ee

Cost and Cost-Effectiveness of Large-Scale Screening for Type 1 Diabetes in Colorado

OBJECTIVE

To assess the costs and project the potential lifetime cost-effectiveness of the ongoing Autoimmunity Screening for Kids (ASK) program, a large-scale, presymptomatic type 1 diabetes screening program for children and adolescents in the metropolitan Denver region.

RESEARCH DESIGN AND METHODS

We report the resource utilization, costs, and effectiveness measures from the ongoing ASK program compared with usual care (i.e., no screening). Additionally, we report a practical screening scenario by including utilization and costs relevant to routine screening in clinical practice. Finally, we project the potential cost-effectiveness of ASK and routine screening by identifying clinical benchmarks (i.e., diabetic ketoacidosis [DKA] events avoided, HbA1c improvements vs. no screening) needed to meet value thresholds of $50,000–$150,000 per quality-adjusted life-year (QALY) gained over a lifetime horizon.

RESULTS

Cost per case detected was $4,700 for ASK screening and $14,000 for routine screening. To achieve value thresholds of $50,000–$150,000 per QALY gained, screening costs would need to be offset by cost savings through 20% reductions in DKA events at diagnosis in addition to 0.1% (1.1 mmol/mol) improvements in HbA1c over a lifetime compared with no screening for patients who develop type 1 diabetes. Value thresholds were not met from avoiding DKA events alone in either scenario.

CONCLUSIONS

Presymptomatic type 1 diabetes screening may be cost-effective in areas with a high prevalence of DKA and an infrastructure facilitating screening and monitoring if the benefits of avoiding DKA events and improved HbA1c persist over long-run time horizons. As more data are collected from ASK, the model will be updated with direct evidence on screening effects.




ee

Obstructive Sleep Apnea, a Risk Factor for Cardiovascular and Microvascular Disease in Patients With Type 2 Diabetes: Findings From a Population-Based Cohort Study

OBJECTIVE

To determine the risk of cardiovascular disease (CVD), microvascular complications, and mortality in patients with type 2 diabetes who subsequently develop obstructive sleep apnea (OSA) compared with patients with type 2 diabetes without a diagnosis of OSA.

RESEARCH DESIGN AND METHODS

This age-, sex-, BMI-, and diabetes duration–matched cohort study used data from a U.K. primary care database from 1 January 2005 to 17 January 2018. Participants aged ≥16 years with type 2 diabetes were included. Exposed participants were those who developed OSA after their diabetes diagnosis; unexposed participants were those without diagnosed OSA. Outcomes were composite CVD (ischemic heart disease [IHD], stroke/transient ischemic attack [TIA], heart failure [HF]), peripheral vascular disease (PVD), atrial fibrillation (AF), peripheral neuropathy (PN), diabetes-related foot disease (DFD), referable retinopathy, chronic kidney disease (CKD), and all-cause mortality. The same outcomes were explored in patients with preexisting OSA before a diagnosis of type 2 diabetes versus diabetes without diagnosed OSA.

RESULTS

A total of 3,667 exposed participants and 10,450 matched control participants were included. Adjusted hazard ratios for the outcomes were as follows: composite CVD 1.54 (95% CI 1.32, 1.79), IHD 1.55 (1.26, 1.90), HF 1.67 (1.35, 2.06), stroke/TIA 1.57 (1.27, 1.94), PVD 1.10 (0.91, 1.32), AF 1.53 (1.28, 1.83), PN 1.32 (1.14, 1.51), DFD 1.42 (1.16, 1.74), referable retinopathy 0.99 (0.82, 1.21), CKD (stage 3–5) 1.18 (1.02, 1.36), albuminuria 1.11 (1.01, 1.22), and all-cause mortality 1.24 (1.10, 1.40). In the prevalent OSA cohort, the results were similar, but some associations were not observed.

