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

OBJECTIVE

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

RESEARCH DESIGN AND METHODS

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

RESULTS

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

CONCLUSIONS

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




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Boom heard in Washington state likely an exploding meteor

A loud booming sound reported by multiple witnesses in Washington state was likely a meteor exploding over the area, experts said.




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Look: Fox rescued from between walls of home, garage

Animal rescuers in Britain said a fox was rescued from the narrow gap between the external walls of a house and its garage.




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After Deportation, Some Congolese Returnees Face Detention and Extortion

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.




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Democrats Under Pressure: Political Calendar Exposes Ideological Differences on Immigration

Ideological differences in the Democratic Party over immigration that were once masked by unity against President Trump’s border wall and immigration agenda are now being exposed as Democratic presidential candidates seek to stand out in a crowded field and amid controversy over an emergency border spending bill. As the 2020 electoral calendar accelerates, how the party navigates the gulf between its most liberal and conservative wings will become a greater challenge for its leaders.




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From Control to Crisis: Changing Trends and Policies Reshaping U.S.-Mexico Border Enforcement

How did the U.S. border enforcement picture go in the span of two years from the lowest levels of illegal immigration since 1971 to a spiraling border security and humanitarian crisis? This report draws on enforcement and other data as well as analysis of changing migration trends and policies to tell this story. The authors outline key elements for a new strategy that can succeed over the long term.




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Exploring the Potential of the SGLT2 Inhibitor Dapagliflozin in Type 1 Diabetes: A Randomized, Double-Blind, Placebo-Controlled Pilot Study

Robert R. Henry
Mar 1, 2015; 38:412-419
Evolving Tactics With Inhibition of Sodium-Glucose Cotransporters




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Serum 25-Hydroxyvitamin D3 Concentrations and Prevalence of Cardiovascular Disease Among Type 2 Diabetic Patients

Massimo Cigolini
Mar 1, 2006; 29:722-724
BR Cardiovascular and Metabolic Risk




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Personalized Management of Hyperglycemia in Type 2 Diabetes: Reflections from a Diabetes Care Editors' Expert Forum

Itamar Raz
Jun 1, 2013; 36:1779-1788
Diabetes Care Expert Forum




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Prevalence of Diabetes in Mexican Americans, Cubans, and Puerto Ricans From the Hispanic Health and Nutrition Examination Survey, 1982-1984

Katherine M Flegal
Jul 1, 1991; 14:628-638
Supplement 3: Diabetes in Hispanic Americans




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Beneficial Effect of Low-Glycemic Index Diet in Overweight NIDDM Subjects

Thomas M S Wolever
Apr 1, 1992; 15:562-564
Short Report




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Cardiovascular Outcomes Trials in Type 2 Diabetes: Where Do We Go From Here? Reflections From a Diabetes Care Editors Expert Forum

William T. Cefalu
Jan 1, 2018; 41:14-31
Diabetes Care Expert Forum




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Can a Shift in Fuel Energetics Explain the Beneficial Cardiorenal Outcomes in the EMPA-REG OUTCOME Study? A Unifying Hypothesis

Sunder Mudaliar
Jul 1, 2016; 39:1115-1122
Diabetes Care Symposium




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A Prospective Analysis of the HOMA Model: The Mexico City Diabetes Study

Steven M Haffner
Oct 1, 1996; 19:1138-1141
Short Report




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Periodontal Disease: The sixth complication of diabetes mellitus

Harald Löe
Jan 1, 1993; 16:329-334
Supplement 1: Diabetes in Native Americans




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Current State of Type 1 Diabetes Treatment in the U.S.: Updated Data From the T1D Exchange Clinic Registry

Kellee M. Miller
Jun 1, 2015; 38:971-978
Type 1 Diabetes at a Crossroads




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Ex-South Korea comfort woman accuses activist of exploiting women, funds

A former South Korean comfort woman accused an influential activist group of misappropriating funds and using past victims to advance their cause.




