Scottsdale, Ariz. — In February, the Arizona Dental Association was fully prepared to host the Western Regional Dental Experience April 2-4 at the Renaissance Phoenix Glendale Hotel and Spa.
The American Dental Association is urging the Centers for Disease Control and Prevention to “quickly provide guidance” on how to safely reopen dental practices during the deceleration phase of the COVID-19 outbreak.
The COVID-19 pandemic has left a path of destruction in urban centers throughout the northeastern United States, but the next outbreak hotspots could have even deadlier effects in rural areas.
New York City has been the epicenter of the COVID-19 outbreak in the United States, with immigrant populations in areas such as the Bronx "disproportionately" affected, a commentary in JAMA Internal Medicine says.
Combination therapy with interferon beta-1b plus lopinavir-ritonavir and ribavirin appears to improve symptoms and shorten hospital stays for people with mild to moderate COVID-19.
As European countries launch ambitious new legal migration partnerships with several origin and transit countries in Africa, this report takes stock of the long and mixed history of such projects. To make the most of their potential to encourage skills development and fill pressing labor gaps, policymakers will need to think carefully about the partners and sectors they choose, among other key considerations.
In the three years since the European migration and refugee crisis vividly captured public attention, a wave of innovative initiatives has emerged to help newcomers settle into receiving societies. Now, as the sense of crisis abates, this report explores what these initiatives will need to do to outlast the hype and produce lasting change on key integration issues such as housing, economic inclusion, and community building.
We sought to determine the prevalence of diabetes and associated cardiovascular outcomes in a contemporary cohort of young individuals presenting with their first myocardial infarction (MI) at age ≤50 years.
We retrospectively analyzed records of patients presenting with a first type 1 MI at age ≤50 years from 2000 to 2016. Diabetes was defined as a hemoglobin A1c ≥6.5% (48 mmol/mol) or a documented diagnosis of or treatment for diabetes. Vital status was ascertained for all patients, and cause of death was adjudicated.
Among 2,097 young patients who had a type 1 MI (mean age 44.0 ± 5.1 years, 19.3% female, 73% white), diabetes was present in 416 (20%), of whom 172 (41%) were receiving insulin. Over a median follow-up of 11.2 years (interquartile range 7.3–14.2 years), diabetes was associated with a higher all-cause mortality (hazard ratio 2.30; P < 0.001) and cardiovascular mortality (2.68; P < 0.001). These associations persisted after adjusting for baseline covariates (all-cause mortality: 1.65; P = 0.008; cardiovascular mortality: 2.10; P = 0.004).
Diabetes was present in 20% of patients who presented with their first MI at age ≤50 years and was associated with worse long-term all-cause and cardiovascular mortality. These findings highlight the need for implementing more-aggressive therapies aimed at preventing future adverse cardiovascular events in this population.
To investigate the association of the cardiovascular risk factor lipoprotein (Lp)(a) and vascular complications in patients with type 1 diabetes.
Patients with type 1 diabetes receiving regular care were recruited in this observational cross-sectional study and divided into four groups according to their Lp(a) levels in nmol/L (very low <10, low 10–30, intermediate 30–120, high >120). Prevalence of vascular complications was compared between the groups. In addition, the association between metabolic control, measured as HbA1c, and Lp(a) was studied.
The patients (n = 1,860) had a median age of 48 years, diabetes duration of 25 years, and HbA1c of 7.8% (61 mmol/mol). The median Lp(a) was 19 (interquartile range 10–71) nmol/L. No significant differences between men and women were observed, but Lp(a) levels increased with increasing age. Patients in the high Lp(a) group had higher prevalence of complications than patients in the very low Lp(a) group. The age- and smoking-status–adjusted relative risk ratio of having any macrovascular disease was 1.51 (95% CI 1.01–2.28, P = 0.048); coronary heart disease, 1.70 (95% CI 0.97–3.00, P = 0.063); albuminuria, 1.68 (95% CI 1.12–2.50, P = 0.01); and calcified aortic valve disease, 2.03 (95% CI 1.03–4.03; P = 0.042). Patients with good metabolic control, HbA1c <6.9% (<52 mmol/mol), had significantly lower Lp(a) levels than patients with poorer metabolic control, HbA1c >6.9% (>52 mmol/mol).