CONCLUSIONS

Patients with type 2 diabetes who develop OSA are at increased risk of CVD, AF, PN, DFD, CKD, and all-cause mortality compared with patients without diagnosed OSA. Patients with type 2 diabetes who develop OSA are a high-risk population, and strategies to detect OSA and prevent cardiovascular and microvascular complications should be implemented.




ee

Screening and Treatment Outcomes in Adults and Children With Type 1 Diabetes and Asymptomatic Celiac Disease: The CD-DIET Study

OBJECTIVE

To describe celiac disease (CD) screening rates and glycemic outcomes of a gluten-free diet (GFD) in patients with type 1 diabetes who are asymptomatic for CD.

RESEARCH DESIGN AND METHODS

Asymptomatic patients (8–45 years) were screened for CD. Biopsy-confirmed CD participants were randomized to GFD or gluten-containing diet (GCD) to assess changes in HbA1c and continuous glucose monitoring over 12 months.

RESULTS

Adults had higher CD-seropositivity rates than children (6.8% [95% CI 4.9–8.2%, N = 1,298] vs. 4.7% [95% CI 3.4–5.9%, N = 1,089], P = 0.035) with lower rates of prior CD screening (6.9% vs. 44.2%, P < 0.0001). Fifty-one participants were randomized to a GFD (N = 27) or GCD (N = 24). No HbA1c differences were seen between the groups (+0.14%, 1.5 mmol/mol; 95% CI –0.79 to 1.08; P = 0.76), although greater postprandial glucose increases (4-h +1.5 mmol/L; 95% CI 0.4–2.7; P = 0.014) emerged with a GFD.

CONCLUSIONS

CD is frequently observed in asymptomatic patients with type 1 diabetes, and clinical vigilance is warranted with initiation of a GFD.




ee

Continuous Positive Airway Pressure Treatment, Glycemia, and Diabetes Risk in Obstructive Sleep Apnea and Comorbid Cardiovascular Disease

OBJECTIVE

Despite evidence of a relationship among obstructive sleep apnea (OSA), metabolic dysregulation, and diabetes, it is uncertain whether OSA treatment can improve metabolic parameters. We sought to determine effects of long-term continuous positive airway pressure (CPAP) treatment on glycemic control and diabetes risk in patients with cardiovascular disease (CVD) and OSA.

RESEARCH DESIGN AND METHODS

Blood, medical history, and personal data were collected in a substudy of 888 participants in the Sleep Apnea Cardiovascular End Points (SAVE) trial in which patients with OSA and stable CVD were randomized to receive CPAP plus usual care, or usual care alone. Serum glucose and glycated hemoglobin A1c (HbA1c) were measured at baseline, 6 months, and 2 and 4 years and incident diabetes diagnoses recorded.

RESULTS

Median follow-up was 4.3 years. In those with preexisting diabetes (n = 274), there was no significant difference between the CPAP and usual care groups in serum glucose, HbA1c, or antidiabetic medications during follow-up. There were also no significant between-group differences in participants with prediabetes (n = 452) or in new diagnoses of diabetes. Interaction testing suggested that women with diabetes did poorly in the usual care group, while their counterparts on CPAP therapy remained stable.

CONCLUSIONS

Among patients with established CVD and OSA, we found no evidence that CPAP therapy over several years affects glycemic control in those with diabetes or prediabetes or diabetes risk over standard-of-care treatment. The potential differential effect according to sex deserves further investigation.




ee

Angela's Tips for Handling Your Child's Special Education Needs

This guest post is written by Angela Peterson who writes on the topic of Online Psychology Degrees and can be emailed at angela_peterson@rediffmail.com

It’s not easy raising a child, and when he or she is affected by a severe disorder or disease, you have a greater challenge ahead of you. You have to put in extra effort, energy and thought into your child’s development and progress, one aspect of which includes their education. Some parents of children with special needs may be tempted to overprotect by keeping them in cloistered environments and limiting their interaction with the outside world. This usually only hampers the child instead of helping them. If you’re a parent with a child who has special needs, here’s some strategies:

* Understand your child: Some children may be able to express themselves while others are limited because of their disability. Whatever the case, understand your child and know that they have a mind of their own even if they are unable to speak it. Instead of forcing your will on them, get to know what they wish to do and cater to their needs as much as possible as long as it does not cause them any harm.

