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The prospects of carbon dioxide removal in climate policymaking within the United States

Research Event

19 November 2019 - 9:00am to 5:00pm

School of Law, University of California, Davis

This meeting formed part of a programme of work which investigates the role of negative emissions technologies (NETs) in achieving the Paris Agreement climate targets. Previous meetings held in London and Brussels have looked at integrating negative emissions into EU policy-making, the implications and degree to which NETs, and in particular bioenergy with carbon capture storage (BECCS), can be an effective climate mitigation tool. This meeting focused on the possible deployment pathways of NETs and alternatives to BECCS for the US in particular, in the context of geographical constraints and socioenvironmental implications, the role of the private sector, and appropriate governance and finance mechanisms. 

Melissa MacEwen

Project Manager, Energy, Environment and Resources Programme




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Covid-19: UK advisory panel members are revealed after experts set up new group




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

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




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

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




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Explainer: Who Is An Immigrant?

Who is an immigrant? Does that status change if, for example, a foreigner marries a native-born resident or serves in his or her adopted country's military? This explainer answers basic questions about international migrants—who they are, their top destinations, where they come from, how they are counted, and more.




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

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




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

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




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

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




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Vanishing Frontiers: The Forces Driving Mexico and the United States Together

Marking the release of MPI President Andrew Selee's latest book, speakers explore emerging trends in migration, economic interdependence, technology innovation, and cultural exchange that are transforming the relationship between the United States and Mexico, and the policy implications of these changes for the future.




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

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




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Executive Power Showdown: Congress and White House Quarrel over Immigration Spending

Though a faceoff between the U.S. executive and legislative branches is now in the courts, with President Trump's decision to declare a national emergency so he can allocate more money for construction of a border wall, a less-noted dispute has been taking place over the Department of Homeland Security's decision to add thousands more immigration detention beds than Congress provides annually, as this article explains.




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House Bills Would Largely Dismantle Asylum System at U.S.-Mexico Border

The House is set to vote on two bills that would largely dismantle the U.S. asylum system at the southern border by significantly narrowing grounds to apply for asylum, eliminating protections for the vast majority of unaccompanied minors, and unilaterally declaring Mexico a safe third country. The result would be a sharp reduction in the number of people permitted to seek humanitarian protection, as this commentary explains.




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Doctors as Taxi Drivers: The Costs of Brain Waste among Highly Skilled Immigrants in the United States

A report release and presentation of first-ever U.S. estimates on the actual economic costs of skill underutilization for immigrants, their families, and the U.S. economy, in terms of forgone earnings and unrealized federal, state, and local taxes.




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2010 E Pluribus Unum Prizes: Honoring Exceptional Immigrant Integration Initiatives

Award winners were honored at the second annual awards ceremony in Washington, DC, on May 18, 2010.




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2010 E Pluribus Unum Prizes: Honoring Exceptional Immigrant Integration Initiatives

Winners of the 2nd annual E Pluribus Unum Prizes awarded to exceptional immigrant integration initiatives by MPI's National Center on Immigrant Integration Policy are the Illinois New Americans Integration Initiative; the Latino Community Credit Union in Durham, NC; Tacoma Community House in Tacoma, WA; and Upwardly Global in San Francisco, CA. McDonald's Corp. of Oak Brook, IL, received the sole honorable mention. The Prizes seek to reward exemplary efforts that uphold and update the ideal of "out of many, one" and inspire others to take on the important work of helping immigrants and their children join the mainstream of U.S. society as well as build stronger ties between immigrants and the native-born. Award winners were honored at the second annual awards ceremony in Washington, DC, on May 18, 2010. Watch highlights of the ceremony here.




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Remain in Mexico Plan Echoes Earlier U.S. Policy to Deter Haitian Migration

Remain in Mexico—the Trump administration policy aimed at deterring the rising numbers of migrants from Central America by requiring them to stay in Mexico through most of their U.S. asylum adjudication process—bears striking similarities to U.S. policy in the 1980s and 1990s that sought to discourage Haitians from making the sea journey to the United States. This article explores the parallels and differences between Remain in Mexico and the earlier narrowing of asylum for Haitians.




