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The Green Knowe Books & Multiculturalism in Children's Literature

Recently while listening to WNYC, I heard a segment about the lack of diversity in children's literature. While the US's population is becoming more diverse, it is apparently not reflected in children's books. Lucy Maria Boston was a head of the curve since four of the Green Knowe books could be regarded as multicultural since they contain not only Asian and African main characters but also a physically disabled character and deal with the issues of slavery and exile due to war.

Ping, a young refugee from Burma, is the main human character in A Stranger at Greene Knowe and a supporting character in The River at Green Knowe and An Enemy at Green Knowe. Ping has spent most of his life in a hostel for displaced children and goes to stay at Green Knowe during his summer holiday. He is eventually asked by Mrs. Oldknow to live with her and Tolly at Green Knowe. His experiences as a homeless child trapped in the grey world of the London home cause him to appreciate not only the natural world around the house but also to empathize with the escaped gorilla, Hanno. Boston wanted to dedicate Stranger to a gorilla keeper that she knew but was forbidden to do so by the zoo since it portrayed captivity for animals as cruel and harmful to the animal. When Green Knowe is under siege from evil in Enemy, Ping calls back Hanno with a traditional prayer to help save the house.

Jacob, in Treasure at Green Knowe, is bought as a child in a slave auction by Captain Oldknowe as a companion for the Captain's blind daughter, Susan. Susan's mother is uninterested in Susan since she views her as an unmarriageable burden. Susan's blindness puts her outside of the normal constraints for an upper-class girl so she can spend her time climbing trees with Jacob and learning how to write with him and their tutor Jonathan. Susan's brother Sefton views Jacob as less than human, buying him clothes patterned on those of an organ-grinder's monkey. Both Jacob and Susan rely on each other to navigate the rules of a society that views them as worthless because of their respective race and disability. They work together to educate themselves and lead successful adult lives despite their differences in race, sex, and station.

Despite the fifty or so years since they were written, the books still hold up due to the quality of the writing, the strong characterizations, and the universal themes. They are well-worth being placed on any reading list, multicultural or not. Good children's books should be read whether or not they are written by US authors.




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Discipline and Punish, by Michel Foucault


Discipline and Punish (1975), is a genealogy of power based on particulars of penal history, and is considered Foucault’s “out-of-the-ordinary,” “intellectually charismatic,” and “soundly subversive” work, in which he also reveals his passionate empathy for the disenfranchised and the dispossessed, and a desire to trace the overt and covert networks of power, which underlie modern societies. Highly interdisciplinary and thought-provoking in its content, the book is at once a work of history, sociology, philosophy, penology, legal analysis and cultural criticism, therby making it difficult to categorize in any given literature or tradition.
Foucault, who is hailed as a “theorist of paradox” by highly acclaimed critics, was influenced by some of the greatest European philosophers such as Maurice Merleau-Ponty, Jean Beaufret—Martin Heidegger’s major interpreter in France—and Louis Althusser. He earned his License de philosophie in 1948 and Diplôme de psycho-pathologie in 1952, and taught in Sweden, Poland, and Germany before his appointment as the head of the philosophy department at the University of Clermont-Ferrand. The range of his creative (and massively subversive) thought knows no bounds but throughout his many studies, on subjects as varied as madness, medicine, modern discourse, sexuality, there is a definite tendency to reverse “taken-for-granted” understandings and to discover, not unlike Freud, the latent behind the manifest--especially when it come to the nature of power and its pervasive effects in the human condition.
Moreover, Foucault in his major works, has undertaken a sustained assault upon what he regards as the myths of "the Enlightenment," "Reason," "science," "freedom," "justice," and "democracy"--all these salient features of modern civilization, and has exposed their “hidden side.” Foucault has also argued that the hidden side usually stays hidden because the “production of discourse” in modern societies is controlled, selected, and organized according to certain behind-the-scenes procedures. He suggests that when an idea appears before us repeatedly through different modalities, we are unaware of the prodigious machinery behind, which is diligently doing discourse selection and dissemination.
To make sense of this incredibly crucial work for our times, please join us at Brooklyn Book Talk and share your views about matters of power and punishment, and their subtle manifestations, which ought to concern us all, if we are to leave this world a little better than the way we found it.




