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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.




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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!





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How to Stay Sane While Staying Home: Advice from an Introvert

For loners, recluses, and other solitary types such as myself, sheltering-in-place feels natural and normal. However scary other aspects of this pandemic might be, for us, this aspect isn’t. Working...




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Quality for Whom? Supporting Diverse Children and Workers in Early Childhood Quality Rating and Improvement Systems

For children in U.S. homes where a language other than English is spoken, early childhood programs that are responsive to their needs can be key to later academic success. But as states refine their Quality Rating and Improvement Systems (QRIS) to assess such programs, immigrant early childhood workers with in-demand language and cultural skills may be left behind. This report examines the challenges these workers face and promising practices to serve diverse communities.




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Can High-Intensity Exercise Improve Your Memory?

Exercise like walking, swimming, and even dancing have been shown to be good for your memory, but the optimal intensity of that exercise has been unclear... until now

-- Read more on ScientificAmerican.com




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A Needed Evidence Revolution: Using Cost-Benefit Analysis to Improve Refugee Integration Programming

European countries have ramped up their investments in helping refugees find work and integrate into society. Yet little hard evidence exists of what programs and policies work best. This report proposes a new framework for thinking smartly about integration programming, using cost-benefit analysis to look beyond short-term, economic outcomes to also measure indirect benefits through a social-value concept.




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Money Wise: Improving How EU Funds Support Migration and Integration Policy Objectives

European policymakers are negotiating the blueprint for the next EU funding cycle—a plan that will determine how much money is available for migration and integration aims, what it can be used for, and who can access it. This policy brief explores some of the limitations of EU funds, as well as strategies that could help them more effectively serve migration and integration policy goals.




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New Data Resources Can Help Improve Targeting of State Early Childhood and Parent-Focused Programs

As states work to build high-quality early childhood systems and implement the federal Workforce Innovation and Opportunity Act (WIOA) and Every Student Succeeds Act (ESSA), having detailed knowledge of the characteristics of immigrant parents can help maximize the effectiveness of programs that seek to improve child and family outcomes, as this commentary explains.




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As European policymakers take stock of seasonal worker programmes, MPI Europe brief outlines principles to improve these schemes for all parties

Findings will be discussed during 25 February MPI Europe – SVR webinar




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

OBJECTIVE

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

RESEARCH DESIGN AND METHODS

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

RESULTS

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

CONCLUSIONS

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




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

OBJECTIVE

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

RESEARCH DESIGN AND METHODS

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

RESULTS

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

CONCLUSIONS

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




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

OBJECTIVE

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

RESEARCH DESIGN AND METHODS

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

RESULTS

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

CONCLUSIONS

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




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Inoreader v13 is Here With Improved Looks and New Features!

Since the beginning, Inoreader was meant to be a power-user tool, pushing the boundaries of what RSS readers can do.…




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Insulin Strategies for Primary Care Providers

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




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Diabetes Self-Management in a Community Health Center: Improving Health Behaviors and Clinical Outcomes for Underserved Patients

Daren Anderson
Jan 1, 2008; 26:22-27
Bridges to Excellence




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Standards of Medical Care in Diabetes--2019 Abridged for Primary Care Providers

American Diabetes Association
Jan 1, 2019; 37:11-34
Position Statements




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Standards of Medical Care in Diabetes--2016 Abridged for Primary Care Providers

American Diabetes Association
Jan 1, 2016; 34:3-21
Position Statements




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Improving Patient Adherence

Alan M. Delamater
Apr 1, 2006; 24:71-77
Feature Articles




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Standards of Medical Care in Diabetes--2018 Abridged for Primary Care Providers

American Diabetes Association
Jan 1, 2018; 36:14-37
Position Statements




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Standards of Medical Care in Diabetes--2017 Abridged for Primary Care Providers

American Diabetes Association
Jan 1, 2017; 35:5-26
Position Statements




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Standards of Medical Care in Diabetes--2015 Abridged for Primary Care Providers

American Diabetes Association
Apr 1, 2015; 33:97-111
Position Statements




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Microvascular and Macrovascular Complications of Diabetes

Michael J. Fowler
Apr 1, 2008; 26:77-82
Diabetes Foundation




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May HoP, including a Special Section: Who Was Little Albert? The Historical Controversy

Photographs of John Watson (left) and Rosalie Rayner (right) via Ben Harris. The May 2020 issue of History of Psychology is now online. The issue includes a special section on “Who Was Little Albert? The Historical Controversy.” Full details follow below. Special Section: Who Was Little Albert? The Historical Controversy“Journals, referees, and gatekeepers in the … Continue reading May HoP, including a Special Section: Who Was Little Albert? The Historical Controversy




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How Technology Is Improving Safety On the Roads and Reducing Driving Anxiety

Technology has changed a number of aspects of our everyday lives and has led to increased efficiency. But when it comes to driving, has it helped or hindered the process? In this article, we will be looking into some of the ways that technology has improved safety on our roads in the last 10 years. […]




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A campaign for period positivity | Ananya Grover

Having your period is exhausting -- and for many people across the world, menstruation is even more challenging because of stigmas and difficulty getting basic hygiene supplies, says social activist Ananya Grover. In this uplifting, actionable talk, she shares how "Pravahkriti," her campaign to spread period positivity, creatively engages with everyone to promote menstrual health, raise awareness and break taboos around periods.