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

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




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

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




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Examining the Adequacy and Enforcement of Our Nation’s Immigration Laws

Testimony of Marc R. Rosenblum, Deputy Director, U.S. Immigration Program, before the House Judiciary Committee on the efficacy of immigration enforcement at the U.S. border and in the interior.




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Targeted Enforcement: Projecting the Effects of Executive Action on Deportations

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




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African Countries Relax Short-Term Visa Policies for Chinese in Sign of Increased Openness to China

China has been Africa’s largest trading partner since 2009, and as commerce and investment have increased, so have flows of people in both directions. With an estimated 1 million to 2 million Chinese migrants across Africa, some countries have relaxed their short-term visa requirements in hopes of facilitating cultural and business exchanges. High levels of Chinese investment do not, however, correlate with more liberal visa policies, as this article explores.




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Mexican Migration Flows: From Great Wave to Gentle Stream?

This event focuses on the changing face of Mexican migration to the United States, Mexican immigrants' contributions to U.S. society and political and economic power, as well as that of those who have returned to Mexico.




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Criminalizing Irregular Migrant Labor: Thailand’s Crackdown in Context

Thailand has become a key destination for migrant workers, primarily from Myanmar, Cambodia, and Laos. Many lack authorization, however, and as their numbers have grown, so has the government's intent in regulating their movement—sometimes provoking unintended results. This article explores recent patterns in labor migration to Thailand and examines the likely impacts of a 2017 decree criminalizing illegal employment.




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Understanding the Policy Context for Migrant Return and Reintegration

In advance of the December 2018 adoption of the Global Compact for Safe, Orderly, and Regular Migration and its commitment to facilitate the return, readmission, and reintegration of migrants, this webinar examines the policies, practices, and contextual factors that make compulsory returns such a difficult issue for international cooperation, and the programs that are being implemented to make reintegration of returnees sustainable.




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Embracing Emigration: The Migration-Development Nexus in Albania

From ongoing emigration flows and a surge in asylum seekers, to more than 150,000 returnees, this country profile examines contemporary and historical migration trends in Albania. Driven by extreme poverty and unemployment, more than one-third of Albania's population has emigrated in the last 25 years. The government now seeks to capitalize on diaspora resources by linking migration and development policies.




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Cuban Migration: A Postrevolution Exodus Ebbs and Flows

The Cuban Revolution unleashed a massive exodus from the island. Cuba is now among the top origin countries of immigrants in the United States—where for decades they have received preferential treatment—with smaller numbers across Europe and Latin America. This article explores the evolution of Cuban migration, particularly within the context of the Cold War and shifting U.S. policies toward the country.




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Years After Crimea’s Annexation, Integration of Ukraine’s Internally Displaced Population Remains Uneven

With nearly 1.4 million internally displaced persons (IDPs), Ukraine is home to one of the largest IDP populations in the world. Five years after Russia's annexation of Crimea, displaced Ukrainians continue to face challenges related to national identity, social cohesion, and political participation. While the Ukrainian government has had some success integrating IDPs, the conflict’s end remains uncertain, and many are unlikely to return to their communities of origin no matter the outcome.




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With Millions Displaced by Climate Change or Extreme Weather, Is There a Role for Labor Migration Pathways?

Climate-related displacement is not hypothetical: An average of 21.5 million people per year have been displaced since 2008 by natural disasters, and thousands more have fled slow-onset environmental hazards. While migration can serve as a safety valve to adapt to changing conditions, few orderly, legal channels exist for climate migrants (also known as environmental migrants), as this article explores.




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Many Psychology Experiments Lack Evidence of Validity, Says Report

Source:

An examination of nearly 350 published psychological experiments found that nearly half failed to show that they were based on a valid foundation of empirical evidence, suggesting that a wide swath of psychological science may be based on an "untested foundation."






