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Talk Evidence - Talking about harms

In this special edition of talk evidence, Helen Macdonald and Carl Henneghan talk about creating an evidence base from harms. We hear from a member of the pubic who experienced harm from a drug, and now advises the FDA. A former regulator who explains why reporting harms is so important. And finally, an investigative journalist who explains what...




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Writing a good outpatient letter means addressing it to the patient

In many countries (including the UK and Australia) it is still common practice for hospital doctors to write letters to patients’ general practitioners (GPs) following outpatient consultations, and for patients to receive copies of these letters. However, Hugh Rayner, consultant nephrologist, and Peter Rees, former Chair of the Academy of...




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Cycling - Does the health benefit outweigh the accident risk (in the UK)

We all know we should be doing more exercise, and one way to do that is by active commuting - journeying to work on foot or by bike. One thing preventing people from taking up cycling is the fear of being involved in road traffic accidents, and that the risk isn't worth the benefit of the extra exercise. It’s even more confusing when air...




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COVID burnout! - Health workers burdened as they fight stubborn virus

Edmond Campbell/Senior Parliamentary Reporter Conceding that healthcare workers in the public sector are burnt out as they combat COVID-19, Health and Wellness Minister Dr Christopher Tufton says the Government is taking steps to boost its...




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Downswell reaches out to Central Village - Carry Me singer delivers care packages to community

The wet weather last Saturday (May 2) could not dampen the spirits of award-winning gospel artiste and ordained evangelist Kevin Downswell as he ventured into the St Catherine community of Central Village, where he spent some of his formative years...




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Thousands of hungry people line up for food in South Africa

OLIEVENHOUTBOS, South Africa (AP) — Thousands of people stood in line for hours on Saturday in a South African township waiting for handouts of food. The scene has repeated for days in one of the world’s most unequal countries as...




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Diabetes: precision approach will improve outcomes, says research director




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Progress in diabetes care has not improved outcomes in US, study finds




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Bell lays out vision on first day of workouts

Wednesday marked the first time that manager David Bell got to address Reds players as a group when he spoke to pitchers and catchers ahead of their first workout of Spring Training. Bell put a lot of thought into what he wanted to tell them.




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Winker unfazed by crowded Reds outfield

Since Jesse Winker suffered a season-ending shoulder injury on July 23, he's gained a lot of company in the corner-outfield spots.




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What about social rights?

THE EDITOR, Madam: The right to education, decent work, an adequate standard of living, and housing all fall within the realm of economic, social, and cultural rights (ESCRs) guaranteed under the International Covenant on Economic, Social and...




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A Single Bout of One-Legged Exercise to Local Exhaustion Decreases Insulin Action in Nonexercised Muscle Leading to Decreased Whole-Body Insulin Action

A single bout of exercise enhances insulin action in the exercised muscle. However, not all human studies find that this translates into increased whole-body insulin action, suggesting that insulin action in rested muscle or other organs may be decreased by exercise. To investigate this, eight healthy men underwent a euglycemic-hyperinsulinemic clamp on 2 separate days: one day with prior one-legged knee-extensor exercise to local exhaustion (~2.5 h) and another day without exercise. Whole-body glucose disposal was ~18% lower on the exercise day as compared with the resting day due to decreased (~37%) insulin-stimulated glucose uptake in the nonexercised muscle. Insulin signaling at the level of Akt2 was impaired in the nonexercised muscle on the exercise day, suggesting that decreased insulin action in nonexercised muscle may reduce GLUT4 translocation in response to insulin. Thus, the effect of a single bout of exercise on whole-body insulin action depends on the balance between local effects increasing and systemic effects decreasing insulin action. Physiologically, this mechanism may serve to direct glucose into the muscles in need of glycogen replenishment. For insulin-treated patients, this complex relationship may explain the difficulties in predicting the adequate insulin dose for maintaining glucose homeostasis following physical activity.




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Famine Threatens South Sudan

9 July 2014

Rob Bailey

Former Research Director, Energy, Environment and Resources
Despite early warnings that the country could soon be facing famine, a half-funded appeal and muted media coverage suggest that lessons from Somalia’s 2011 humanitarian crisis have not been learned.

20140709SSUDANW.jpg

Thousands of people wait in the hot sun in Leer, South Sudan 5 July, 2014 for the first air drops by the ICRC for nearly two decades. Photo by Nichole Sobecki/AFP/Getty Images.