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Expansion of legal migration opportunities for third-country nationals, particularly in middle- and low-skill sectors, holds potential but should not be oversold as migration management tool, new study cautions

BRUSSELS — While the European Union has called on Member States to expand channels for foreign workers as a way to meet labour market needs and potentially tackle spontaneous migration, they have struggled to deliver on this pledge. To date, policies have focused more on attracting high-skilled workers, but less attention has been paid to admission of low- or middle-skilled nationals. Policymakers would do well not to overestimate the potential of legal channels to reduce irregular migration.




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Thoughtful Investments Are Needed to Effectively Engage Volunteers in Refugee Integration

WASHINGTON — Rapid arrivals of humanitarian migrants in Europe and North America have been matched by an equally unprecedented outpouring of public support. As offers to volunteer and donate pour in, many have asked whether this generosity can be harnessed to ease pressures on overburdened receiving communities and service providers. But using volunteers to meet the longer-term integration needs of resettled refugees and recognized asylum seekers is not an automatic salve: it requires thoughtful training and investment to be effective.




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What Should Successful Integration Look Like for Vulnerable Newcomers?

WASHINGTON — As host countries in Europe, North America and beyond prioritize getting refugees and other newly arrived migrants into work, another challenge has received less attention: Helping those who may never find jobs participate meaningfully in their new communities. Newcomers who are not in the workplace (particularly refugee women, migrants who are unskilled or illiterate and the elderly) are at high risk for social isolation.




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MPI Estimates No More than 167,000 Non-Citizens Could Be Ineligible for Green Cards Based on Current Public Benefits Use

WASHINGTON – While the new Trump administration public charge rule is likely to vastly reshape future legal immigration based on its test to assess if a person might ever use public benefits in the future, the universe of non-citizens who could be denied a green card based on current benefits use is quite small.




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Immigrant Workers Are Vital to the U.S. Coronavirus Pandemic Response, But Disproportionately Vulnerable

WASHINGTON — Six million immigrant workers are at the frontlines of keeping U.S. residents healthy, safe and fed during the COVID-19 pandemic, according to a Migration Policy Institute (MPI) analysis of U.S. Census Bureau data issued today. While the foreign born represented 17 percent of the 156 million civilians working in 2018, they account for larger shares in pandemic-response frontline occupations: 29 percent of all physicians in the United States, 38 percent of home health aides and 23 percent of retail-store pharmacists, for example.




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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

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.




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Moroccan chicken skewers with feta, pea and tomato tabbouleh

1 onion, grated 1 cup Greek yoghurt 1/2 cup olive oil 1/2 lemon, juiced 2 cloves of garlic, crushed 1 tsp. smoked paprika 1/2 tsps. ground coriander 1/2 tsps. ground cumin 500g chicken thighs, cut in to 3 cm pieces 2 tbsps. sesame seeds, toasted tabbouleh 100g burghul 2 1/2 cups frozen peas 1 handful of flat leaf parsley, chopped 1 punnit of cherry tomatoes, halved 1 handful of mint leaves, lightly chopped 3 shallots, thinly sliced 200g Greek feta, crumbled 1/3 cup olive oil 1/2 lemon, juiced 1/2 tsp. ground cinnamon Good pinch of sea salt flakes and black pepper




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Julie's Coconut Cake

This recipe was featured on Foodie Tuesday, a weekly segment with Raf Epstein on Drive, 774 ABC Melbourne, 3:30 PM, courtesy of Julie Goodwin. Julie's new book is "Homemade Takeaway."




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Dulche de Leche

This delicious Argentinian confection (also known as Spanish Caramel/milk jam) is a thick caramel milk-based sauce to die for and is so easy to make at home. Use as a filling for tartlets or cakes, serve over ice cream, as a filling for crepes, as a sauce over baked pears or apples or simply eat from a spoon!