Lp(a) is a significant risk factor for macrovascular disease, albuminuria, and calcified aortic valve disease in patients with type 1 diabetes. Poor metabolic control in patients with type 1 diabetes is associated with increased Lp(a) levels.
Transient neonatal diabetes mellitus (TNDM) occurs during the 1st year of life and remits during childhood. We investigated glucose metabolism and socioeducational outcomes in adults.
We included 27 participants with a history of TNDM currently with (n = 24) or without (n = 3) relapse of diabetes, and 16 non-TNDM relatives known to be carriers of causal genetic defects and currently with (n = 9) or without (n = 7) diabetes. Insulin sensitivity and secretion were assessed by hyperinsulinemic-euglycemic clamp and arginine-stimulation testing in a subset of 8 TNDM participants and 7 relatives carrying genetic abnormalities, with and without diabetes, compared with 17 unrelated control subjects without diabetes.
In TNDM participants, age at relapse correlated positively with age at puberty (P = 0.019). The mean insulin secretion rate and acute insulin response to arginine were significantly lower in TNDM and relatives of participants with diabetes than in control subjects (4.7 [3.6–5.9] vs. 13.4 [11.8–16.1] pmol/kg/min, P < 0.0001; and 84.4 [33.0–178.8] vs. 399.6 [222.9–514.9] µIU/mL, P = 0.0011), but were not different between participants without diabetes (12.7 [10.4–14.3] pmol/kg/min and 396.3 [303.3–559.3] µIU/mL, respectively) and control subjects. Socioeducational attainment was lower in TNDM participants than in the general population, regardless of diabetes duration.
Relapse of diabetes occurred earlier in TNDM participants compared with relatives and was associated with puberty. Both groups had decreased educational attainment, and those with diabetes had lower insulin secretion capacity; however, there was no difference in insulin resistance in adulthood. These forms of diabetes should be included in maturity-onset diabetes of the young testing panels, and relatives of TNDM patients should be screened for underlying defects, as they may be treated with drugs other than insulin.
To determine the relationship between ATP7B mutations and diabetes in Wilson disease (WD).
A total of 21 exons and exon-intron boundaries of ATP7B were identified by Sanger sequencing.
Two novel compound heterozygous mutations (c.525 dupA/ Val176Serfs*28 and c.2930 C>T/ p.Thr977Met) were detected in ATP7B. After
This is the first report of diabetes caused by WD.
Screening for diabetes is typically done using hemoglobin A1c (HbA1c) or fasting plasma glucose (FPG). The 2019 Endocrine Society guidelines recommend further testing using an oral glucose tolerance test (OGTT) in older adults with prediabetic HbA1c or FPG. We evaluated the impact of this recommendation on diabetes prevalence, eligibility for glucose-lowering treatment, and estimated cost of implementation in a nationally representative sample.
We included 2,236 adults aged ≥65 years without known diabetes from the 2005–2016 National Health and Nutrition Examination Survey. Diabetes was defined using: 1) the Endocrine Society approach (HbA1c ≥6.5%, FPG ≥126 mg/dL, or 2-h plasma glucose ≥200 mg/dL among those with HbA1c 5.7–6.4% or FPG 100–125 mg/dL); and 2) a standard approach (HbA1c ≥6.5% or FPG ≥126 mg/dL). Treatment eligibility was defined using HbA1c cut points (≥7 to ≥9%). OGTT screening costs were estimated using Medicare fee schedules.
Diabetes prevalence was 15.7% (~5.0 million) using the Endocrine Society’s approach and 7.3% (~2.3 million) using the standard approach. Treatment eligibility ranged from 5.4 to 0.06% and 11.8–1.3% for diabetes cases identified through the Endocrine Society or standard approach, respectively. By definition, diabetes identified exclusively through the Endocrine Society approach had HbA11c <6.5% and would not be recommended for glucose-lowering treatment. Screening all older adults with prediabetic HbA1c/FPG (~18.3 million) with OGTT could cost between $737 million and $1.7 billion.
