an Acrylamide Exposure and Oxidative DNA Damage, Lipid Peroxidation, and Fasting Plasma Glucose Alteration: Association and Mediation Analyses in Chinese Urban Adults By care.diabetesjournals.org Published On :: 2020-04-28T14:58:19-07:00 OBJECTIVEAcrylamide 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.RESEARCH DESIGN AND METHODSFPG 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]-l-cysteine [AAMA], N-acetyl-S-[2-carbamoyl-2-hydroxyethyl]-l-cysteine [GAMA]) were measured for 3,270 general adults from the Wuhan-Zhuhai cohort. The associations of urinary acrylamide metabolites with 8-OHdG, 8-iso-PGF2α, and FPG were assessed by linear mixed models. The mediating roles of 8-OHdG and 8-iso-PGF2α were evaluated by mediation analysis.RESULTSWe 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.CONCLUSIONSExposure 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. Full Article
an Screening and Treatment Outcomes in Adults and Children With Type 1 Diabetes and Asymptomatic Celiac Disease: The CD-DIET Study By care.diabetesjournals.org Published On :: 2020-04-28T14:58:19-07:00 OBJECTIVETo describe celiac disease (CD) screening rates and glycemic outcomes of a gluten-free diet (GFD) in patients with type 1 diabetes who are asymptomatic for CD.RESEARCH DESIGN AND METHODSAsymptomatic patients (8–45 years) were screened for CD. Biopsy-confirmed CD participants were randomized to GFD or gluten-containing diet (GCD) to assess changes in HbA1c and continuous glucose monitoring over 12 months.RESULTSAdults had higher CD-seropositivity rates than children (6.8% [95% CI 4.9–8.2%, N = 1,298] vs. 4.7% [95% CI 3.4–5.9%, N = 1,089], P = 0.035) with lower rates of prior CD screening (6.9% vs. 44.2%, P < 0.0001). Fifty-one participants were randomized to a GFD (N = 27) or GCD (N = 24). No HbA1c differences were seen between the groups (+0.14%, 1.5 mmol/mol; 95% CI –0.79 to 1.08; P = 0.76), although greater postprandial glucose increases (4-h +1.5 mmol/L; 95% CI 0.4–2.7; P = 0.014) emerged with a GFD.CONCLUSIONSCD is frequently observed in asymptomatic patients with type 1 diabetes, and clinical vigilance is warranted with initiation of a GFD. Full Article
an Dietary Manganese, Plasma Markers of Inflammation, and the Development of Type 2 Diabetes in Postmenopausal Women: Findings From the Womens Health Initiative By care.diabetesjournals.org Published On :: 2020-04-28T10:59:59-07:00 OBJECTIVETo examine the association between manganese intake and the risk of type 2 diabetes in postmenopausal women and determine whether this association is mediated by circulating markers of inflammation.RESEARCH DESIGN AND METHODSWe included 84,285 postmenopausal women without a history of diabetes from the national Women’s Health Initiative Observational Study (WHI-OS). Replication analysis was then conducted among 62,338 women who participated in the WHI-Clinical Trial (WHI-CT). Additionally, data from a case-control study of 3,749 women nested in the WHI-OS with information on biomarkers of inflammation and endothelial dysfunction were examined using mediation analysis to determine the relative contributions of these known biomarkers by which manganese affects type 2 diabetes risk.RESULTSCompared with the lowest quintile of energy-adjusted dietary manganese, WHI-OS participants in the highest quintile had a 30% lower risk of type 2 diabetes (hazard ratio [HR] 0.70 [95% CI 0.65, 0.76]). A consistent association was also confirmed in the WHI-CT (HR 0.79 [95% CI 0.73, 0.85]). In the nested case-control study, higher energy-adjusted dietary manganese was associated with lower circulating levels of inflammatory biomarkers that significantly mediated the association between dietary manganese and type 2 diabetes risk. Specifically, 19% and 12% of type 2 diabetes risk due to manganese were mediated through interleukin 6 and hs-CRP, respectively.CONCLUSIONSHigher intake of manganese was directly associated with a lower type 2 diabetes risk independent of known risk factors. This association may be partially mediated by inflammatory biomarkers. Full Article