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Garden peas, cauliflower, almonds, lemon

This recipe was featured on Foodie Tuesday, a weekly segment with Raf Epstein on Drive, 774 ABC Melbourne, 3:30 PM, courtesy of George Calombaris. George's new book is called "Greek."




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Cassoulet

This recipe features on Foodie Tuesday, a weekly segment with Raf Epstein on Drive, 774 ABC Melbourne, 3.30PM, courtesy of Annie Smithers from du Fermier, a wonderful French farmhouse style kitchen in Trentham.




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Slow-cooked pork shoulder with apples and crackling

This recipe features on Foodie Tuesday, a weekly segment on 774 Drive with Raf Epstein, 3.30PM, courtesy of Justine Schofield. Justine's latest book is "Dinner With Justine".




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Greek cauliflower with a minted maple and tamarind sauce

150g panko crumbs 1 clove of crushed garlic 1 tsp. ground ginger 2 tsps. curry powder 1 tsp. ground cumin 2 tsps. ground coriander 1 tsp. black mustard seeds 1 tsp. chilli flakes 2 tsps. caster sugar Pinch of salt 3 free range eggs, beaten 100g plain flour with a pinch of salt 1 cauliflower, broken in to small florets Sunflower oil for deep frying Sauce: Handful of chopped parsley Handful of chopped coriander leaves Handful of chopped mint leaves 1 tbsp. tamarind paste 1 tsp. maple syrup 1 tbsp. olive oil 2 tsps. lime juice Pinch of salt 2 tbsps. water




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Citrus cured salmon, pickled clams, herb emulsion

This recipe features on Foodie Tuesday, a weekly segment on 774 Drive with Raf Epstein, 3.30PM, courtesy of David Hall of Pure South Dining.




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CAULIFLOWER PAKORAS WITH MINTED YOGURT

These tasty little Indian Fritters will convert a body who has a dislike of cauliflower. Served simply with a minty yogurt they are simply delicious.




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Indian mango kulfi with maple, oat and ginger crumb

Mango kulfi: 1 cup condensed milk 60g butter 1 tsp. vanilla extract 250 ml (1 cup) mango puree, frozen mangos are fine Oat-ginger crumb: 1/2 cup coconut oil 20g butter 125 ml 1/2 cup maple syrup 90 g (1 cup) rolled oats 1 tbsp. ground ginger 1/4 cup desiccated coconut




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Indian cauliflower rice and coriander pesto

Cauliflower rice: 1 head cauliflower, cut into florets 2 tbsps. ghee Coriander pesto: 1 large bunch coriander 1 garlic clove 1/4 cup cashews 2 tbsps. parmesan, finely grated 1 lime, zested and juiced 3 tbsps. coconut oil




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COVID-19 in Latin America: Tackling Health Care & Other Impacts for Vulnerable Migrant Populations

This MPI webinar brought together public health and migration experts to analyze the impact that COVID-19 preventative measures will have on vulnerable immigrants and refugees in Latin America, with a particular look at Colombia as a case study. Speakers also discussed how policymakers and international organizations can include migrant populations in their emergency response plans.




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Lucky Spurs hold off Fulham

Tottenham Hotspur has survived a late onslaught to earn a somewhat fortunate 3-1 win at London rival Fulham and remain fifth in the English Premier League standings.




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Myocardial Ischemic Burden and Differences in Prognosis Among Patients With and Without Diabetes: Results From the Multicenter International REFINE SPECT Registry

OBJECTIVE

Prevalence and prognostic impact of cardiovascular disease differ between patients with or without diabetes. We aimed to explore differences in the prevalence and prognosis of myocardial ischemia by automated quantification of total perfusion deficit (TPD) among patients with and without diabetes.