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Chinese exports up in April, Beijing’s data show

China's exports rebounded in April, growing 3.5 percent, according to the latest data from Beijing's General Administration of Customs on Thursday.




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Digitizing financial services key to Africa's post-pandemic growth, experts say

As the COVID-19 pandemic begins to take root in Africa, experts say that digitizing financial services could help keep the continent safe




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Northrop Grumman, Raytheon partner for Next Generation Interceptor bid

Northrop Grumman Corp. and Raytheon Missiles and Defense will partner to develop the Defense Department's next missile interceptor, they announced on Monday.




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Israel Defense Ministry buys small exploding drones

Israel's Ministry of Defense ordered small drones for its ground forces working in urban areas, maker Rafael Advanced Defense Systems Ltd. said Monday.




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Air Force sets May 16 launch for X-37B spy plane

The Air Force said Wednesday it will launch the sixth mission of the uncrewed X-37B spy plane May 16 from Florida with a record number of experiments on board.




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Gestational Diabetes Mellitus and Diet: A Systematic Review and Meta-analysis of Randomized Controlled Trials Examining the Impact of Modified Dietary Interventions on Maternal Glucose Control and Neonatal Birth Weight

Jennifer M. Yamamoto
Jul 1, 2018; 41:1346-1361
Reconsidering Pregnancy With Diabetes




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Effect of a Lifestyle Intervention Program With Energy-Restricted Mediterranean Diet and Exercise on Weight Loss and Cardiovascular Risk Factors: One-Year Results of the PREDIMED-Plus Trial

Jordi Salas-Salvadó
May 1, 2019; 42:777-788
Continuing Evolution of Nutritional Therapy for Diabetes




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Impact of Fat, Protein, and Glycemic Index on Postprandial Glucose Control in Type 1 Diabetes: Implications for Intensive Diabetes Management in the Continuous Glucose Monitoring Era

Kirstine J. Bell
Jun 1, 2015; 38:1008-1015
Type 1 Diabetes at a Crossroads




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Cardiovascular Outcomes Trials in Type 2 Diabetes: Where Do We Go From Here? Reflections From a Diabetes Care Editors Expert Forum

William T. Cefalu
Jan 1, 2018; 41:14-31
Diabetes Care Expert Forum




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Index


Jan 1, 2020; 43:S207-S212
Index




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A Multinational, Multicenter, Randomized, Double-Blinded, Placebo-Controlled Trial to Evaluate the Efficacy of Cyclical Topical Wound Oxygen (TWO2) Therapy in the Treatment of Chronic Diabetic Foot Ulcers: The TWO2 Study

OBJECTIVE

Topical oxygen has been used for the treatment of chronic wounds for more than 50 years. Its effectiveness remains disputed due to the limited number of robust high-quality investigations. The aim of this study was to assess the efficacy of multimodality cyclical pressure Topical Wound Oxygen (TWO2) home care therapy in healing refractory diabetic foot ulcers (DFUs) that had failed to heal with standard of care (SOC) alone.

RESEARCH DESIGN AND METHODS

Patients with diabetes and chronic DFUs were randomized (double-blind) to either active TWO2 therapy or sham control therapy—both in addition to optimal SOC. The primary outcome was the percentage of ulcers in each group achieving 100% healing at 12 weeks. A group sequential design was used for the study with three predetermined analyses and hard stopping rules once 73, 146, and ultimately 220 patients completed the 12-week treatment phase.

RESULTS

At the first analysis point, the active TWO2 arm was found to be superior to the sham arm, with a closure rate of 41.7% compared with 13.5%. This difference in outcome produced an odds ratio (OR) of 4.57 (97.8% CI 1.19, 17.57), P = 0.010. After adjustment for University of Texas Classification (UTC) ulcer grade, the OR increased to 6.00 (97.8% CI 1.44, 24.93), P = 0.004. Cox proportional hazards modeling, also after adjustment for UTC grade, demonstrated >4.5 times the likelihood to heal DFUs over 12 weeks compared with the sham arm with a hazard ratio of 4.66 (97.8% CI 1.36, 15.98), P = 0.004. At 12 months postenrollment, 56% of active arm ulcers were closed compared with 27% of the sham arm ulcers (P = 0.013).