an Using the BRAVO Risk Engine to Predict Cardiovascular Outcomes in Clinical Trials With Sodium-Glucose Transporter 2 Inhibitors By care.diabetesjournals.org Published On :: 2020-04-28T12:58:49-07:00 OBJECTIVEThis 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.RESEARCH DESIGN AND METHODSBaseline 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.RESULTSBRAVO 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.CONCLUSIONSThe 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. Full Article
an Strict Preanalytical Oral Glucose Tolerance Test Blood Sample Handling Is Essential for Diagnosing Gestational Diabetes Mellitus By care.diabetesjournals.org Published On :: 2020-04-29T13:46:01-07:00 OBJECTIVEPreanalytical processing of blood samples can affect plasma glucose measurement because on-going glycolysis by cells prior to centrifugation can lower its concentration. In June 2017, ACT Pathology changed the processing of oral glucose tolerance test (OGTT) blood samples for pregnant women from a delayed to an early centrifugation protocol. The effect of this change on the rate of gestational diabetes mellitus (GDM) diagnosis was determined.RESEARCH DESIGN AND METHODSAll pregnant women in the Australian Capital Territory (ACT) are recommended for GDM testing with a 75-g OGTT using the World Health Organization diagnostic criteria. From January 2015 to May 2017, OGTT samples were collected into sodium fluoride (NaF) tubes and kept at room temperature until completion of the test (delayed centrifugation). From June 2017 to October 2018, OGTT samples in NaF tubes were centrifuged within 10 min (early centrifugation).RESULTSA total of 7,509 women were tested with the delayed centrifugation protocol and 4,808 with the early centrifugation protocol. The mean glucose concentrations for the fasting, 1-h and 2-h OGTT samples were, respectively, 0.24 mmol/L (5.4%), 0.34 mmol/L (4.9%), and 0.16 mmol/L (2.3%) higher using the early centrifugation protocol (P < 0.0001 for all), increasing the GDM diagnosis rate from 11.6% (n = 869/7,509) to 20.6% (n = 1,007/4,887).CONCLUSIONSThe findings of this study highlight the critical importance of the preanalytical processing protocol of OGTT blood samples used for diagnosing GDM. Delay in centrifuging of blood collected into NaF tubes will result in substantially lower rates of diagnosis than if blood is centrifuged early. Full Article
an The Association of Energy and Macronutrient Intake at Dinner Versus Breakfast With Disease-Specific and All-Cause Mortality Among People With Diabetes: The U.S. National Health and Nutrition Examination Survey, 2003-2014 By care.diabetesjournals.org Published On :: 2020-04-30T07:25:50-07:00 OBJECTIVEThis 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.RESEARCH DESIGN AND METHODSA 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.RESULTSAmong 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.CONCLUSIONSHigher 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. Full Article
an The Influence of Baseline Diastolic Blood Pressure on the Effects of Intensive Blood Pressure Lowering on Cardiovascular Outcomes and All-Cause Mortality in Type 2 Diabetes By care.diabetesjournals.org Published On :: 2020-05-04T10:48:32-07:00 OBJECTIVETo examine whether low baseline diastolic blood pressure (DBP) modifies the effects of intensive systolic blood pressure (SBP) lowering on cardiovascular outcomes in type 2 diabetes mellitus (T2DM).RESEARCH DESIGN AND METHODSThe Action to Control Cardiovascular Risk in Diabetes Blood Pressure trial (ACCORD BP), a two-by-two factorial randomized controlled trial, examined effects of SBP (<120 vs. <140 mmHg) and glycemic (HbA1c <6% vs. 7.0–7.9% [<42 vs. 53–63 mmol/mol]) control on cardiovascular events in T2DM (N = 4,731). We examined whether effects of SBP control on cardiovascular composite were modified by baseline DBP and glycemic control.RESULTSIntensive SBP lowering