RESEARCH DESIGN AND METHODS

Of 20,418 individuals who underwent single-photon emission computed tomography myocardial perfusion imaging, 2,951 patients with diabetes were matched to 2,951 patients without diabetes based on risk factors using propensity score. TPD was categorized as TPD = 0%, 0% < TPD < 1%, 1% ≤ TPD < 5%, 5% ≤ TPD ≤ 10%, and TPD >10%. Major adverse cardiovascular events (MACE) were defined as a composite of all-cause mortality, myocardial infarction, unstable angina, or late revascularization.

RESULTS

MACE risk was increased in patients with diabetes compared with patients without diabetes at each level of TPD above 0 (P < 0.001 for interaction). In patients with TPD >10%, patients with diabetes had greater than twice the MACE risk compared with patients without diabetes (annualized MACE rate 9.4 [95% CI 6.7–11.6] and 3.9 [95% CI 2.8–5.6], respectively, P < 0.001). Patients with diabetes with even very minimal TPD (0% < TPD < 1%) experienced a higher risk for MACE than those with 0% TPD (hazard ratio 2.05 [95% CI 1.21–3.47], P = 0.007). Patients with diabetes with a TPD of 0.5% had a similar MACE risk as patients without diabetes with a TPD of 8%.

CONCLUSIONS

For every level of TPD >0%, even a very minimal deficit of 0% < TPD < 1%, the MACE risk was higher in the patients with diabetes compared with patients without diabetes. Patients with diabetes with minimal ischemia had comparable MACE risk as patients without diabetes with significant ischemia.




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Microvascular and Cardiovascular Outcomes According to Renal Function in Patients Treated With Once-Weekly Exenatide: Insights From the EXSCEL Trial

OBJECTIVE

To evaluate the impact of once-weekly exenatide (EQW) on microvascular and cardiovascular (CV) outcomes by baseline renal function in the Exenatide Study of Cardiovascular Event Lowering (EXSCEL).

RESEARCH DESIGN AND METHODS

Least squares mean difference (LSMD) in estimated glomerular filtration rate (eGFR) from baseline between the EQW and placebo groups was calculated for 13,844 participants. Cox regression models were used to estimate effects by group on incident macroalbuminuria, retinopathy, and major adverse CV events (MACE). Interval-censored time-to-event models estimated effects on renal composite 1 (40% eGFR decline, renal replacement, or renal death) and renal composite 2 (composite 1 variables plus macroalbuminuria).

RESULTS

EQW did not change eGFR significantly (LSMD 0.21 mL/min/1.73 m2 [95% CI –0.27 to 0.70]). Macroalbuminuria occurred in 2.2% of patients in the EQW group and in 2.5% of those in the placebo group (hazard ratio [HR] 0.87 [95% CI 0.70–1.07]). Neither renal composite was reduced with EQW in unadjusted analyses, but renal composite 2 was reduced after adjustment (HR 0.85 [95% CI 0.74–0.98]). Retinopathy rates did not differ by treatment group or in the HbA1c-lowering or prior retinopathy subgroups. CV outcomes in those with eGFR <60 mL/min/1.73 m2 did not differ by group. Those with eGFR ≥60 mL/min/1.73 m2 had nominal risk reductions for MACE, all-cause mortality, and CV death, but interactions by renal function group were significant for only stroke (HR 0.74 [95% CI 0.58–0.93]; P for interaction = 0.035) and CV death (HR 1.08 [95% CI 0.85–1.38]; P for interaction = 0.031).

CONCLUSIONS

EQW had no impact on unadjusted retinopathy or renal outcomes. CV risk was modestly reduced only in those with eGFR ≥60 mL/min/1.73 m2 in analyses unadjusted for multiplicity.




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Glycated Hemoglobin, Prediabetes, and the Links to Cardiovascular Disease: Data From UK Biobank

OBJECTIVE

HbA1c levels are increasingly measured in screening for diabetes; we investigated whether HbA1c may simultaneously improve cardiovascular disease (CVD) risk assessment, using QRISK3, American College of Cardiology/American Heart Association (ACC/AHA), and Systematic COronary Risk Evaluation (SCORE) scoring systems.