Adopting the 2019 Endocrine Society guidelines would substantially increase the number of older adults classified as having diabetes, require significant financial resources, but likely offer limited benefits.
Acrylamide exposure from daily-consumed food has raised global concern. We aimed to assess the exposure-response relationships of internal acrylamide exposure with oxidative DNA damage, lipid peroxidation, and fasting plasma glucose (FPG) alteration and investigate the mediating role of oxidative DNA damage and lipid peroxidation in the association of internal acrylamide exposure with FPG.
FPG and urinary biomarkers of oxidative DNA damage (8-hydroxy-deoxyguanosine [8-OHdG]), lipid peroxidation (8-iso-prostaglandin-F2α [8-iso-PGF2α]), and acrylamide exposure (N-acetyl-S-[2-carbamoylethyl]-
We found significant linear positive dose-response relationships of urinary acrylamide metabolites with 8-OHdG, 8-iso-PGF2α, and FPG (except GAMA with FPG) and 8-iso-PGF2α with FPG. Each 1-unit increase in log-transformed level of AAMA, AAMA + GAMA (UAAM), or 8-iso-PGF2α was associated with a 0.17, 0.15, or 0.23 mmol/L increase in FPG, respectively (P and/or P trend < 0.05). Each 1% increase in AAMA, GAMA, or UAAM was associated with a 0.19%, 0.27%, or 0.22% increase in 8-OHdG, respectively, and a 0.40%, 0.48%, or 0.44% increase in 8-iso-PGF2α, respectively (P and P trend < 0.05). Increased 8-iso-PGF2α rather than 8-OHdG significantly mediated 64.29% and 76.92% of the AAMA- and UAAM-associated FPG increases, respectively.
Exposure of the general adult population to acrylamide was associated with FPG elevation, oxidative DNA damage, and lipid peroxidation, which in turn partly mediated acrylamide-associated FPG elevation.
This study evaluated the ability of the Building, Relating, Assessing, and Validating Outcomes (BRAVO) risk engine to accurately project cardiovascular outcomes in three major clinical trials—BI 10773 (Empagliflozin) Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients (EMPA-REG OUTCOME), Canagliflozin Cardiovascular Assessment Study (CANVAS), and Dapagliflozin Effect on Cardiovascular Events–Thrombolysis in Myocardial Infarction (DECLARE-TIMI 58) trial—on sodium–glucose cotransporter 2 inhibitors (SGLT2is) to treat patients with type 2 diabetes.
Baseline data from the publications of the three trials were obtained and entered into the BRAVO model to predict cardiovascular outcomes. Projected benefits of reducing risk factors of interest (A1C, systolic blood pressure [SBP], LDL, or BMI) on cardiovascular events were evaluated, and simulated outcomes were compared with those observed in each trial.
BRAVO achieved the best prediction accuracy when simulating outcomes of the CANVAS and DECLARE-TIMI 58 trials. For the EMPA-REG OUTCOME trial, a mild bias was observed (~20%) in the prediction of mortality and angina. The effect of risk reduction on outcomes in treatment versus placebo groups predicted by the BRAVO model strongly correlated with the observed effect of risk reduction on the trial outcomes as published. Finally, the BRAVO engine revealed that most of the clinical benefits associated with SGLT2i treatment are through A1C control, although reductions in SBP and BMI explain a proportion of the observed decline in cardiovascular events.
The BRAVO risk engine was effective in predicting the benefits of SGLT2is on cardiovascular health through improvements in commonly measured risk factors, including A1C, SBP, and BMI. Since these benefits are individually small, the use of the complex, dynamic BRAVO model is ideal to explain the cardiovascular outcome trial results.
This study aims to evaluate the association of energy and macronutrient intake at dinner versus breakfast with disease-specific and all-cause mortality in people with diabetes.
