:00 OBJECTIVEThe vast number of antihyperglycemic medications and growing amount of evidence make clinical decision making difficult. The aim of this study was to investigate the safety of antihyperglycemic dual and triple therapies for type 2 diabetes management with respect to major adverse cardiovascular events, severe hypoglycemia, and all-cause mortality in a real-life clinical setting.RESEARCH DESIGN AND METHODSCox regression models were constructed to analyze 20 years of data from the Danish National Patient Registry with respect to effect of the antihyperglycemic therapies on the three end points.RESULTSA total of 66,807 people with type 2 diabetes were treated with metformin (MET) including a combination of second- and third-line therapies. People on MET plus sulfonylurea (SU) had the highest risk of all end points, except for severe hypoglycemia, for which people on MET plus basal insulin (BASAL) had a higher risk. The lowest risk of major adverse cardiovascular events was seen for people on a regimen including a glucagon-like peptide 1 (GLP-1) receptor agonist. People treated with MET, GLP-1, and BASAL had a lower risk of all three end points than people treated with MET and BASAL, especially for severe hypoglycemia. The lowest risk of all three end points was, in general, seen for people treated with MET, sodium–glucose cotransporter 2 inhibitor, and GLP-1.CONCLUSIONSFindings from this study do not support SU as the second-line treatment choice for patients with type 2 diabetes. Moreover, the results indicate that adding a GLP-1 for people treated with MET and BASAL could be considered, especially if those people suffer from severe hypoglycemia. Full Article
rta The Association of Energy and Macronutrient Intake at Dinner Versus Breakfast With Disease-Specific and All-Cause Mortality Among People With Diabetes: The U.S. National Health and Nutrition Examination Survey, 2003-2014 By care.diabetesjournals.org Published On :: 2020-04-30T07:25:50-07:00 OBJECTIVEThis study aims to evaluate the association of energy and macronutrient intake at dinner versus breakfast with disease-specific and all-cause mortality in people with diabetes.RESEARCH DESIGN AND METHODSA total of 4,699 people with diabetes who enrolled in the National Health and Nutrition Examination Survey from 2003 to 2014 were recruited for this study. Energy and macronutrient intake was measured by a 24-h dietary recall. The differences () in energy and macronutrient intake between dinner and breakfast ( = dinner – breakfast) were categorized into quintiles. Death information was obtained from the National Death Index until 2015. Cox proportional hazards regression models were developed to evaluate the survival relationship between and diabetes, cardiovascular disease (CVD), and all-cause mortality.RESULTSAmong the 4,699 participants, 913 deaths, including 269 deaths due to diabetes and 314 deaths due to CVD, were documented. After adjustment for potential confounders, compared with participants in the lowest quintile of in terms of total energy and protein, participants in the highest quintile were more likely to die due to diabetes (hazard ratio [HR]energy 1.92, 99% CI 1.08–3.42; HRprotein 1.92, 99% CI 1.06–3.49) and CVD (HRenergy 1.69, 99% CI 1.02–2.80; HRprotein 1.96, 99% CI 1.14–3.39). The highest quintile of total fat was related to CVD mortality (HR 1.67, 99% CI 1.01–2.76). Isocalorically replacing 5% of total energy at dinner with breakfast was associated with 4% and 5% lower risk of diabetes (HR 0.96, 95% CI 0.94–0.98) and CVD (HR 0.95, 95% CI 0.93–0.97) mortality, respectively.CONCLUSIONSHigher intake of energy, total fat, and protein from dinner than breakfast was associated with greater diabetes, CVD, and all-cause mortality in people with diabetes. Full Article