On its third anniversary, South Sudan is teetering on the brink of humanitarian disaster. Without urgent action, some parts of the country face famine as a result of conflict, a poor harvest and high, pre-existing levels of malnutrition and poverty. If all this sounds eerily familiar, it should. In July 2011 similar conditions saw famine strike in Somalia, just as South Sudan gained its independence. It is estimated that more than a quarter of a million people died during this catastrophe, most of them children.

The situation in South Sudan shows the lessons of 2011 have not been learned. Early warnings of disaster in Somalia accumulated for almost a year before famine was eventually declared by the UN. The threat was first explicitly raised by the Famine Early-Warning Systems Network (FEWSNET) in March 2011 and again in May. Yet the humanitarian system remained dormant. Had donors and agencies intervened early, they could have prevented the downward spiral into destitution and starvation. The reasons why early warnings did not lead to early action were documented in a major Chatham House report that concluded with numerous recommendations for how programmes, funding and decision-making should be reformed to avoid such a failure ever happening again.

Fast forward to 2014 and head 1,000 miles west, and little seems to have changed. FEWSNET warned of famine in South Sudan in early May, yet official UN data reveals no subsequent increase in funding. If anything, contributions to the South Sudan emergency appeal appear to have slowed, with April, May and June showing markedly less being received than in previous months. With the lean season (when food insecurity peaks) now well underway, the appeal is less than half-funded.

Experience shows that the thing most likely to mobilize emergency funding is not early warning but media coverage, which can lead to pressure from publics for donor governments to act. News of the situation in South Sudan has been muted, however. According to Google Trends, there was no increase in the number of headlines on South Sudan following the famine warning in May for example. Three years ago in Somalia, it was not until famine was declared that the crisis caught the global media’s attention and donors finally responded. By then it was, by definition, too late to avert catastrophe.

Despite these alarming similarities, it is not inevitable that South Sudan will mark its third anniversary with famine. Like all complex forecasts, famine early warnings do not deal in certainties. And, although the window of opportunity for preventive action has probably closed by now and the challenge of reaching communities in the midst of conflict is huge, it is still possible for humanitarian actors to mitigate the worst-case scenario with a concerted and coordinated push to distribute aid and scale-up emergency infant nutrition programmes in the worst-affected areas. But even if famine is avoided, communities in South Sudan will be left weaker, poorer and more vulnerable to the next crisis. The risk will remain. 

To comment on this article, please contact Chatham House Feedback




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The Marikana Killings and Labour Dispute Resolution in South Africa: Implications of an Inquiry

Research Event

4 August 2015 - 4:00pm to 5:00pm

Chatham House, London

Event participants

Toby Fisher, Barrister, Landmark Chambers; Representative of the South African Human Rights Commission, Marikana Commission of Inquiry
Gary White, Director of Operations, Ineqe Group; Expert Witness on Policing, Marikana Commission of Inquiry
Chair: Muzong Kodi, Associate Fellow, Africa Programme

The Marikana Commission of inquiry was appointed by South Africa’s President Jacob Zuma following more than 40 deaths (with many others left injured) after police opened fire on striking miners at Marikana in August 2012.

The massacre was reported as the worst use of lethal force by the South African Police Service since 1994, and brought issues of labour dispute resolution, public-order policing and accountability into stark relief.

Speakers will discuss the Commission's recently-published report and its potential impact on industrial stakeholders, as well as the wider consequences for South Africa.

Department/project

Christopher Vandome

Research Fellow, Africa Programme
+44 (0) 20 7314 3669




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MLB to honor Jackie Robinson throughout 2019

Jackie Robinson was born a century ago this Jan. 31. To commemorate the 100th anniversary of the birth of one of baseball's most important pioneers, Major League Baseball has planned a yearlong slate of activities in Robinson's honor.




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D-backs announce record turnout to Fan Fest

As he walked around D-backs Fan Fest on Saturday afternoon at Salt River Fields, general manager Mike Hazen was pleasantly surprised to see the fan reaction as a record crowd of over 40,000 poured into the event.




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D-backs to sort out closer role in spring

After watching his pitchers and catchers go through their first workout Wednesday, D-backs manager Torey Lovullo said it was too early to say whether Archie Bradley, Greg Holland or Yoshihisa Hirano would be his closer come Opening Day.