RESEARCH DESIGN AND METHODS

UK Biobank participants without baseline CVD or known diabetes (n = 357,833) were included. Associations of HbA1c with CVD was assessed using Cox models adjusting for classical risk factors. Predictive utility was determined by the C-index and net reclassification index (NRI). A separate analysis was conducted in 16,596 participants with known baseline diabetes.

RESULTS

Incident fatal or nonfatal CVD, as defined in the QRISK3 prediction model, occurred in 12,877 participants over 8.9 years. Of participants, 3.3% (n = 11,665) had prediabetes (42.0–47.9 mmol/mol [6.0–6.4%]) and 0.7% (n = 2,573) had undiagnosed diabetes (≥48.0 mmol/mol [≥6.5%]). In unadjusted models, compared with the reference group (<42.0 mmol/mol [<6.0%]), those with prediabetes and undiagnosed diabetes were at higher CVD risk: hazard ratio (HR) 1.83 (95% CI 1.69–1.97) and 2.26 (95% CI 1.96–2.60), respectively. After adjustment for classical risk factors, these attenuated to HR 1.11 (95% CI 1.03–1.20) and 1.20 (1.04–1.38), respectively. Adding HbA1c to the QRISK3 CVD risk prediction model (C-index 0.7392) yielded a small improvement in discrimination (C-index increase of 0.0004 [95% CI 0.0001–0.0007]). The NRI showed no improvement. Results were similar for models based on the ACC/AHA and SCORE risk models.

CONCLUSIONS

The near twofold higher unadjusted risk for CVD in people with prediabetes is driven mainly by abnormal levels of conventional CVD risk factors. While HbA1c adds minimally to cardiovascular risk prediction, those with prediabetes should have their conventional cardiovascular risk factors appropriately measured and managed.




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Visit-to-Visit HbA1c Variability Is Associated With Cardiovascular Disease and Microvascular Complications in Patients With Newly Diagnosed Type 2 Diabetes

OBJECTIVE

To investigate the association between visit-to-visit HbA1c variability and cardiovascular events and microvascular complications in patients with newly diagnosed type 2 diabetes.

RESEARCH DESIGN AND METHODS

This retrospective cohort study analyzed patients from Tayside and Fife in the Scottish Care Information–Diabetes Collaboration (SCI-DC) who were observable from the diagnosis of diabetes and had at least five HbA1c measurements before the outcomes were evaluated. We used the previously reported HbA1c variability score (HVS), calculated as the percentage of the number of changes in HbA1c >0.5% (5.5 mmol/mol) among all HbA1c measurements within an individual. The association between HVS and 10 outcomes was assessed using Cox proportional hazards models.

RESULTS

We included 13,111–19,883 patients in the analyses of each outcome. The patients with HVS >60% were associated with elevated risks of all outcomes compared with the lowest quintile (for example, HVS >80 to ≤100 vs. HVS ≥0 to ≤20, hazard ratio 2.38 [95% CI 1.61–3.53] for major adverse cardiovascular events, 2.4 [1.72–3.33] for all-cause mortality, 2.4 [1.13–5.11] for atherosclerotic cardiovascular death, 2.63 [1.81–3.84] for coronary artery disease, 2.04 [1.12–3.73] for ischemic stroke, 3.23 [1.76–5.93] for heart failure, 7.4 [3.84–14.27] for diabetic retinopathy, 3.07 [2.23–4.22] for diabetic peripheral neuropathy, 5.24 [2.61–10.49] for diabetic foot ulcer, and 3.49 [2.47–4.95] for new-onset chronic kidney disease). Four sensitivity analyses, including adjustment for time-weighted average HbA1c, confirmed the robustness of the results.

CONCLUSIONS

Our study shows that higher HbA1c variability is associated with increased risks of all-cause mortality, cardiovascular events, and microvascular complications of diabetes independently of high HbA1c.




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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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Impact of Glucose Level on Micro- and Macrovascular Disease in the General Population: A Mendelian Randomization Study

OBJECTIVE

To evaluate whether high glucose levels in the normoglycemic range and higher have a causal genetic effect on risk of retinopathy, neuropathy, nephropathy, chronic kidney disease (CKD), peripheral arterial disease (PAD), and myocardial infarction (MI; positive control) in the general population.