A total of 4,699 people with diabetes who enrolled in the National Health and Nutrition Examination Survey from 2003 to 2014 were recruited for this study. Energy and macronutrient intake was measured by a 24-h dietary recall. The differences () in energy and macronutrient intake between dinner and breakfast ( = dinner – breakfast) were categorized into quintiles. Death information was obtained from the National Death Index until 2015. Cox proportional hazards regression models were developed to evaluate the survival relationship between and diabetes, cardiovascular disease (CVD), and all-cause mortality.
Among the 4,699 participants, 913 deaths, including 269 deaths due to diabetes and 314 deaths due to CVD, were documented. After adjustment for potential confounders, compared with participants in the lowest quintile of in terms of total energy and protein, participants in the highest quintile were more likely to die due to diabetes (hazard ratio [HR]energy 1.92, 99% CI 1.08–3.42; HRprotein 1.92, 99% CI 1.06–3.49) and CVD (HRenergy 1.69, 99% CI 1.02–2.80; HRprotein 1.96, 99% CI 1.14–3.39). The highest quintile of total fat was related to CVD mortality (HR 1.67, 99% CI 1.01–2.76). Isocalorically replacing 5% of total energy at dinner with breakfast was associated with 4% and 5% lower risk of diabetes (HR 0.96, 95% CI 0.94–0.98) and CVD (HR 0.95, 95% CI 0.93–0.97) mortality, respectively.
Higher intake of energy, total fat, and protein from dinner than breakfast was associated with greater diabetes, CVD, and all-cause mortality in people with diabetes.
The aim of this study was to examine the association of circulating retinol-binding protein 4 (RBP4) levels with β-cell function across the spectrum of glucose tolerance from normal to overt type 2 diabetes.
A total of 291 subjects aged 35–60 years with normal glucose tolerance (NGT), newly diagnosed impaired fasting glucose or glucose tolerance (IFG/IGT), or type 2 diabetes were screened by a standard 2-h oral glucose tolerance test (OGTT) with the use of traditional measures to evaluate β-cell function. From these participants, 74 subjects were recruited for an oral minimal model test, and β-cell function was assessed with model-derived indices. Circulating RBP4 levels were measured by a commercially available ELISA kit.
Circulating RBP4 levels were significantly and inversely correlated with β-cell function indicated by the Stumvoll first-phase and second-phase insulin secretion indices, but not with HOMA of β-cell function, calculated from the 2-h OGTT in 291 subjects across the spectrum of glycemia. The inverse association was also observed in subjects involved in the oral minimal model test with β-cell function assessed by both direct measures and model-derived measures, after adjustment for potential confounders. Moreover, RBP4 emerged as an independent factor of the disposition index-total insulin secretion.
Circulating RBP4 levels are inversely and independently correlated with β-cell function across the spectrum of glycemia, providing another possible explanation of the linkage between RBP4 and the pathogenesis of type 2 diabetes.
I would like to apologize to my readers for the leave of absense over the last few months. The past few months have been excessively busy for me, and School Psychologist Files has been put on the back burner. Now I'm back and have some new ideas for posts and updates. Look for new information in the coming months and weeks. Thanks for being patient with me.
Confession time. I tend to write this blog with my professional hat on, keeping my personal life, personal. Today, I am writing as a mother of two very dear, but very spirited children. People tend to think since I am a School Psychologist, that I know exactly what to do in my own family, and that I should have it all together. The reality is that I have struggles just like everyone else. Sometimes, my kids just don't listen. Sometimes, I feel overwhelmed too. Sometimes, I don't respond in the most positive manner.
Sometimes it can be very difficult to be positive. I know this from experience. While I'm usually an optimistic person, who tends to find good in situations (at least eventually), I sometimes struggle in the heat of the moment. Especially, when I am running late or stressed about something, I have much less tolerance for resistance and disobedience from my children.