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Manual acupuncture versus sham acupuncture and usual care for prophylaxis of episodic migraine without aura: multicentre, randomised clinical trial




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Occurrence, prevention, and management of the psychological effects of emerging virus outbreaks on healthcare workers: rapid review and meta-analysis




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Sagicor raises doubt about Scotia Life T&T deal

Sagicor Finance Company has raised doubt about whether the deal to acquire the assets of Scotia Life Trinidad...




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The Indo-Pacific: Geostrategic Outlook to 2024 - Workshop 4

Invitation Only Research Event

26 November 2019 - 9:30am to 12:00pm

Gateway House, Stevens Street, Colaba

This closed-door roundtable explores possible strategic shifts in the Indo-Pacific between now and 2024.

Focusing on trade security, climate change disruptions and security cooperation, it aims to enhance the understanding of the regional goals of, and strategic relationships between, the key countries active in the region.

The workshop is part of a larger project funded by the Strategic Policy Division of the Australian Department of Defence.

The project includes workshops in the United States, the United Kingdom, France, Japan, India and the Pacific Islands (Tonga).

Anna Aberg

Research Analyst, Energy, Environment and Resources Programme
020 7314 3629




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Iran Workshop Series: Domestic, Regional and International Outlook

Invitation Only Research Event

17 December 2019 - 10:00am to 3:30pm

Chatham House | 10 St James's Square | London | SW1Y 4LE

After a summer of regional tensions and continued uncertainty regarding the future of the JCPOA, the Chatham House MENA Programme held a closed workshop to examine the impact of the Trump administration’s maximum pressure campaign.

Discussions focused on the domestic developments and challenges inside Iran, prospects for new negotiations with Iran, and the regional issues facing the country. Participants also considered the differences between American and European approaches towards Iran.

 

Event attributes

Chatham House Rule

Reni Zhelyazkova

Programme Coordinator, Middle East and North Africa Programme
+44 (0)20 7314 3624




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Virtual Breakfast: Engaging with the EU From the Outside: A Perspective From Norway

Invitation Only Research Event

24 April 2020 - 8:30am to 9:30am

Event participants

Niels Engelschiøn, Director-General, Department for European Affairs, Norwegian Ministry of Foreign Affairs
Chair: Dr Robin Niblett, Director; Chief Executive, Chatham House

Please note this an online-only event.

Norway is one of the few European countries that remains outside of the European Union. After the country’s population rejected the prospect of joining the EU twice, Norway’s relationship with the Union has been based on its membership of the European Economic Area (EEA), alongside Iceland and Liechtenstein.

The ‘Norway Model’ was often mentioned in the run up to the Brexit vote as a possible basis for Britain’s future relationship with the bloc, not least because it offers the least disruption to the current arrangement. Equally, Norway is not subject to the EU fisheries policy - an anticipated major issue in the next phase of Brexit talks. Nor is it part of the EU Customs Union.

Even though Prime Minister Johnson has now ruled out the type of deep economic and regulatory integration with the EU that Norway enjoys through its EEA membership, the country’s experience can still offer valuable lessons for the UK as it prepares to exit the transition period at the end of 2020.

In this session, the speaker will share Norway’s experience as a long-standing EEA member and discuss the challenges of engaging with the EU from the outside. What lessons can Norway offer the UK ahead of the negotiations on the future of UK-EU relations? What are the limits of its current arrangement with the EU? And is there any appetite among the Norwegian population to revisit it?

Alina Lyadova

Europe Programme Coordinator




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Webinar: Turkey’s Challenging Post-COVID 19 Outlook

Invitation Only Research Event

7 May 2020 - 1:00pm to 2:00pm

Event participants

Dr Murat Ucer, Turkey Country Analyst, GlobalSource Partners 
Chair: Fadi Hakura, Manager, Turkey Project, Europe Programme, Chatham House

Turkish President Recep Tayyip Erdogan has so far refused to impose a nation-wide lockdown to suppress the spread of coronavirus in the country. In late March, Turkish health officials announced that they expect the virus to peak in three weeks' time and for Turkey to overcome it quickly. At the same time, Turkey has ruled out turning to the IMF for help in dealing with the crisis despite growing pressures on the Lira and the wider economy. The country's relations with its traditional allies, the US and Europe, remain thorny.
 
This event will focus on the likely impact of the epidemic on Turkey's economy and politics. What are the reasons behind Erdogan’s reluctance to implement a comprehensive lockdown to break the chain of virus transmission? Why is Turkey resolutely opposed to agreeing a funding package with the IMF? What is the macro outlook for 2020 and beyond for the country's economy? And how may the government's long-term popularity be affected?