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Signs Your COVID-19 Anxiety Has Become Unhealthy, and What to Do

Source:

As the coronavirus pandemic drags on, experts fear that some of us may begin to lose our ability to cope with the anxiety and stress. Here are five signs that coronavirus anxiety is becoming unhealthy, and tips on how to reduce it.






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Climate Change and COVID-19: Five Charts That Explain the Impacts

Source:

We're living through the biggest carbon crash ever recorded. No war, no recession, no previous pandemic has had such a dramatic impact on emissions of carbon dioxide over the past century as COVID-19 has in a few short months. What does this unrivaled drop in carbon dioxide mean for climate change?






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

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




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

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




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

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




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Exploring Innovative Ideas to Strengthen the Global Protection System

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




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Leadership Visions: A Discussion with Mexican Foreign Minister Claudia Ruiz-Massieu

An MPI Leadership Visions discussion with the Foreign Minister of Mexico, Claudia Ruiz-Massieu, for her first public appearance in Washington, DC. 




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Mexican Immigrants in the United States

Mexican immigration to the United States has slowed in recent years, and since the Great Recession more Mexican immigrants have returned to Mexico than have migrated to the United States. Mexicans, however, remain the largest origin group in the country, accounting for 28 percent of all immigrants. See how Mexican immigrants compare to the overall foreign- and U.S.-born populations on key indicators with this Spotlight article.




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La Situación de Cambio Constante entre EE UU y México: Tendencias y Políticas de Migración, Incluyendo Menores No Acompañados

Una llamada en español que analiza las dinámicas cambiantes y las cuestiones políticas relacionadas con la migración a través de México a los Estados Unidos.




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La Situación de Cambio Constante entre EE UU y México: Tendencias y Políticas de Migración, Incluyendo Menores No Acompañados

Durante este seminario, ponentes presentaron hallazgos de un reciente informe que utiliza datos de agencias gubernamentales mexicanas, entrevistas con funcionarios clave y relatos de la sociedad civil para examinar el marco legal para la protección de menores no acompañados y su aplicación, al igual que las brechas entre este marco y su aplicación durante los procesos de detención, interrogación y alojamiento. El presidente de MPI, Andrew Selee, también expuso cómo el cambio en la dinámica política en Estados Unidos puede afectar las cuestiones migratorias con México, así como los efectos en la relación bilateral en medio de tensiones sobre el muro fronterizo, la renegociación del acuerdo del TLCAN y una cifra significativa de repatriaciones de migrantes mexicanos.




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Vanishing Frontiers: The Forces Driving Mexico and the United States Together

Marking the release of MPI President Andrew Selee's book, this discussion explores the emerging trends in migration, economic interdependence, technology innovation, and cultural exchange that are transforming the relationship between the United States and Mexico.




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

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




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Sex Difference in Effects of Low-Dose Aspirin on Prevention of Dementia in Patients With Type 2 Diabetes: A Long-term Follow-up Study of a Randomized Clinical Trial

OBJECTIVE

To evaluate and compare the efficacy of long-term use of low-dose aspirin for the prevention of dementia in men and women.

RESEARCH DESIGN AND METHODS

This study is a follow-up cohort study of the Japanese Primary Prevention of Atherosclerosis With Aspirin for Diabetes (JPAD) trial, which was a randomized, open-label, standard care–controlled trial examining the effects of low-dose aspirin on cardiovascular events. We followed up 2,536 Japanese patients with type 2 diabetes (T2D) enrolled in the JPAD trial from 2002 to 2017. The primary outcome of this post hoc analysis was the incidence of dementia, which was defined by the prescription of antidementia drugs or admission due to dementia.

RESULTS

Among the originally enrolled patients, 2,121 (84%) retained their original allocation. During a median follow-up of 11.4 years, 128 patients developed dementia. The overall effect of low-dose aspirin on the prevention of dementia adjusted for age, sex, and other established risk factors was not significant (hazard ratio [HR] 0.82, 95% CI 0.58–1.16). However, a significant reduction was seen in the risk of dementia in women (HR 0.58, 95% CI 0.36–0.95), but not in men (HR 1.27, 95% CI 0.75–2.13) (Pinteraction = 0.03).