In the last few weeks I've really been having a difficult time with the morning routine. There are a lot of procedures that need to occur efficiently in order for everyone to get to work and school on time. I do not like that I have turned into a Drill Sargent with very little patience for any deviation from the schedule. There are mornings that I tell my children to get dressed multiple times and am ignored multiple times. As the clock ticks and it's time to rush out the door with two children (age 5 and 3) who haven't gotten dressed yet, I become more and more negative. By the time we get to the daily "Yes you are wearing a coat- it's 25 degrees outside!" argument with the second child, I have lost all patience. When they walk to the car, I'm behind carrying everything and making sure the door shuts, and have been known to yell "RUN!, RUN TO THE CAR, RUN!" and eventually pick up the meandering child and put her in the car at my own pace. How's that for a start to one's day? I don't feel very good about those days.
Thankfully, not every morning is like that. There are also days that everyone is calm and everyone got ready (although hurriedly), but we got to school/work on time and in good spirits. Specifically I think of a day earlier this week that I handed all the clothes to my five year old and asked him to get himself dressed and see if he could help his little sister a little bit. He helped her step by step, and was extremely proud of himself. I enthusiastically praised him for his help and everyone went to school and work happy that day.
So what is the difference between the crazy mornings and the relatively calm mornings? I want to say- "my kids." I want to say "some mornings they choose to focus on getting dressed and I don't have to argue with them, so we are happy." And while they do play a small part, the biggest factor is ME. I'm the difference. When I am more calm, I have the mindset to be more positive and encouraging, which the children actually respond to. When I am frantic, I think they retreat and are much more prone to act out or start throwing their own fits (about coats or shoes). Yes, there are days that my kids don't listen the first time. However, they are 3 and 5 years old. Also, they don't care if I am late, it means nothing to them. So, what is the main thing I can do to change our crazy mornings. It's not a magic cure to make my kids get ready in a hurried and frantic manner that will get everyone out the door on time. The answer is getting myself up earlier, so I am not stressing about my tardiness and I can focus on helping everyone else get ready.
So here's the challenge to all parents- Take a look at a part of your day that is prone to go poorly with your kids. Think about what you can do yourself to help change the situation. I don't mean what your children could or should do or what you need to do to change your child. Let's take a hard look at yourself first, and see what you can do to yourself to make a positive change in a situation. For my mornings- it's pretty obvious- like it or not, I need to wake up earlier. I'm always saying I should wake up earlier, but that snooze button is quite tempting every morning. Since I'm blogging about it, I now have many people out there to keep me accountable. I'm thinking that if I were not rushed and frantic, then I would be more patient with my kids and able to start using more positive methods for getting them to get ready. While there is an issue that I'm being ignored sometimes- right now I'm just going to focus on making a change to myself. I'm guessing it will spill into everyone else.
Let's all find one small thing we can do ourselves that will help be a blessing for our entire family.
On paper, the Diversity Visa Program is not set up to bring in the highly skilled; applicants need only a high school diploma (or equivalent) or two years of mid-level work experience. Yet as this commentary explains, the green-card lottery has become a channel for entry of the highly skilled—with half of recipients coming to the United States in recent years having a college degree.
Authorities have charged a fourth person connected to the shooting death of a Flint, Mich., security guard who was killed after confronting a customer who entered a store without a state-mandated facemask.
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.
The mission of Medip Academy Resources site is to provide teaching and learning materials to medical students (UG and PG) and medical professionals. Medip Academy Resources is a platform for sharing University Examination Papers, Medical Educational Materials, Practical Guides, MCQs, Problem solving etc. The resources available on this site are easily searchable and free to download. URL: http://www.medipacademy.com/resources Email: resources@medipacademy.com How to add a resource? Please share your useful resource by email to resources@medipacademy.com Happy Sharing! Dr. Bhaven Kataria Department of Pharmacology, GMERS Medical College, Sola Ahmedabad, Gujarat, India
A 29 years old female presented to us in the metabolic clinic of the University of Port Harcourt Teaching Hospital (UPTH) on account of a week history of easy fatigability, weakness, and lower extremity muscle cramps associated with numbness and tingling sensation in the peri-oral area, fingers and toes. Two weeks prior to the onset of her presenting symptoms, she had visited a local pharmaceutical shop on account of a distressing epigastric discomfort and was subsequently placed on daily oral omeprazole 20mg daily for a month by a pharmacist. She had been on the omeprazole medication for two weeks before her present symptoms manifested. Her past medical history was not suggestive of hypoparathyroidism nor pancreatitis. She was married with three children and has an uneventful family, social and obstetric histories. On examination, she was a healthy well-oriented young female with positive Trousseau’s, Chvostek’s and epigastric tenderness signs. Further Laboratory evaluation revealed she had low plasma magnesium, low plasma albumin-corrected calcium, and low serum parathyroid hormone levels, while other laboratory parameters were essentially normal. A diagnosis of omeprazole-induced electrolyte disorders (hypomagnesaemia and hypocalcaemia) associated with hypoparathyroidism was made following the review of her clinical examination and laboratory findings. She was subsequently managed with oral magnesium supplements following the withdrawal of the omeprazole medication (replaced with oral ranitidine), monitored weekly, and full recovery was achieved after three weeks.