rta The Influence of Baseline Diastolic Blood Pressure on the Effects of Intensive Blood Pressure Lowering on Cardiovascular Outcomes and All-Cause Mortality in Type 2 Diabetes By care.diabetesjournals.org Published On :: 2020-05-04T10:48:32-07:00 OBJECTIVETo examine whether low baseline diastolic blood pressure (DBP) modifies the effects of intensive systolic blood pressure (SBP) lowering on cardiovascular outcomes in type 2 diabetes mellitus (T2DM).RESEARCH DESIGN AND METHODSThe Action to Control Cardiovascular Risk in Diabetes Blood Pressure trial (ACCORD BP), a two-by-two factorial randomized controlled trial, examined effects of SBP (<120 vs. <140 mmHg) and glycemic (HbA1c <6% vs. 7.0–7.9% [<42 vs. 53–63 mmol/mol]) control on cardiovascular events in T2DM (N = 4,731). We examined whether effects of SBP control on cardiovascular composite were modified by baseline DBP and glycemic control.RESULTSIntensive SBP lowering decreased the risk of the cardiovascular composite (hazard ratio [HR] 0.76 [95% CI 0.59–0.98]) in the standard glycemic arm but not in the intensive glycemic arm (HR 1.06 [95% CI 0.81–1.40]). Spline regression models relating the effects of the intervention on the cardiovascular composite across the range of baseline DBP did not show evidence of effect modification by low baseline DBP for the cardiovascular composite in the standard or intensive glycemic arms. The relation between the effect of the intensive SBP intervention and baseline DBP was similar between glycemic arms for the cardiovascular composite three-way interaction (P = 0.83).CONCLUSIONSIn persons with T2DM, intensive SBP lowering decreased the risk of cardiovascular composite end point irrespective of baseline DBP in the setting of standard glycemic control. Hence, low baseline DBP should not be an impediment to intensive SBP lowering in patients with T2DM treated with guidelines recommending standard glycemic control. Full Article
rta Record cold, snow overtakes northeastern U.S. By www.upi.com Published On :: Sat, 09 May 2020 09:50:22 -0400 Americans across a large portion of the Northeast are in the midst of an unusually late-season blast of Arctic air courtesy of the polar vortex. Full Article
rta Entertainer Roy Horn of Siegfried & Roy dies of COVID-19 complications at 75 By www.upi.com Published On :: Sat, 09 May 2020 08:39:06 -0400 German-born entertainer Roy Uwe Ludwig Horn, one half of the stage duo Siegfried & Roy, has died of complications from the coronavirus. He was 75. Full Article
rta How Can Parents Help Teach Generation Z Teens about Living in Uncertain Times? By psychcentral.com Published On :: Wed, 06 May 2020 10:30:09 +0000 The prolonged health and safety stressors of COVID-19 has many parents reaching out to mental health professionals with concern over their teenagers’ increased levels of anxiety. In the United States,... Full Article Children and Teens Parenting Child Development Coping Skills coronavirus COVID-19 Emotional Development pandemic Uncertainty
rta [ Law & Ethics ] Open Question : If a relict population of Neandertals were found to be living in a certain cave, on a certain remote island, or in a certain house on? By answers.yahoo.com Published On :: Sat, 09 May 2020 17:19:55 +0000 Pennsylvania Avenue, would placing some of them in zoos be unethical? Would they be considered human enough to receive human rights? Full Article
rta Reminders of Mortality Bring Out the Charitable Side By www.washingtonpost.com Published On :: Mon, 24 Dec 2007 00:00:00 EST Scrooge crept towards it, trembling as he went; and following the finger, read upon the stone of the neglected grave his own name, Ebenezer Scrooge . . . "Spirit!" he cried, tight clutching at its robe, "hear me! I am not the man I was. I will not be the man I must have been . . . " Full Article Opinions Reminders of Mortality Bring Out the Charitable Side
rta A Dose of Libertarian Paternalism By www.washingtonpost.com Published On :: Mon, 07 Apr 2008 00:00:00 EDT About 25 years ago, Cass Sunstein opened a retirement account that had two portfolios. One was mostly bonds, the other mostly stocks. Like many academics who use the TIAA-CREF investment program, Sunstein divided his money equally between stocks and bonds. Full Article Opinions A Dose of Libertarian Paternalism
rta Cracked Foundation, Uncertain Future: Structural Weaknesses in the Common European Asylum System By www.migrationpolicy.org Published On :: Fri, 16 Mar 2018 18:13:48 -0400 During the 2015–16 migration crisis, European asylum systems were stretched to a breaking point. Yet many of the structural issues that contributed to failures to register newcomers, insufficient reception capacity, and growing backlogs of asylum cases existed before—and many remain unresolved. This report critically evaluates Common European Asylum System legal and operational shortcomings at a time when reform is on the table. Full Article