CONCLUSIONS

This sham-controlled, double-blind randomized controlled trial demonstrates that, at both 12 weeks and 12 months, adjunctive cyclical pressurized TWO2 therapy was superior in healing chronic DFUs compared with optimal SOC alone.




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Leukocyte Telomere Length, DNA Oxidation, and Risk of Lower-Extremity Amputation in Patients With Long-standing Type 1 Diabetes

OBJECTIVE

Telomere shortening and DNA oxidation are associated with premature vascular aging, which may be involved in lower-extremity amputation (LEA). We sought to investigate whether leukocyte telomere length (LTL) and plasma 8-hydroxy-2'-deoxyguanosine (8-OHdG), a biomarker of DNA oxidation, were associated with LEA in subjects with type 1 diabetes at high vascular risk.

RESEARCH DESIGN AND METHODS

LTL (quantitative PCR) and plasma 8-OHdG concentrations (immunoassay method) were assessed at baseline in the GENEDIAB (Génétique de la Néphropathie Diabétique) type 1 diabetes cohort. Logistic and Cox proportional hazards regression models were fitted to estimate odds ratio (OR) (at baseline) and hazard ratio (HR) (during follow-up), with related 95% CI, by increasing biomarker tertiles (T1, T2, T3).

RESULTS

Among 478 participants (56% male, mean ± SD age 45 ± 12 years and diabetes duration 29 ± 10 years), 84 patients had LEA at baseline. Baseline history of LEA was associated with shorter LTL (OR for T2 vs. T1 0.62 [95% CI 0.32–1.22] and for T3 vs. T1 0.41 [0.20–0.84]) but not with plasma 8-OHdG (1.16 [0.56–2.39] and 1.24 [0.61–2.55], respectively). New cases of LEA occurred in 34 (12.3%) participants during the 10-year follow-up. LTL were shorter (HR T2 vs. T1 0.25 [95% CI 0.08–0.67] and T3 vs. T1 0.29 [0.10–0.77]) and plasma 8-OHdG higher (2.20 [0.76–7.35] and 3.11 [1.07–10.32]) in participants who developed LEA during follow-up compared with others. No significant interaction was observed between biomarkers on their association with LEA.

CONCLUSIONS

We report the first independent association between LTL shortening and excess risk of LEA in type 1 diabetes. High plasma 8-OHdG was also associated with incident LEA but partly dependent on cofounding variables.




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The Contemporary Prevalence of Diabetic Neuropathy in Type 1 Diabetes: Findings From the T1D Exchange

OBJECTIVE

To evaluate the contemporary prevalence of diabetic peripheral neuropathy (DPN) in participants with type 1 diabetes in the T1D Exchange Clinic Registry throughout the U.S.

RESEARCH DESIGN AND METHODS

DPN was assessed with the Michigan Neuropathy Screening Instrument Questionnaire (MNSIQ) in adults with ≥5 years of type 1 diabetes duration. A score of ≥4 defined DPN. Associations of demographic, clinical, and laboratory factors with DPN were assessed.

RESULTS

Among 5,936 T1D Exchange participants (mean ± SD age 39 ± 18 years, median type 1 diabetes duration 18 years [interquartile range 11, 31], 55% female, 88% non-Hispanic white, mean glycated hemoglobin [HbA1c] 8.1 ± 1.6% [65.3 ± 17.5 mmol/mol]), DPN prevalence was 11%. Compared with those without DPN, DPN participants were older, had higher HbA1c, had longer duration of diabetes, were more likely to be female, and were less likely to have a college education and private insurance (all P < 0.001). DPN participants also were more likely to have cardiovascular disease (CVD) (P < 0.001), worse CVD risk factors of smoking (P = 0.008), hypertriglyceridemia (P = 0.002), higher BMI (P = 0.009), retinopathy (P = 0.004), reduced estimated glomerular filtration rate (P = 0.02), and Charcot neuroarthropathy (P = 0.002). There were no differences in insulin pump or continuous glucose monitor use, although DPN participants were more likely to have had severe hypoglycemia (P = 0.04) and/or diabetic ketoacidosis (P < 0.001) in the past 3 months.