decreased the risk of the cardiovascular composite (hazard ratio [HR] 0.76 [95% CI 0.59–0.98]) in the standard glycemic arm but not in the intensive glycemic arm (HR 1.06 [95% CI 0.81–1.40]). Spline regression models relating the effects of the intervention on the cardiovascular composite across the range of baseline DBP did not show evidence of effect modification by low baseline DBP for the cardiovascular composite in the standard or intensive glycemic arms. The relation between the effect of the intensive SBP intervention and baseline DBP was similar between glycemic arms for the cardiovascular composite three-way interaction (P = 0.83).CONCLUSIONSIn persons with T2DM, intensive SBP lowering decreased the risk of cardiovascular composite end point irrespective of baseline DBP in the setting of standard glycemic control. Hence, low baseline DBP should not be an impediment to intensive SBP lowering in patients with T2DM treated with guidelines recommending standard glycemic control. Full Article
an Cardiovascular Risk Reduction With Liraglutide: An Exploratory Mediation Analysis of the LEADER Trial By care.diabetesjournals.org Published On :: 2020-05-04T10:48:32-07:00 OBJECTIVEThe LEADER trial (ClinicalTrials.gov reg. no. NCT01179048) demonstrated a reduced risk of cardiovascular (CV) events for patients with type 2 diabetes who received the glucagon-like peptide 1 receptor agonist liraglutide versus placebo. The mechanisms behind this CV benefit remain unclear. We aimed to identify potential mediators for the CV benefit observed with liraglutide in the LEADER trial.RESEARCH DESIGN AND METHODSWe performed exploratory analyses to identify potential mediators of the effect of liraglutide on major adverse CV events (MACE; composite of CV death, nonfatal myocardial infarction, or nonfatal stroke) from the following candidates: glycated hemoglobin (HbA1c), body weight, urinary albumin-to-creatinine ratio (UACR), confirmed hypoglycemia, sulfonylurea use, insulin use, systolic blood pressure, and LDL cholesterol. These candidates were selected as CV risk factors on which liraglutide had an effect in LEADER such that a reduction in CV risk might result. We used two methods based on a Cox proportional hazards model and the new Vansteelandt method designed to use all available information from the mediator and to control for confounding factors.RESULTSAnalyses using the Cox methods and Vansteelandt method indicated potential mediation by HbA1c (up to 41% and 83% mediation, respectively) and UACR (up to 29% and 33% mediation, respectively) on the effect of liraglutide on MACE. Mediation effects were small for other candidates.CONCLUSIONSThese analyses identify HbA1c and, to a lesser extent, UACR as potential mediators of the CV effects of liraglutide. Whether either is a marker of an unmeasured factor or a true mediator remains a key question that invites further investigation. Full Article
an Effects of Novel Dual GIP and GLP-1 Receptor Agonist Tirzepatide on Biomarkers of Nonalcoholic Steatohepatitis in Patients With Type 2 Diabetes By care.diabetesjournals.org Published On :: 2020-05-07T07:52:43-07:00 OBJECTIVETo determine the effect of tirzepatide, a dual agonist of glucose-dependent insulinotropic polypeptide and glucagon-like peptide 1 receptors, on biomarkers of nonalcoholic steatohepatitis (NASH) and fibrosis in patients with type 2 diabetes mellitus (T2DM).RESEARCH DESIGN AND METHODSPatients with T2DM received either once weekly tirzepatide (1, 5, 10, or 15 mg), dulaglutide (1.5 mg), or placebo for 26 weeks. Changes from baseline in alanine aminotransferase (ALT), aspartate aminotransferase (AST), keratin-18 (K-18), procollagen III (Pro-C3), and adiponectin were analyzed in a modified intention-to-treat population.RESULTSSignificant (P < 0.05) reductions from baseline in ALT (all groups), AST (all groups except tirzepatide 10 mg), K-18 (tirzepatide 5, 10, 15 mg), and Pro-C3 (tirzepatide 15 mg) were observed at 26 weeks. Decreases with tirzepatide were significant compared with placebo for K-18 (10 mg) and Pro-C3 (15 mg) and with dulaglutide for ALT (10, 15 mg). Adiponectin significantly increased from baseline with tirzepatide compared with placebo (10, 15 mg).CONCLUSIONSIn post hoc analyses, higher tirzepatide doses significantly decreased NASH-related biomarkers and increased adiponectin in patients with T2DM. Full Article