The two astronauts who are to begin a new era of human spaceflight from U.S. soil this month said Friday they hope to inspire generations of Americans.
This fact sheet compares key components of immigration reform outlined in the 2013 Senate immigration bill against provisions included in bills considered by the Senate in 2006 and 2007: border security, detention, and enforcement; worksite enforcement; visa reforms; earned legalization of unauthorized immigrants; strengthening the U.S. economy and workforce; and integration of new Americans.
MPI has completed an analysis of the major provisions in the 2013 framework, comparing them to provisions of the legislation the Senate considered in 2006 and 2007.
This fact sheet is formatted as a chart comparing the framework of comprehensive immigration reform outlined in the 2013 Senate immigration bill against provisions included in bills considered by the Senate in 2006 and 2007.
This fact sheet offers a detailed review of the comprehensive immigration reform legislation approved by the U.S. Senate in June 2013 and compares its major provisions with those of the five targeted immigration bills approved by the House Judiciary Committee and the House Homeland Security Committee.
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.
Here’s my Q&A column from the WSJ this week — and if you have any questions for me, you can tweet them to @danariely with the hashtag #askariely, post a comment on my Ask Ariely Facebook page, or email them to AskAriely@wsj.com. ___________________________________________________ Dear Dan, People in my office drink a...
Here’s my Q&A column from the WSJ this week — and if you have any questions for me, you can tweet them to @danariely with the hashtag #askariely, post a comment on my Ask Ariely Facebook page, or email them to AskAriely@wsj.com. ___________________________________________________ Dear Dan, My partner and I are students,...
The USS Montgomery and the USNS Cesar Chavez sailed into the South China Sea this week in support of the West Capella drill ship, according to U.S. Indo-Pacific Command.
Based on the newest forecasting models, AccuWeather forecasters have extended the upper range of hurricanes predicted for the Atlantic hurricane season.
South Dakota Gov. Kristi Noem has ordered two Sioux tribes to remove checkpoints designed to curb the coronavirus on tribal lands.
Pete Davidson discussed on "The Tonight Show" how Bill Hader helped him land a spot on "Saturday Night Live."
Kelly Clarkson discussed the challenges of filming "The Voice" at home amid the coronavirus pandemic.
Katy Perry announced "Daisies," a first single from her forthcoming fifth studio album and a rumored collaboration with Taylor Swift.
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.
CBS said it has ordered first seasons of three new shows -- "Clarice," "The Equalizer" and "B Positive" for the 2020-21 television season.
While our external world begins to shrink during this time of social distancing and shelter-in-place health orders, we are challenged to expand our personal, internal limits and thresholds for almost...
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
While low-skilled workers generally have limited opportunities to legally migrate to the European Union, seasonal migration forms an important exception. This MPI Europe-SVR webinar explores lessons from Europe on managing seasonal worker programs that are responsive to labor market needs but also prioritize the well-being of seasonal workers and interests of receiving countries.
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.
New research in mice suggests that a pregnancy hormone contributes to brain and behavioral changes caused by childhood adversity
-- Read more on ScientificAmerican.com
Health journalist Judy Foreman talks about her new book Exercise Is Medicine: How Physical Activity Boosts Health and Slows Aging.
-- Read more on ScientificAmerican.com