CONCLUSIONS

The prevalence of DPN in this national cohort with type 1 diabetes is lower than in prior published reports but is reflective of current clinical care practices. These data also highlight that nonglycemic risk factors, such as CVD risk factors, severe hypoglycemia, diabetic ketoacidosis, and lower socioeconomic status, may also play a role in DPN development.




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Mexican Immigrants in the United States

For decades, Mexicans have been the largest immigrant group in the United States. While this is still the case, the Mexican immigrant population is no longer growing at the rate it once was. In fact, between 2010 and 2017, the number of Mexicans in the country first leveled off and then began to decline. This article explores the latest data on Mexican immigrants in the United States.




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International Experience Suggests Safe Third-Country Agreement Would Not Solve the U.S.-Mexico Border Crisis

While safe third-country agreements appear to hold the potential of deterring new asylum claims, experience suggests this may be a false promise. As the Trump administration explores the possibility of such agreements with Mexico and Guatemala, this commentary examines the evidence of safe third-country arrangements in Europe, finding them difficult to enforce and playing little role in deterring new claims.




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Invertir en el Vecindario: Cambios en los Patrones de Migración Entre México y Estados Unidos y Oportunidades para una Cooperación Sostenible

Presentación del reporte que refleja el contenido de encuentros del grupo de estudio sobre la migración México-Estados Unidos convocado por El Colegio de México y el Migration Policy Institute (MPI).




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Interlocking Set of Trump Administration Policies at the U.S.-Mexico Border Bars Virtually All from Asylum

Through a set of interlocking policies, the Trump administration has walled off the asylum system at the U.S.-Mexico border, guaranteeing that only a miniscule few can successfully gain protection. While the Migrant Protection Protocols, more commonly known as Remain in Mexico, have been a key part of throttling asylum applications, two newer, far less visible programs hold the potential to complete the job, as this article explores.




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A Proxy War on Minorities? India Crafts Citizenship and Refugee Policies through the Lens of Religion

The Modi government's push for a Citizenship Amendment Act and National Register of Citizens sparked deadly riots and chilled India's 200 million Muslims, who fear being relegated to second-class citizenship—and for some, even statelessness. This article explores actions by Modi's Bharatiya Janata Party, the significance of Bangladeshi illegal immigration as a driver, and what a register of citizens in Assam might mean for India.




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

This MPI webinar focuses on reception and reintegration services for returning migrants, along with the heightened pressure policymakers in Mexico and Central America are facing to design systems and programs that support both returnees and the communities in which they settle. Authors of a year-long study of reception and reintegration services in Mexico and the Northern Triangle discuss the findings of their fieldwork.




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On the Move in a War Zone: Mixed Migration Flows to and through Yemen

War and impending famine in Yemen have captured significant attention. Yet often overlooked is the country’s role as the epicenter of one of the world’s busiest mixed migration routes, linking Africa, Asia, and Europe. This article examines the migration pathways to and through the country, push and pull factors, and the impact of civil war on human movement.




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Explainer: Illegal Immigration in the United States

How has the size of the unauthorized population in the United States changed over time? How is illegal immigration changing, and where do unauthorized immigrants come from? This explainer answers basic questions about illegal immigration, the changing patterns from Mexico, and more.




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A New Migration Policy for A New Era: A Conversation with Mexico&#039;s Interior Secretary Olga Sánchez Cordero

On her first official trip to Washington, DC, Secretary of the Interior Olga Sánchez Cordero offered a public address on Mexico’s new approach to migration policy at MPI. Her remarks and the event discussion were mostly conducted in Spanish, and this recording is of the simultaneous English interpretation. 