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North Carolina Teachers Turn Out in Droves for Daylong Protest

A sea of red-clad teachers took to the streets around North Carolina's legislative building in Raleigh to fight for higher pay and more school funding. See photos from the event.




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New Study Shows 1-to-1 Technology Improves Student Achievement in Math Over Time

A new study published in the Educational Evaluation and Policy Analysis journal found that there is potential for 1-to-1 technology programs to increase achievement in the short term, but more so in the medium term.




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North Carolina Awards $12 Million Dollar Grant to Improve Literacy Instruction

A $12.2 million dollar grant from the state Department of Public Instruction will go to a program based at North Carolina State University to provide additional training literacy training to teachers in 16 high-needs districts across the state.




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Staff Email Addresses Removed From District Websites to Improve Cybersecurity

Some district technology leaders say having staff email addresses publicly available opens the door for phishing scams and potential hacks.




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Eligibility for Federal School Improvement Grants Helped Ohio Students, Study Says

Academic achievement at Ohio schools eligible for School Improvement Grants during the Obama administration increased for a few years, a new study says, but SIG's legacy remains complicated.




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Ohio primary voters approved fewer school tax issues




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Ohio primary voters approved fewer school tax issues




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North Dakota the Latest State to Win ESSA-Plan Approval

With the plan's approval, North Dakota's educators will experience some of the nation's most dramatic changes under the Every Student Succeeds Act this fall.




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Here's Why a Maryland School Finance Overhaul Could Prove Groundbreaking

Maryland's legislature has proposed a unique way to fund schools and also wants to hold school districts more accountable for how they spend their money as part of a new funding formula.




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A Look at Teacher Improvement in Tennessee

A state department leader outlines what Tennessee is learning about teacher improvement and where the state still needs to learn more.




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Ohio primary voters approved fewer school tax issues




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School buses provide wi-fi internet for students at home




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Arkansas Provides K-12 Districts With Volunteer IT Team to Fight Cyber Attacks

The Arkansas Department of Education will now provide on-site help for schools and districts in the state that are experiencing cybersecurity incidents.




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Arkansas panel approves charter school campus




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R.I. Proposal Would Provide More School Choice, With Some Restrictions

Democratic Gov. Gina Raimondo proposes to allow traditional public schools to be free of certain regulations, including opening up enrollment outside their neighborhoods.




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Connecticut Provides Resources to Ease Transition to Kindergarten

These tools encourage school administrators to gather as much information as possible about the students who will be entering kindergarten and the early-learning offerings in their communities.




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Improvement under new coaches is wide-ranging

In 2018, the programs with new coaches had a combined .433 winning percentage (120-157), up from .416 (117-164) a year earlier. Four schools won or shared conference titles and made the postseason - ETSU (under Randy Sanders), UIW (Eric Morris), North Carolina A&T (Sam Washington) and Wofford (Josh Conklin). The winning percentage at schools with new coaches was .448 (137-169), up from .444 (123-154) in 2018, with a decline in record at 13 schools and a better one at the other 12.




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Building confidence in enrolling learners with disability for providers of education and training / ACPET, NDCO.




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24 1/2 Almond Tree Grove i:n the Vales / by Grandmother Christine.

"24 1⁄2 Almond Tree Grove is the second story in the series In the Vales. A fun, light fantasy story about a young girl who inherits her Grammy's Cottage in the Vales, then starts to remember some of Grammy's favourite stories of her wee friends. The Almond Tree fairies are so helpful to us all, just read my wee story and see. "These stories allow you to enter into a parallel world set within our local community. They will take you on a journey to allow your imagination to tell the tales of the adventurous characters in a variety of unique situ's. The dialogue twists between now and then to provide a rich connection to the character's shenanigans, which motivates the reader to visualise beyond the text to create deeper meaning and connection to self, family and the community we live in."




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Wills and Estates Family Provision and Contested Probate Case Update.




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Forum 2019 : 2C: Inheritance (Family Provision) Act claims / paper presented by Melisa Yule, Adelta Legal.




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Forum 2019 : 3D The keys to profit and cash flow improvement : slides / presented by Mathew Schlyder, Director, FWO Chartered Accountants.




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Forum 2019 : 4A Transform your business culture with a 'meta' skill... : one that improves all other skills : slides / presented by Tomas Jajesnica, Mr Meditate.




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Obligations of executors to potential family provision claimants / paper presented by The Hon. Justice Samuel Doyle, Supreme Court of South Australia.