RESEARCH DESIGN AND METHODS

This study applied observational and one-sample Mendelian randomization (MR) analyses to individual-level data from 117,193 Danish individuals, and validation by two-sample MR analyses on summary-level data from 133,010 individuals from the Meta-Analyses of Glucose and Insulin-Related Traits Consortium (MAGIC), 117,165 from the CKDGen Consortium, and 452,264 from the UK Biobank.

RESULTS

Observationally, glucose levels in the normoglycemic range and higher were associated with high risks of retinopathy, neuropathy, diabetic nephropathy, PAD, and MI (all P for trend <0.001). In genetic causal analyses, the risk ratio for a 1 mmol/L higher glucose level was 2.01 (95% CI 1.18–3.41) for retinopathy, 2.15 (1.38–3.35) for neuropathy, 1.58 (1.04–2.40) for diabetic nephropathy, 0.97 (0.84–1.12) for estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2, 1.19 (0.90–1.58) for PAD, and 1.49 (1.02–2.17) for MI. Summary-level data from the MAGIC, the CKDGen Consortium, and the UK Biobank gave a genetic risk ratio of 4.55 (95% CI 2.26–9.15) for retinopathy, 1.48 (0.83–2.66) for peripheral neuropathy, 0.98 (0.94–1.01) for eGFR <60 mL/min/1.73 m2, and 1.23 (0.57–2.67) for PAD per 1 mmol/L higher glucose level.

CONCLUSIONS

Glucose levels in the normoglycemic range and higher were prospectively associated with a high risk of retinopathy, neuropathy, diabetic nephropathy, eGFR <60 mL/min/1.73 m2, PAD, and MI. These associations were confirmed in genetic causal analyses for retinopathy, neuropathy, diabetic nephropathy, and MI, but they could not be confirmed for PAD and seemed to be refuted for eGFR <60 mL/min/1.73 m2.




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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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Effects of Bariatric Surgery in Early- and Adult-Onset Obesity in the Prospective Controlled Swedish Obese Subjects Study

OBJECTIVE

Bariatric surgery is an effective treatment for obesity, but it is unknown if outcomes differ between adults with early- versus adult-onset obesity. We investigated how obesity status at 20 years of age affects outcomes after bariatric surgery later in life.

RESEARCH DESIGN AND METHODS

The Swedish Obese Subjects study is a prospective matched study performed at 25 surgical departments and 480 primary health care centers. Participants aged 37–60 years with BMI ≥34 kg/m2 (men) or ≥38 kg/m2 (women) were recruited between 1987 and 2001; 2,007 participants received bariatric surgery and 2,040 usual care. Self-reported body weight at 20 years of age was used to stratify patients into subgroups with normal BMI (<25 kg/m2), overweight (BMI 25–29.9 kg/m2), or obesity (BMI ≥30 kg/m2). Body weight, energy intake, and type 2 diabetes status were examined over 10 years, and incidence of cardiovascular and microvascular disease was determined over up to 26 years using data from health registers.

RESULTS

There were small but statistically significant differences in reduction of body weight among the subgroups after bariatric surgery (interaction P = 0.032), with the largest reductions among those with obesity aged 20 years. Bariatric surgery increased type 2 diabetes remission (odds ratios 4.51, 4.90, and 5.58 in subgroups with normal BMI, overweight, or obesity at 20 years of age, respectively; interaction P = 0.951), reduced type 2 diabetes incidence (odds ratios 0.15, 0.13, and 0.15, respectively; interaction P = 0.972), and reduced microvascular complications independent of obesity status at 20 years of age (interaction P = 0.650). The association between bariatric surgery and cardiovascular disease was similar in the subgroups (interaction P = 0.674). Surgical complications were similar in the subgroups.

CONCLUSIONS

The treatment benefits of bariatric surgery in adults are similar regardless of obesity status at 20 years of age.