Event attributes

Chatham House Rule

Department/project

Alina Lyadova

Europe Programme Coordinator




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Geostrategic Outlook for the Indo-Pacific 2019-2024

The project aims to broaden and deepen understanding of the geostrategic realities in, and outlook for, the Indo-Pacific region.

Focusing on trade security, climate change disruptions and security cooperation, the project will develop scenarios exploring possible shifts in regional economic and security priorities from 2019-2024.

Research staff from Chatham House will, in cooperation with local partners, convene expert roundtables in the United Kingdom, France, Japan, India, the United States and Tonga to enhance the discourse and understanding of the strategic relationships in the region, as well as the shared – or disparate – goals of the various countries.

A podcast will be recorded and released in conjunction with each event. The project will culminate with a research paper, amalgamating the roundtable discussions with analyses and policy recommendations developed by the Chatham House team.

Department contact

Anna Aberg

Research Analyst, Energy, Environment and Resources Programme
020 7314 3629




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Chile’s Social Unrest: Why It’s Time to Get Serious about a ‘Just’ Transition

4 November 2019

Patrick Schröder

Senior Research Fellow, Energy, Environment and Resources Programme
President Sebastián Piñera’s decision to cancel the COP25 climate negotiations, which Chile was due to host in early December, shows the importance of ensuring the transition to a sustainable world is just.

2019-11-04-Chile-Protests.jpg

Demonstrators march in Santiago, Chile during street protests which erupted over a now suspended hike in metro ticket prices. Photo: Getty Images.

One year ago, during the last annual Conference of Parties (COP) held in Katowice, the Polish government launched a Solidarity and Just Transition Declaration, signed by 56 governments including the UK, making the case for why the green transition must be just.

Three years earlier in 2015, the landmark Paris Agreement also included provisions for a just transition where it stated that the decarbonization process should be ‘Taking into account the imperatives of a just transition of the workforce and the creation of decent work and quality jobs in accordance with nationally defined development priorities’. In practice, however, the concept of a just transition has not yet been implemented and has not been sufficiently considered by governments or corporations around the world.

The social unrest that has erupted in Chile’s capital Santiago over the past month, which has forced the Chilean government to ask to move this year’s COP to Madrid, is a case in point. This discontent clearly shows that climate action cannot be separated from social justice concerns. There has not been a real commitment by governments to ensure a just transition based on social dialogue from the local to the national level. This was seen in France with the gilets jaunes protests in November 2018 – one month after President Emmanuel Macron ended the so-called ‘fortune tax’ and instead introduced taxes on diesel fuel as part of an effort to transition to green energy – and the current situation in Chile has some striking parallels. 

Sustainability transitions are a complex web of political choices and investment decisions which affect countries and societies in many different ways. Questions of social justice are everywhere, but in most cases, poorly understood by decision-makers. For example, although poverty has been reduced significantly over the last decade, Chile has one of the worst rates of inequality in Latin America and the highest Gini index in the OECD. The decisions taken in 2017 to power Metro de Santiago with solar photovoltaics and wind energy are commendable from a climate perspective, however, it led to students and young people protesting against rises in subway fares in October 2019.

They were joined by Chileans who are frustrated with rising living costs and by workers and trade unions struggling with low wages. As reported by the Chilean Human Rights Commission (INDH), so far more than 4,200 people have been arrested and more than 1,300 injured and hospitalized.

Climate negotiations beyond technicalities

This time there is also another important dimension to the protests: social unrest as a reaction to worsening inequality has the potential to derail multilateral cooperation on climate change and other global issues. Since tackling climate change is a race against the clock, the world faces the challenge of addressing both urgency and equity. The world cannot afford delays and needs to move fast but decision-makers need to take time for deliberation and civic participation to avoid rapid and ill-conceived transitions which eventually meet public resistance.

Many technical experts and negotiators, who often unintentionally divorce climate policy and technical discussions about emission reductions from social justice concerns, have been caught by surprise by the cancellation of the negotiations. For this year’s COP, one important focus of the official negotiations are the so-called 'Article 6 Rules' – the accounting mechanisms and modalities for a new form of international interaction on carbon markets and off-setting to ensure carbon markets can support countries in enhancing the ambitions of their stated climate action, known as Nationally Determined Contributions (NDCs). 