CONCLUSIONS

Long-term use of low-dose aspirin may reduce the risk for dementia in women with T2D.




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

OBJECTIVE

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

RESEARCH DESIGN AND METHODS

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

RESULTS

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

CONCLUSIONS

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




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Ex-MLB players in spotlight as world turns to Asia for baseball

Playing in Taiwan once was a last option Justin Nicolino had to continue a professional baseball career. Now the former Miami Marlins pitcher is one of many ex-MLB players who provide entertainment for U.S. sports fans.




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Ex-ABA commissioner, NBA executive Mike Storen dies at 84

Former American Basketball Association commissioner and NBA executive Mike Storen died Thursday after a lengthy battle with a rare form of cancer. He was 84.




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Case Study: Postsexual Penile Ulcer as a Symptom of Diabetes

Nehman Lauder
Oct 1, 2005; 23:191-192
Case Studies




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Within-Trial Evaluation of Medical Resources, Costs, and Quality of Life Among Patients With Type 2 Diabetes Participating in the Exenatide Study of Cardiovascular Event Lowering (EXSCEL)

OBJECTIVE

To compare medical resource use, costs, and health utilities for 14,752 patients with type 2 diabetes who were randomized to once-weekly exenatide (EQW) or placebo in addition to usual diabetes care in the Exenatide Study of Cardiovascular Event Lowering (EXSCEL).

RESEARCH DESIGN AND METHODS

Medical resource use data and responses to the EuroQol 5-Dimension (EQ-5D) instrument were collected at baseline and throughout the trial. Medical resources and medications were assigned values by using U.S. Medicare payments and wholesale acquisition costs, respectively. Secondary analyses used English costs.

RESULTS

Patients were followed for an average of 3.3 years, during which time those randomized to EQW experienced 0.41 fewer inpatient days (7.05 vs. 7.46 days; relative rate ratio 0.91; P = 0.05). Rates of outpatient medical visits were similar, as were total inpatient and outpatient costs. Mean costs for nonstudy diabetes medications over the study period were ~$1,600 lower with EQW than with placebo (P = 0.01). Total within-study costs, excluding study medication, were lower in the EQW arm than in the placebo arm ($28,907 vs. $30,914; P ≤ 0.01). When including the estimated cost of EQW, total mean costs were significantly higher in the EQW group than in the placebo group ($42,697 vs. $30,914; P < 0.01). With English costs applied, mean total costs, including exenatide costs, were £1,670 higher in the EQW group than the placebo group (£10,874 vs. £9,204; P < 0.01). There were no significant differences in EQ-5D health utilities between arms over time.

CONCLUSIONS

Medical costs were lower in the EQW arm than the placebo arm, but total costs were significantly higher once the cost of branded exenatide was incorporated.




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Plasma Lipidome and Prediction of Type 2 Diabetes in the Population-Based Malmo&#x0308; Diet and Cancer Cohort

OBJECTIVE

Type 2 diabetes mellitus (T2DM) is associated with dyslipidemia, but the detailed alterations in lipid species preceding the disease are largely unknown. We aimed to identify plasma lipids associated with development of T2DM and investigate their associations with lifestyle.

RESEARCH DESIGN AND METHODS

At baseline, 178 lipids were measured by mass spectrometry in 3,668 participants without diabetes from the Malmö Diet and Cancer Study. The population was randomly split into discovery (n = 1,868, including 257 incident cases) and replication (n = 1,800, including 249 incident cases) sets. We used orthogonal projections to latent structures discriminant analyses, extracted a predictive component for T2DM incidence (lipid-PCDM), and assessed its association with T2DM incidence using Cox regression and lifestyle factors using general linear models.

RESULTS

A T2DM-predictive lipid-PCDM derived from the discovery set was independently associated with T2DM incidence in the replication set, with hazard ratio (HR) among subjects in the fifth versus first quintile of lipid-PCDM of 3.7 (95% CI 2.2–6.5). In comparison, the HR of T2DM among obese versus normal weight subjects was 1.8 (95% CI 1.2–2.6). Clinical lipids did not improve T2DM risk prediction, but adding the lipid-PCDM to all conventional T2DM risk factors increased the area under the receiver operating characteristics curve by 3%. The lipid-PCDM was also associated with a dietary risk score for T2DM incidence and lower level of physical activity.