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Inoreader mobile apps updated to support Automatic Night Mode, Microblogs, Sort by Magic and popularity indicators.

Hey, it’s been quite some time without updates on this front, but our latest updates to our Android and iOS…




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Effects of MK-0941, a Novel Glucokinase Activator, on Glycemic Control in Insulin-Treated Patients With Type 2 Diabetes

OBJECTIVE

To assess the efficacy and safety of MK-0941, a glucokinase activator (GKA), when added to stable-dose insulin glargine in patients with type 2 diabetes.

RESEARCH DESIGN AND METHODS

In this double-blind study, 587 patients taking stable-dose insulin glargine (±metformin ≥1,500 mg/day) were randomized (1:1:1:1:1) to MK-0941 10, 20, 30, or 40 mg or matching placebo t.i.d. before meals (a.c.). This study included an initial 14-week, dose-ranging phase followed by a 40-week treatment phase during which patients were to be uptitrated as tolerated to 40 mg (or placebo) t.i.d. a.c. The primary efficacy end point was change from baseline in A1C at Week 14.

RESULTS

At Week 14, A1C and 2-h postmeal glucose (PMG) improved significantly versus placebo with all MK-0941 doses. Maximal placebo-adjusted least squares mean changes from baseline in A1C (baseline A1C 9.0%) and 2-h PMG were –0.8% and –37 mg/dL (–2 mmol/L), respectively. No significant effects on fasting plasma glucose were observed at any dose versus placebo. By 30 weeks, the initial glycemic responses noted at 14 weeks were not sustained. MK-0941 at one or more doses was associated with significant increases in the incidence of hypoglycemia, triglycerides, systolic blood pressure, and proportion of patients meeting criteria for predefined limits of change for increased diastolic blood pressure.

CONCLUSIONS

In patients receiving stable-dose insulin glargine, the GKA MK-0941 led to improvements in glycemic control that were not sustained. MK-0941 was associated with an increased incidence of hypoglycemia and elevations in triglycerides and blood pressure.




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COVID-19 in Latin America: Tackling Health Care &amp; Other Impacts for Vulnerable Migrant Populations

This MPI webinar brought together public health and migration experts to analyze the impact that COVID-19 preventative measures will have on vulnerable immigrants and refugees in Colombia and Latin America. Speakers also discussed how policymakers and international organizations can include migrant populations in their emergency response plans.




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In the Age of Trump: Populist Backlash and Progressive Resistance Create Divergent State Immigrant Integration Contexts

As long-simmering passions related to federal immigration policies have come to a full boil, less noted but no less important debates are taking place at state and local levels with regards to policies affecting immigrants and their children. As states are increasingly diverging in their responses, this report examines how some of the key policies and programs that support long-term integration success are faring in this volatile era.




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Chilling Effects: The Expected Public Charge Rule and Its Impact on Legal Immigrant Families’ Public Benefits Use

According to leaked drafts, the Trump administration is considering a rule that could have sweeping effects on both legal immigration to the United States and the use of public benefits by legal immigrants and their families. This report examines the potential scale of the expected rule’s impact, including at national and state levels and among children, as well as Hispanic and Asian American/Pacific Islander immigrants.




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Chilling Effects: The Expected Public-Charge Rule and Its Impact on Immigrant Families

This webinar highlights findings from an MPI report examining the potential impacts of expected changes to the public charge rule by the Trump administration. Leaked draft versions suggest the rule could sharply expand the number of legally present noncitizens facing difficulty getting a green card or extending a visa as a result of their family's use of public benefits. The rule likely would discourage millions from accessing health, nutrition, and social services for which they or their U.S.-citizen dependents are eligible.




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Through the Back Door: Remaking the Immigration System via the Expected “Public-Charge” Rule

A Trump administration “public-charge” rule expected to be unveiled soon could create the potential to significantly reshape family-based legal immigration to the United States—and reduce arrivals from Asia, Latin America, and Africa—by imposing a de facto financial test that 40 percent of the U.S. born themselves would fail, as this commentary explains.