What is becoming much more obvious now is that just transitions are at least equally important for achieving NDCs and other long-term mitigation strategies.

In order to meet the 1.5 degree target, stated by the Intergovernmental Panel on Climate Change (IPCC), the world will have to invest an average of around $3 trillion a year over the next three decades in transforming its energy supply systems. But how can we ensure that these investments benefit low-income communities? Will they further increase everyday living costs? The climate finance related discussions focussing on commercially-oriented investments for low-carbon energy systems in most cases only consider the aspect of affordability, but not the other important principles of alternative ‘just’ energy finance, such as good governance, due process, intra-generational equity, spatial equity and financial resilience. Investments to support just transitions need to ensure investments, not only for large energy infrastructure, but also in the jobs, skills and work vital to both adaptation and mitigation.

Just transitions for a circular economy

The just transition concept is also the entry point to broader discussions about inclusive economic transformations, questioning the dominant paradigm of consumerism and ending the wasteful use of critical resources. The current linear economic model of take-make-throw away – in Chile epitomized by the linear extractive model of the mining sector that has contributed to widening inequality – the linear extractive model is not only destructive on the natural environment but also destructive for social cohesion.

In Chile, the commodity boom in copper production – the country accounts for about 30 per cent of the world’s output – and more recently lithium – which is used in batteries for mobile phones, laptops and electric cars – have generated enormous prosperity in Chile. But the wealth has been unequally distributed and has not been used to lay the foundation for raising the overall level of incomes.

A socially embedded and inclusive circular economy can, therefore, be a way forward from the current situation the Latin American country finds itself in. The circular economy was intended to feature prominently during the 25th COP and Chile’s policies – from the Ministry of Environment and Chile's Production Development Corporation (CORFO) – have played an important role in supporting the development of a circular economy, launching in 2018, the first public circular economy programme in Latin America

The government’s support for start-up companies and entrepreneurs to develop inclusive circular economy business models is the right approach to addressing the issues of waste, employment, services for low-income communities and local economic development. These are solutions that need to be scaled up having the potential to reduce Chile’s economic reliance on the dominant extractive model.

As a global community, it is necessary to address the environmental and social objectives equally as not addressing social objectives will become an obstacle in achieving climate mitigation and solving other environmental issues. 

The Chilean protests are a wake-up call and present an opportunity for the global climate change community – which includes governments – to ensure just transitions are implemented in practice.




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COP26 Diplomatic Briefing Series: Outcomes of COP25 and What It Means for 2020

Invitation Only Research Event

22 January 2020 - 4:30pm to 6:00pm

Chatham House | 10 St James's Square | London | SW1Y 4LE

HE Raffaele Trombetta, Italian Ambassador to the UK, Co-Host, COP 26
Archie Young, UK Lead Climate Negotiator, Cabinet Office 
Peter Betts, Associate Fellow, Energy, Environment and Resources Department, Chatham House
Chair: Professor Tim Benton, Research Director, Energy, Environment and Resources, Chatham House  

The UK will host the 26th Conference of the Parties (COP26) in November 2020 in Glasgow. In the run up, Chatham House is organizing a monthly briefing series targeted to:

  • The diplomatic service based in London, in particular, staff of the London embassies who are reporting on climate change issues.
  • Senior UK government civil servants, officials and politicians engaged in climate change.
  • Academics, experts, business representatives and NGOs.

The first briefing in the series focuses on the results from COP25 held in Madrid in December 2019 and what this means for 2020.

This briefings series offer an opportunity to discuss, in an informal setting, the most pressing and complex climate issues of the day with UK and international government officials and experts.

Johanna Tilkanen

Project Manager, Energy, Environment and Resources Department

Event attributes

Chatham House Rule




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The Indo-Pacific: Geostrategic Outlook to 2024 - Workshop 4

Invitation Only Research Event

26 November 2019 - 9:30am to 12:00pm

Gateway House, Stevens Street, Colaba

This closed-door roundtable explores possible strategic shifts in the Indo-Pacific between now and 2024.

Focusing on trade security, climate change disruptions and security cooperation, it aims to enhance the understanding of the regional goals of, and strategic relationships between, the key countries active in the region.

The workshop is part of a larger project funded by the Strategic Policy Division of the Australian Department of Defence.

The project includes workshops in the United States, the United Kingdom, France, Japan, India and the Pacific Islands (Tonga).