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Policy Solutions to Address Crisis at Border Exist, But Require Will and Staying Power to Execute

Closing the U.S.-Mexico border and cutting off aid to Central America would only feed the crisis unfolding at key points along the U.S.-Mexico border. This commentary outlines a range of immediate and long-term policy responses that would more effectively address the complex mix of factors fueling rising Central American migration to the United States.




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Is U.S.-Mexico Cooperation on Migration Possible?

Over recent months, the number of Central American migrants apprehended at the U.S.-Mexico border has surged, presenting a critical challenge in the relationship between the two neighboring countries. Experts from a Study Group on U.S.-Mexico Migration convened by El Colegio de México and MPI discuss current trends, policies, and politics surrounding migration from the Northern Triangle of Central America and the U.S.-Mexico relationship, ways to improve U.S. and Mexican asylum systems, possible new approaches to labor migration, ways to address smuggling networks, and modernize border management.




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Beyond Walls and Tariffs: Responding to Migration Challenges at the U.S.-Mexico Border

This event organized by the Migration Policy Institute and American Enterprise Institute features a conversation on U.S.-Mexico border conditions, as well as policy responses and regional cooperation on illegal immigration. 




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Beyond Walls and Tariffs: Responding to Migration Challenges at the U.S.-Mexico Border

This event features a smart conversation by a range of experts on U.S.-Mexico border conditions, looking at policy responses by both countries and regional cooperation.




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Strategic Solutions for the United States and Mexico to Manage the Migration Crisis

Amid surging migration from Central America, the United States and Mexico in June 2019 agreed to a series of enforcement measures. Yet these near-term efforts will be difficult to maintain given chronic institutional weaknesses and poorly thought-out policy structures in both countries. This commentary, by the presidents of MPI and El Colegio de México, offers a set of long-term, collaborative solutions to dissuade illegal migration while ensuring fairness to those seeking protection.




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Soluciones estratégicas para afrontar la crisis migratoria en Estados Unidos y México

Dado el incremento de los flujos migratorios provenientes de Centroamérica, el pasado mes de junio de 2019, los Estados Unidos y México acordaron tomar una serie de medidas para reducir los flujos irregulares. Sin embargo, será muy difícil mantener estos esfuerzos de corto plazo, debido a una debilidad institucional crónica y a estructuras de política pública poco planificadas en ambos países. Este comentario ofrece cinco recomendaciones a ambos países considerando soluciones de mediano y largo plazo para disuadir la migración irregular y, al mismo tiempo, garantizar que aquellos que busquen protección tengan un proceso justo.




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Ally or Exploiter? The Smuggler-Migrant Relationship Is a Complex One

As highly industrialized countries ramp up their border controls, human smugglers are playing a central role in moving migrants through key migration corridors around the world. Despite the illicit nature of their work and being cast as villains in the public eye, smugglers have complex, multifaceted relationships with their clients. At times, the relationship can be mutually beneficial or even lifesaving; at others, it can be predatory and dangerous, as this article explores.




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HHS releases video tutorial for searching list of excluded individuals/entities

The Department of Health and Human Services released Nov. 25 a five-minute video explaining how to search its list of excluded individuals and entities, called LEIE.




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Texas A&M dental school opens new clinic, education building

Texas A&M College of Dentistry announced Jan. 17 it opened it’s a new 160,000-square-foot, nine-story clinic, which enables the dental school to increase underserved patients’ access to care.




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February JADA examines connection between healthy eating habits, untreated caries

Greater compliance with dietary guidelines may reduce the chance of untreated caries in adults, according to a study published in the February issue of The Journal of the American Dental Association.




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Dental practice sued for allegedly sending unsolicited text messages

A class action lawsuit alleging that a Florida dental practice sent unsolicited text messages in violation of the Telephone Consumer Protection Act was filed in the U.S. District Court for the Southern District of Florida Jan. 6.