rta Las puertas abiertas para los migrantes venezolanos y nicaragüenses en América Latina y el Caribe se cierran un poco a medida que aumenta la escala de los flujos y la presión en los servicios públicos By www.migrationpolicy.org Published On :: Mon, 10 Feb 2020 18:22:00 -0500 WASHINGTON – A pesar de que los gobiernos de América Latina y el Caribe han tomado medidas generosas e innovadoras para lidiar con el desplazamiento forzado desde Venezuela y más recientemente desde Nicaragua, la cálida bienvenida se ha enfriado en algunos lugares a medida que el número de entradas, la presión sobre los servicios públicos y la preocupación del público aumenta. Full Article
rta As U.S. Health Care System Sags under Strain of Pandemic, Immigrants and Refugees with Degrees in Health Care Could Serve as an Important Resource By www.migrationpolicy.org Published On :: Mon, 06 Apr 2020 22:39:48 -0400 WASHINGTON – Even as 1.5 million immigrants and refugees are already employed in the U.S. health care system as doctors, registered nurses and pharmacists, another 263,000 foreign-born health care graduates are on the sidelines during the COVID-19 pandemic—many of them because of difficulties getting their credentials accepted by employers and licensing bodies. Full Article
rta Global Demand for Medical Professionals Drives Indians Abroad Despite Acute Domestic Health-Care Worker Shortages By www.migrationpolicy.org Published On :: Tue, 21 Jan 2020 10:02:55 -0500 India is the world's largest source for immigrant physicians, and for Indian-trained doctors and nurses the allure of working abroad is strong despite an acute domestic shortage of health-care workers. Against this pull, the Indian government has enacted a number of policies to limit and regulate the emigration of health-care professionals, though these have been more ad hoc in nature and not part of a fully realized strategy. Full Article
rta ¿Se Están Cerrando las Puertas? Respuestas a la Migración Venezolana en América Latina y el Caribe By www.migrationpolicy.org Published On :: Mon, 03 Feb 2020 12:33:28 -0500 MPI llevó a cabo un seminario en línea para marcar el lanzamiento de: Un portal sobre Migración en América Latina y el Caribe; y un informe que examina los efectos de las políticas migratorias y de integración en 11 países en América Latina y el Caribe ante el aumento de la migración venezolana y nicaragüense. Full Article
rta Association of BMI, Fitness, and Mortality in Patients With Diabetes: Evaluating the Obesity Paradox in the Henry Ford Exercise Testing Project (FIT Project) Cohort By care.diabetesjournals.org Published On :: 2020-02-20T11:55:30-08:00 OBJECTIVE To determine the effect of fitness on the association between BMI and mortality among patients with diabetes. RESEARCH DESIGN AND METHODS We identified 8,528 patients with diabetes (self-report, medication use, or electronic medical record diagnosis) from the Henry Ford Exercise Testing Project (FIT Project). Patients with a BMI <18.5 kg/m2 or cancer were excluded. Fitness was measured as the METs achieved during a physician-referred treadmill stress test and categorized as low (<6), moderate (6–9.9), or high (≥10). Adjusted hazard ratios for mortality were calculated using standard BMI (kilograms per meter squared) cutoffs of normal (18.5–24.9), overweight (25–29.9), and obese (≥30). Adjusted splines centered at 22.5 kg/m2 were used to examine BMI as a continuous variable. RESULTS Patients had a mean age of 58 ± 11 years (49% women) with 1,319 deaths over a mean follow-up of 10.0 ± 4.1 years. Overall, obese patients had a 30% lower mortality hazard (P < 0.001) compared with normal-weight patients. In adjusted spline modeling, higher BMI as a continuous variable was predominantly associated with a lower mortality risk in the lowest fitness group and among patients with moderate fitness and BMI ≥30 kg/m2. Compared with the lowest fitness group, patients with higher fitness had an ~50% (6–9.9 METs) and 70% (≥10 METs) lower mortality hazard regardless of BMI (P < 0.001). CONCLUSIONS Among patients with diabetes, the obesity paradox was less pronounced for patients with the highest fitness level, and these patients also had the lowest risk of mortality. Full Article