* Be patient: It’s a tough task, but you need to have an enormous amount of patience with your child. You need to condition yourself to be patient through practice and experience, otherwise you and your child will be subject to a great deal of stress.

* Decide on their education: There are many options for providing education to your special needs child, so look for what is available in your area. If you plan to homeschool, you will need to do some research before you’re up to the task. Many feel that it’s better to let the professionals handle this task who are trained and more experienced. Also, your child gets to mingle with other children and interact with them on a regular basis, which is very important to his or her social development.

*Think about inclusive classrooms: Parents often want their special needs children to attend regular schools. Learn about inclusive classrooms and determine if it is a good fit for your child. Consider if your child is up to the task of being educated with general education children and if he/she can cope with the curriculum in such classrooms. Although teachers in inclusive classrooms are trained to deal with children with special needs, there may be times when your child could be bullied or teased by the other kids for not being like them. Take all these facts into consideration before you decide on an inclusive classroom for your child.


Children with special needs need all the help and support they can get from parents and teachers, and it’s up to you to decide on the best form of education for them.




ee

New Poll: How Do You Feel About the Level Of Education The School Provides Your Child

I will be starting a monthly poll to engage the readers of this blog and start some discussion. Feel free to comment on this topic. I'm sure many of you have a lot to say. At the end of the month, I'll share and discuss results in a blog post. I'm curious to see how the readers of this blog feel about your own schools. You can find the poll in the sidebar. Thanks for participating!




ee

How Much of Your Child's Special Education Meeting Did You Understand?

As a School Psychologist- I attend numerous Special Education Meetings weekly. There are Child Study Meetings, where we discuss interventions and may decide to complete an evaluation. There are eligibility meetings, where we determine if a student is eligible for special education services. There are IEP meetings where we develop a plan for a student who is eligible for special education. Additionally, there are Manifestation Determination meetings, Functional Behavioral Assessments, Behavior Intervention Plans, and 504 Meetings.


I may attend around 5-10 meetings a week and I only work part time. Special education teachers, administrators, and a few others will attend these meetings as well. We are VERY used to the process and the terminology. That being said, we constantly have to remind ourselves that parents are often not used to any of it. We went to school for years to learn this, and we've been living it out in our careers. It's second nature to many of us. Parents often come in understanding very little. I try to be conscious of explaining what we are doing to the parents. However, it's a lot of information that gets thrown out very quickly.

I want to know how many of the readers feel that you understood what transpired in the meetings you attended? Did you feel rushed? Did you feel supported? Share your comments and please vote in the poll. I'll leave it open through January and then discuss the results.




ee

What Parents Need to Know About the Special Education Evaluation


I spend most days of my life working with various students who are at different parts in the sped referral process. I attend Child Study Meetings where we decide if we are going to evaluate a student. I observe and screen children and talk with parents and teachers to help the committee make a good decision about whether we should do a special education evaluation.   I evaluate those students (this includes Psychological testing, observations, talking with student/teacher/parent, doing rating scales, etc.). I attend eligibility meetings where we determine if the student is eligible for for special education services. All of this is second nature to me and sometimes I need to stop and remember when a parent comes in, that this is NEW.

When I talk to parents, I find that many parents do not fully understand the special education referral process, even when they nod and act like they do. We as school staff need to do a better job of helping the parents understand the process. Parents also need to speak up and ask questions when there is not understanding.

This is a guide for parents to understand the process of special education testing, the testing components, and some of the test data. It is important to note that schools systems and states will vary to some degree. If you have any questions about the process in your school system, ask your school psychologist, teacher, or principal. Parents have every right to ask questions and usually school personnel are happy to help make this process less anxiety-provoking for you. It is important for parents to understand their rights during the special education process.


Special Education Process

After data shows that interventions have been attempted and if a student is suspected of having a disability, a referral is made to evaluate him or her for special education testing. Once the parents sign the Permission for Testing Forms, timelines begin and the schools have 65 business days to complete the assessments and hold the eligibility meeting. Some states may have a different timeline.