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Millions Will Feel Chilling Effects of U.S. Public-Charge Rule That Is Also Likely to Reshape Legal Immigration

The public-charge rule issued by the Trump administration in August 2019 will have profound effects on future immigration and on use of public benefits by millions of legal noncitizens and their U.S.-citizen family members. Complex standards for determining when an immigrant is likely to become a public charge could cause a significant share of the nearly 23 million noncitizens and U.S. citizens in benefits-using immigrant families to disenroll, as this commentary explains.




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Health Insurance Test for Green-Card Applicants Could Sharply Cut Future U.S. Legal Immigration

A new Trump administration action requiring intending immigrants to prove they can purchase eligible health insurance within 30 days of arrival has the potential to block fully 65 percent of those who apply for a green card from abroad, MPI estimates.




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Green Cards and Public Charge: Who Could Be Denied Based on Benefits Use?

On this webinar MPI experts discuss their estimates of the populations that could be deemed ineligible for a green card based on existing benefits use. They also discuss the broader consequences of the public-charge rule implemented in February 2020, through its "chilling effects" and imposition of a wealth test aimed at assessing whether green-card applicants ever would be likely to use a public benefit in the future. 




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The Public-Charge Rule: Broad Impacts, But Few Will Be Denied Green Cards Based on Actual Benefits Use

While the Trump administration public-charge rule is likely to vastly reshape legal immigration based on its test to assess if a person might ever use public benefits in the future, the universe of noncitizens who could be denied a green card based on current benefits use is quite small. That's because very few benefit programs are open to noncitizens who do not hold a green card. This commentary offers estimates of who might be affected.




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Green Cards and Public Charge: Who Could Be Denied Based on Benefits Use?

On this webinar, MPI experts discussed the public-charge rule and released estimates of the populations that could be deemed ineligible for a green card based on existing benefits use. They examined the far larger consequences of the rule, through its "chilling effects" and imposition of a test aimed at assessing whether green-card applicants are likely to ever use a public benefit in the future. And they discussed how the latter holds the potential to reshape legal immigration to the United States. 




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As U.S. Health-Care System Buckles under Pandemic, Immigrant &amp; Refugee Professionals Could Represent a Critical Resource

In a time of critical shortages of U.S. health-care workers during the COVID-19 pandemic, retired doctors are being called back to work and medical students are graduating on a fast track. There is another important pool that could be tapped: Immigrants and refugees who have college degrees in health fields but are working in low-skilled jobs or out of work. MPI estimates 263,000 immigrants are experiencing skill underutilization and could be a valuable resource.




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Can a Company be pro-regulation and pro-commerce? Gregg Renfrew from Beautycounter thinks so

It’s the middle of an election year and, according to the Pew Research Center, the country hasn’t been this polarized since the Civil War. In such a climate, it would seem to be an oxymoron for a company to push for both financial growth and tighter regulations. Gregg Renfrew, CEO & Founder of Beautycounter, wouldn’t […]




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Musculoskeletal Complications of Diabetes Mellitus

Rachel Peterson Kim
Jul 1, 2001; 19:
Practical Pointers




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Evaluating the Effect of U-500 Insulin Therapy on Glycemic Control in Veterans With Type 2 Diabetes

Joseph A. Granata
Jan 1, 2015; 33:14-19
Feature Articles




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Gestational Diabetes in High-Risk Populations

Wilfred Fujimoto
Apr 1, 2013; 31:90-94
Diabetes Advocacy




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Clarifying the Role of Insulin in Type 2 Diabetes Management

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




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Insulin Strategies for Primary Care Providers

Karen L. Herbst
Jan 1, 2002; 20:
Feature Articles




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Opportunities and Challenges for Biosimilars: What's on the Horizon in the Global Insulin Market?

Lisa S. Rotenstein
Oct 1, 2012; 30:138-150
Features




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Health Care Transition in Adolescents and Young Adults With Diabetes

Michael E. Bowen
Jun 1, 2010; 28:99-106
Feature Articles