Anna Aberg

Research Analyst, Energy, Environment and Resources Programme
020 7314 3629




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The Indo-Pacific: Geostrategic Outlook From Now to 2024 - Workshop 5

Invitation Only Research Event

18 February 2020 - 12:00pm to 4:30pm

Langafonua Centre

This roundtable explores possible strategic shifts in the Indo-Pacific between now and 2024. Focusing on trade security, climate change disruptions and security cooperation, it aims to enhance the understanding of the regional goals of, and strategic relationships between, the key countries active in the region.

The workshop is part of a larger project funded by the Strategic Policy Division of the Australian Department of Defence. The project includes workshops in the United States, the United Kingdom, France, Japan, India and the Pacific Islands (Tonga).
 

Anna Aberg

Research Analyst, Energy, Environment and Resources Programme
020 7314 3629




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A musical about malignancy




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Covid-19: Home testing programme across England aims to help define way out of lockdown




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Facts about English Learners and the NCLB/ESSA Transition in Select States

These fact sheets provide a sketch of key characteristics of the foreign-born and English Learner (EL) populations in select states. The fact sheets look at the demographics of these states, discuss EL student outcomes as measured by standardized tests, and conclude with an overview of state accountability mechanisms that affect ELs under relevant provisions of the Every Student Succeeds Act and predecessor No Child Left Behind Act.




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English Learners in Select States: Demographics, Outcomes, and State Accountability Policies

States are in the midst of designing new policies to hold schools accountable for the education of English Learner (EL) students, as mandated by the federal Every Student Succeeds Act (ESSA). This series of fact sheets sketches the characteristics of immigrant and EL students in 25 states, the gaps between their educational outcomes and those of their peers, and the accountability policies each state is developing.




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South Korea Carefully Tests the Waters on Immigration, With a Focus on Temporary Workers

Faced with labor shortages in key sectors of the economy, South Korea has moved carefully in recent decades toward accepting greater numbers of workers—albeit in temporary fashion. Its Employment Permit System, launched in 2003, earned international accolades for bringing order and legality to immigration in the country, although several challenges remain to be addressed as this Country Profile explores.




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What We Know About Migration and Development

This policy brief, which concludes a nine-brief series examining what is known about the linkages between migration and development, suggests that the policy framework on migration and development remains relatively weak, and few development agencies have made it a priority to promote the positive impact of international migration.




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Spiraling Violence and Drought Drive Refugee Crisis in South Sudan

Nearly 4 million South Sudanese have been driven from their homes by violence or food insecurity since late 2013, roughly half seeking refuge in neighboring countries. Drought and conflict have converged in the young country to fuel one of the world's most severe humanitarian emergencies. This article examines refugee flows from South Sudan, underlying drivers, and regional and international responses to the crisis.




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Nearly 20,000 Teens in Georgia Receive Licenses Without a Road Test

Source:

The sweaty palms on the steering wheel. The repeated exclamations of "Sorry!" The nervous glances from the examiner. They're all part of the dreaded road test, which, for decades, has been a rite of passage for every U.S. teenager to obtain a driver's license. Yet now, due to the coronavirus pandemic, nearly 20,000 teens in Georgia have received licenses without taking an official road test, and Wisconsin will soon follow suit.






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Suicide Risk Assessment in Youth and Young Adults With Type 1 Diabetes

OBJECTIVE

To describe sociodemographic and clinical characteristics of youth and young adults with type 1 diabetes who endorsed suicidal ideations as part of routine depression screening and the results of their suicide risk assessments.

RESEARCH DESIGN AND METHODS

The Patient Health Questionnaire–9 was used to assess depressive symptoms and suicide/death ideation in 550 youth and young adults with type 1 diabetes ages 10–24 years. Only individuals who endorsed suicidal/death ideations (n = 49) completed a standardized suicide risk assessment protocol and safety planning.

RESULTS

Nine percent of individuals endorsed suicidal/death ideation and of those, 83.4% reported clinically elevated depressive symptoms; 16% made a previous suicide attempt. No youth (n = 39) or young adults (n = 11) disclosed current plans or preparations for suicide, but five who expressed suicidal ideation acknowledged the lethality of insulin for an attempt. Three previously used insulin to attempt suicide. The overwhelming majority of individuals were classified as being low risk for future suicide attempt/completion. None were hospitalized as a part of the suicide risk assessment, and no suicide completions have occurred.