During these 65 days, several testing components will be completed with you and your child. The evaluators will write reports and a copy will be given to parents at the eligibility meeting. However, schools are required to have a copy available for parents to pick up two days before the eligibility meeting. It is advised, that parents take advantage of this and read reports before the meeting to help get familiar with the information and to formulate questions. The reports hold a lot of information that can be overwhelming if you are not familiar with this type of testing. Read Understanding Test Scores to understand the types of tests used and what the scores mean.

Additionally, the meeting is likely to bring forth strong emotions as your child’s difficulties are discussed openly. It can be overwhelming for parents, especially when not prepared. When parents do not read the reports prior to the eligibility meeting, they are the only people at the table who come to the meeting not knowing what to expect.


What if My Child is Found ELIGIBLE for Special Education Services?

Once a child is eligible for special education services, the schools have 30 days to develop an Individualized Education Plan (IEP) for the student. This will consist of accommodations, goals, and describe the services offered. Parents are part of a committee to help create this document. Once it is signed, schools are legally required to follow it. It is reviewed once a year, unless parents or teachers feel that changes are necessary. Every three years, the committee will determine if the student should be reevaluated. This is called a triennial evaluation. Sometimes another full evaluation will be conducted, other times a review of records and updated teacher information is used.


What if My Child is Found INELIGIBLE for Special Education Services?

If your child was found ineligible for special education services and you agree with the eligibility findings, then your child will not receive special education. He or she was evaluated because of a problem that still needs to be addressed within regular education. Ask for a separate meeting with your teacher or a team to determine what accommodations or strategies can be used to help.

If you believe that your child requires special education services and has a disability, but was found ineligible for services, make an appointment to meet with the special education director. If an agreement cannot be reached, you may be able to have an Independent Evaluation at the expense of the school. The results of that testing will be brought back to an eligibility meeting. A child MUST have 2 things before they can receive special education services: They must have a disability and there must be a documented educational impact that the student requires special education services to be successful.






ee

House probe: Trump admin failed to adequately screen travelers from South Korea, Italy for COVID-19

The Trump administration failed to conduct effective screening of passengers from South Korea and Italy for the coronavirus when those countries were experiencing rapid expansion in COVID-19 cases.




ee

DNA genealogy leads police to James E. Zastawnik in 1987 killing of Ohio teen Barbara Blatnik

Cleveland police say they have used DNA research to solve the 33-year-old strangling of a teenage girl, and arrest her killer.




ee

Honey bees face chronic paralysis pandemic in Britain

The virus responsible for chronic bee paralysis is spreading rapidly among honey bee colonies in Britain, according to a new study.




ee

Scientists unveil fossil fuel-free jet propulsion that uses microwave air plasmas

Engineers in China have developed a fossil fuel-free jet propulsion prototype design that uses microwave air plasmas.




ee

Wetter climate to trigger global warming feedback loop in the tropics

As the tropics get wetter, soils are likely experience greater rates of respiration and decomposition, limiting the carbon storage abilities of tropical soils and intensifying global warming.




ee

Researchers find honey bee gene that causes virgin birth

The Cape honey bee, a subspecies found along the southern coast of South Africa, reproduces without having sex. Now, scientists have identified the gene responsible for the bee's virgin births.




ee

Early marine reptiles used pebble-like teeth to crush shellfish

Some early ichthyosaurs used rounded, pebble-like teeth to crush the shells of snails and clam-like bivalves, according to new research.




ee

Disabled flies sleep more as they learn to adapt

New research suggests flies that are unable to fly sleep more as they learn to adapt to their disability.




ee

Migration &amp; Coronavirus: A Complicated Nexus Between Migration Management and Public Health

This webinar, organized by MPI and the Zolberg Institute on Migration and Mobility at The New School, discussed the state of play around the globe surrounding COVID-19 and examined where migration management and enforcement tools may be useful and where they may be ill-suited to advancing public health goals. 




ee

Africa Deepens its Approach to Migration Governance, But Are Policies Translating to Action?