CONCLUSIONS

A lifestyle-related lipidomic profile strongly predicts T2DM development beyond current risk factors. Further studies are warranted to test if lifestyle interventions modifying this lipidomic profile can prevent T2DM.




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Excess BMI Accelerates Islet Autoimmunity in Older Children and Adolescents

OBJECTIVE

Sustained excess BMI increases the risk of type 1 diabetes (T1D) in autoantibody-positive relatives without diabetes of patients. We tested whether elevated BMI also accelerates the progression of islet autoimmunity before T1D diagnosis.

RESEARCH DESIGN AND METHODS

We studied 706 single autoantibody–positive pediatric TrialNet participants (ages 1.6–18.6 years at baseline). Cumulative excess BMI (ceBMI) was calculated for each participant based on longitudinally accumulated BMI ≥85th age- and sex-adjusted percentile. Recursive partitioning analysis and multivariable modeling defined the age cut point differentiating the risk for progression to multiple positive autoantibodies.

RESULTS

At baseline, 175 children (25%) had a BMI ≥85th percentile. ceBMI range was –9.2 to 15.6 kg/m2 (median –1.91), with ceBMI ≥0 kg/m2 corresponding to persistently elevated BMI ≥85th percentile. Younger age increased the progression to multiple autoantibodies, with age cutoff of 9 years defined by recursive partitioning analysis. Although ceBMI was not significantly associated with progression from single to multiple autoantibodies overall, there was an interaction with ceBMI ≥0 kg/m2, age, and HLA (P = 0.009). Among children ≥9 years old without HLA DR3-DQ2 and DR4-DQ8, ceBMI ≥0 kg/m2 increased the rate of progression from single to multiple positive autoantibodies (hazard ratio 7.32, P = 0.004) and conferred a risk similar to that in those with T1D-associated HLA haplotypes. In participants <9 years old, the effect of ceBMI on progression to multiple autoantibodies was not significant regardless of HLA type.

CONCLUSIONS

These data support that elevated BMI may exacerbate islet autoimmunity prior to clinical T1D, particularly in children with lower risk based on age and HLA. Interventions to maintain normal BMI may prevent or delay the progression of islet autoimmunity.




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Health Care Expenditures Among Adults With Diabetes After Oregons Medicaid Expansion

OBJECTIVE

To compare trends in Medicaid expenditures among adults with diabetes who were newly eligible due to the Affordable Care Act (ACA) Medicaid expansion to trends among those previously eligible.

RESEARCH DESIGN AND METHODS

Using Oregon Medicaid administrative data from 1 January 2014 to 30 September 2016, a retrospective cohort study was conducted with propensity score–matched Medicaid eligibility groups (newly and previously eligible). Outcome measures included total per-member per-month (PMPM) Medicaid expenditures and PMPM expenditures in the following 12 categories: inpatient visits, emergency department visits, primary care physician visits, specialist visits, prescription drugs, transportation services, tests, imaging and echography, procedures, durable medical equipment, evaluation and management, and other or unknown services.

RESULTS

Total PMPM Medicaid expenditures for newly eligible enrollees with diabetes were initially considerably lower compared with PMPM expenditures for matched previously eligible enrollees during the first postexpansion quarter (mean values $561 vs. $793 PMPM, P = 0.018). Within the first three postexpansion quarters, PMPM expenditures of the newly eligible increased to a similar but slightly lower level. Afterward, PMPM expenditures of both groups continued to increase steadily. Most of the overall PMPM expenditure increase among the newly eligible was due to rapidly increasing prescription drug expenditures.

CONCLUSIONS

Newly eligible Medicaid enrollees with diabetes had slightly lower PMPM expenditures than previously eligible Medicaid enrollees. The increase in PMPM prescription drug expenditures suggests greater access to treatment over time.