CONCLUSIONS

The findings of this study provide initial insight into the behaviors and cognitions of youth and young adults with type 1 diabetes who experience suicidal and death ideations. Comprehensive suicide risk assessment and safety planning are feasible during routine type 1 diabetes clinic appointments.




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NFL lays out protocols for reopening of team facilities

The NFL outlined protocols Wednesday for the gradual reopening of team facilities amid the coronavirus pandemic.




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Bryce Harper calls MLB 'dumb' to keep stars out of Olympics

Philadelphia Phillies star Bryce Harper thinks Major League Baseball is "dumb" for its policy that makes the Olympics off-limits for baseball's best players.




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Giannis Antetokounmpo sorry for hacked tweets about Kobe Bryant, LeBron James

Milwaukee Bucks star Giannis Antetokounmpo has apologized after he said someone hacked his Twitter account to send inappropriate tweets about several athletes, including LeBron James, Stephen Curry and Kobe Bryant.




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Clinical Outcomes in Patients With Isolated or Combined Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic State: A Retrospective, Hospital-Based Cohort Study

OBJECTIVE

Many patients with hyperglycemic crises present with combined features of diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS). The implications of concomitant acidosis and hyperosmolality are not well known. We investigated hospital outcomes in patients with isolated or combined hyperglycemic crises.

RESEARCH DESIGN AND METHODS

We analyzed admissions data listing DKA or HHS at two academic hospitals. We determined 1) the frequency distributions of HHS, DKA, and combined DKA-HHS (DKA criteria plus elevated effective osmolality); 2) the relationship of markers of severity of illness and clinical comorbidities with 30-day all-cause mortality; and 3) the relationship of hospital complications associated with insulin therapy (hypoglycemia and hypokalemia) with mortality.

RESULTS

There were 1,211 patients who had a first admission with confirmed hyperglycemic crises criteria, 465 (38%) who had isolated DKA, 421 (35%) who had isolated HHS, and 325 (27%) who had combined features of DKA-HHS. After adjustment for age, sex, BMI, race, and Charlson Comorbidity Index score, subjects with combined DKA-HHS had higher in-hospital mortality compared with subjects with isolated hyperglycemic crises (adjusted odds ratio [aOR] 2.7; 95% CI 1.4, 4.9; P = 0.0019). In all groups, hypoglycemia (<40 mg/dL) during treatment was associated with a 4.8-fold increase in mortality (aOR 4.8; 95% CI 1.4, 16.8). Hypokalemia ≤3.5 mEq/L was frequent (55%). Severe hypokalemia (≤2.5 mEq/L) was associated with increased inpatient mortality (aOR 4.9; 95% CI 1.3, 18.8; P = 0.02).

CONCLUSIONS

Combined DKA-HHS is associated with higher mortality compared with isolated DKA or HHS. Severe hypokalemia and severe hypoglycemia are associated with higher hospital mortality in patients with hyperglycemic crises.




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Redesigning Primary Care to Improve Diabetes Outcomes (the UNITED Study)

OBJECTIVE

The effective redesign of primary care delivery systems to improve diabetes care requires an understanding of which particular components of delivery consistently lead to better clinical outcomes. We identified associations between common systems of care management (SysCMs) and the frequency of meeting standardized performance targets for Optimal Diabetes Care (NQF#0729) in primary care practices.

RESEARCH DESIGN AND METHODS

A validated survey of 585 eligible family or general internal medicine practices seeing ≥30 adult patients with diabetes in or near Minnesota during 2017 evaluated the presence of 62 SysCMs. From 419 (72%) practices completing the survey, NQF#0729 was determined in 396 (95%) from electronic health records, including 215,842 patients with type 1 or type 2 diabetes.

RESULTS

Three SysCMs were associated with higher rates of meeting performance targets across all practices: 1) a systematic process for shared decision making with patients (P = 0.001), 2) checklists of tests or interventions needed for prevention or monitoring of diabetes (P = 0.002), and 3) physician reminders of guideline-based age-appropriate risk assessments due at the patient visit (P = 0.002). When all three were in place, an additional 10.8% of the population achieved recommended performance measures. In subgroup analysis, 15 additional SysCMs were associated with better care in particular types of practices.

CONCLUSIONS

Diabetes care outcomes are better in primary care settings that use a patient-centered approach to systematically engage patients in decision making, remind physicians of age-appropriate risk assessments, and provide checklists for recommended diabetes interventions. Practice size and location are important considerations when redesigning delivery systems to improve performance.




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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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