While migration once was a lower-priority topic for African governments, the last decade has seen a deepening in governance. Policymakers have integrated migration into their national development strategies and mainstreamed it across policy domains such as health and education. The actions are promising on paper, yet questions remain about the extent to which they will translate to more effective migration management.




ee

Will Immigration Reform Ever Succeed Again? The Legacy of IRCA &amp; Its Enduring Lessons

This provocative discussion showcases Charles Kamasaki's book, Immigration Reform: The Corpse That Will Not Die, and explores the lessons that can be learned from the Immigration Reform and Control Act of 1986, its intended and unintended consequences, and how the law’s legacy has shaped contemporary politics surrounding immigration.




ee

Mike Pompeo to travel to Israel, meet with Benjamin Netanyahu, Benny Gantz

Secretary of State Mike Pompeo plans to travel to Israel next week to meet with Prime Minister Benjamin Netanyahu in his first international trip since coronavirus-related restrictions were put in place.




ee

U.S. stocks rise again on Wall Street despite job losses

The United States' bellwether stock index, the Dow Jones Industrial Average, climbed another 455 points Friday, posting its first weekly gain in three weeks.




ee

Ohio State University agrees to $10M settlement with abuse victims

Ohio State University will pay more than $40 million to 162 former students who said a team doctor abused them over two decades, the school announced.




ee

What to stream this weekend: 'SNL' season finale, 'Dead to Me' S2

The "Saturday Night Live" Season 45 finale, the Season 2 premiere of Netflix's "Dead to Me" and a second installment of "Disney Family Singalong" are just some of the entertainment options available this weekend.




ee

Podcast: It’s See You Later, Not Goodbye

  All good things must come to an end. And today is one of those days. In this episode of The Not Crazy Podcast, we say a sad farewell to...





ee

The Unseen Trauma of COVID-19

The kind of trauma doctors, nurses, and others in direct contact with COVID-19 patients have endured for months now — with an uncertain future posing a threat of many more...




ee

[ Dogs ] Open Question : I've come to a conclusion,Dogs section on YA is not worth my time or energy, it is bad enough it is full of what I assume are teenagers?

playing games but now I am being repeatedly harassed and accused of being a troll named Sophie. Well you all can just keep this grimy pool. I am not wasting my time or energy. Enjoy yourselves.




ee

[ Religion & Spirituality ] Open Question : Christians, why do some people keep lying by saying trans been using other Gender's room for long time but that lie?

i even got this from pro trans page that say they have laws banning men from women's room & trans aka GD was put into mad house, & even then there been alot of time where rapists &perverted freaks been using other Gender's bath room too doesn't make it right, they go to prison if they find out




ee

[ Singles & Dating ] Open Question : WHAT TO DO, TO MAKE FRIENDS? I NEED ADVICE?




ee

[ Religion & Spirituality ] Open Question : My mother keeps turning water into wine, walking on water and resurrecting from the dead. Is she a witch?




ee

[ Politics ] Open Question : Why hasn't there ever been a great Democrat presidents' face on Mount Rushmore?

Maybe because there's never been a great Democrat president?  And never will be.  They're all horrible.




ee

[ Engineering ] Open Question : How can I determine data rate of wireless device given this information?

802.11n device 20 MHz band 32 QAM 1/2 coding rate What's formula?




ee

[ Religion & Spirituality ] Open Question : How come there are different writers attributed to the Gospel of Mark.... why would Mark need different people to write his Gospel.?




ee

The Multicultural Dilemma: Amid Rising Diversity and Unsettled Equity Issues, New Zealand Seeks to Address Its Past and Present

New Zealand drew global attention for its unity and support for the Muslim community targeted during the horrific Christchurch attacks. Yet the country's road to inclusion has been far from straightforward, and amid rising diversity it is grappling with the best way to achieve inclusion for its multiethnic population, including indigenous Māori peoples and migrants. This article outlines the opportunities and challenges to fostering multiculturalism against a backdrop of bicultural policies.




ee

A Race Against the Clock: Meeting Seasonal Labor Needs in the Age of COVID-19

As governments have reacted to the coronavirus pandemic by closing borders, seasonal workers have been kept out, raising a pressing question: who is going to produce the food amid agricultural labor shortages? Policymakers in the Asia Pacific, Europe, and North America have responded by seeking to recruit residents, lengthen stays for already present seasonal workers, and find ways to continue admitting foreign seasonal labor, as this commentary explores.




ee

Under Lockdown Amid COVID-19 Pandemic, Europe Feels the Pinch from Slowed Intra-EU Labor Mobility

Border closures and lockdowns amid the COVID-19 pandemic have put a chill on intra-EU labor mobility, most immediately with the difficulty for European farmers to gain access to much-needed seasonal workers and for health-care institutions to get care workers. This article explores how these workers, who often face difficult situations, may be more vulnerable now. It also takes on implications for intra-EU labor mobility post-pandemic.




ee

Horses Recognize Pics of Their Keepers

Horses picked out photographs of their current keepers, and even of former keepers whom they had not seen in months, at a rate much better than chance.

-- Read more on ScientificAmerican.com




ee

When Staying Cool Seems Better Than Being Bad

So the bad news is that it is hot and sticky and muggy. Your skin makes tearing sounds when you get up from a plastic chair. On the Metro, you start to tell people apart by how they smell.




ee

How Deep a Distaste for Politicians Who Waffle?

When George W. Bush takes the podium tomorrow night to deliver his sixth State of the Union address, what are the chances he will say this? "The war in Iraq has been one gigantic mistake. I am sorry I got us into this mess. I am going to bring the troops home right away."




ee

Almost Everyone Lies, Often Seeing It as a Kindness

The perjury trial of I. Lewis "Scooter" Libby goes to the jury this week. The case speaks to several issues -- how the Bush administration deals with critics of the war in Iraq, and the games that Washington's reporters and politicians play with each other. As far as the jury is concerned, however,...




ee

Disagree About Iraq? You're Not Just Wrong -- You're Evil.

The conviction of I. Lewis "Scooter" Libby last week gave Americans a chance to pick at the scab of what has become a favored obsession -- the debate over the motives of the Bush administration in the run-up to the war in Iraq.




ee

When Seeing Is Disbelieving

Four years ago tomorrow, President Bush landed on the USS Abraham Lincoln and dramatically strode onto the deck in a flight suit, a crash helmet tucked under one arm. Even without the giant banner that hung from the ship's tower, the president's message about the progress of the war in Iraq was u...




ee

Wariness, Not Hatred, Keeps Civil Wars Raging

Here is a measure of the state of the war in Iraq: The number of Iraqis dying each month now rivals the total number of people who died in the Sept. 11, 2001, attacks.




ee

Why Torture Keeps Pace With Enlightenment

In the year 65, the Roman emperor Nero discovered that a group of nobles had hatched a conspiracy to kill him. The tyrant captured the suspects one by one and threatened them with torture; most confessed and implicated others. One of the conspirators, Epicharis, was publicly tortured -- her bones...




ee

Wondering Wall Street's Mood? Look Up

Forget about buying low and selling high. If you are worried about the recent volatility in the stock market, perhaps you should let the weather be your guide.




ee

The Christmastime Self-Esteem Paradox

Social psychologist William B. Swann once had a group of married people evaluate their spouses even as their spouses evaluated them. People with high self-esteem, the psychologist found, felt closer to their partners when they received positive evaluations. People with low self-esteem, however, felt...




ee

Petroleum Feeds Patriarchy

Climate change. Pollution. Financial expense. Our gas-guzzling ways have long been associated with a variety of problems, but disturbing evidence now points to a new dimension of our love affair with petroleum: Oil consumption and high oil prices hurt the political, social and economic development...




ee

Where the Conscience Meets the Checkbook

If to do were as easy as to know what were good to do, chapels had been churches, and poor men's cottages princes' palaces.




ee

Taking More Risks Because You Feel Safe

The housing market is in free fall: Quick -- let's protect homeowners against foreclosure.




ee

Who Are the Better Managers -- Political Appointees or Career Bureaucrats?

Every time the White House changes hands between the Democrats and the Republicans, the outgoing party quickly sees the virtues of staffing government departments with competent managers. The incoming party invariably seeks to reward loyal campaign operatives with political appointments.