an Continuous Positive Airway Pressure Treatment, Glycemia, and Diabetes Risk in Obstructive Sleep Apnea and Comorbid Cardiovascular Disease By care.diabetesjournals.org Published On :: 2020-05-07T07:52:43-07:00 OBJECTIVEDespite evidence of a relationship among obstructive sleep apnea (OSA), metabolic dysregulation, and diabetes, it is uncertain whether OSA treatment can improve metabolic parameters. We sought to determine effects of long-term continuous positive airway pressure (CPAP) treatment on glycemic control and diabetes risk in patients with cardiovascular disease (CVD) and OSA.RESEARCH DESIGN AND METHODSBlood, medical history, and personal data were collected in a substudy of 888 participants in the Sleep Apnea Cardiovascular End Points (SAVE) trial in which patients with OSA and stable CVD were randomized to receive CPAP plus usual care, or usual care alone. Serum glucose and glycated hemoglobin A1c (HbA1c) were measured at baseline, 6 months, and 2 and 4 years and incident diabetes diagnoses recorded.RESULTSMedian follow-up was 4.3 years. In those with preexisting diabetes (n = 274), there was no significant difference between the CPAP and usual care groups in serum glucose, HbA1c, or antidiabetic medications during follow-up. There were also no significant between-group differences in participants with prediabetes (n = 452) or in new diagnoses of diabetes. Interaction testing suggested that women with diabetes did poorly in the usual care group, while their counterparts on CPAP therapy remained stable.CONCLUSIONSAmong patients with established CVD and OSA, we found no evidence that CPAP therapy over several years affects glycemic control in those with diabetes or prediabetes or diabetes risk over standard-of-care treatment. The potential differential effect according to sex deserves further investigation. Full Article
an A Randomized Controlled Trial Comparing Glargine U300 and Glargine U100 for the Inpatient Management of Medicine and Surgery Patients With Type 2 Diabetes: Glargine U300 Hospital Trial By care.diabetesjournals.org Published On :: 2020-05-07T08:41:18-07:00 OBJECTIVEThe role of U300 glargine insulin for the inpatient management of type 2 diabetes (T2D) has not been determined. We compared the safety and efficacy of glargine U300 versus glargine U100 in noncritically ill patients with T2D.RESEARCH DESIGN AND METHODSThis prospective, open-label, randomized clinical trial included 176 patients with poorly controlled T2D (admission blood glucose [BG] 228 ± 82 mg/dL and HbA1c 9.5 ± 2.2%), treated with oral agents or insulin before admission. Patients were treated with a basal-bolus regimen with glargine U300 (n = 92) or glargine U100 (n = 84) and glulisine before meals. We adjusted insulin daily to a target BG of 70–180 mg/dL. The primary end point was noninferiority in the mean difference in daily BG between groups. The major safety outcome was the occurrence of hypoglycemia.RESULTSThere were no differences between glargine U300 and U100 in mean daily BG (186 ± 40 vs. 184 ± 46 mg/dL, P = 0.62), percentage of readings within target BG of 70–180 mg/dL (50 ± 27% vs. 55 ± 29%, P = 0.3), length of stay (median [IQR] 6.0 [4.0, 8.0] vs. 4.0 [3.0, 7.0] days, P = 0.06), hospital complications (6.5% vs. 11%, P = 0.42), or insulin total daily dose (0.43 ± 0.21 vs. 0.42 ± 0.20 units/kg/day, P = 0.74). There were no differences in the proportion of patients with BG <70 mg/dL (8.7% vs. 9.5%, P > 0.99), but glargine U300 resulted in significantly lower rates of clinically significant hypoglycemia (<54 mg/dL) compared with glargine U100 (0% vs. 6.0%, P = 0.023).CONCLUSIONSHospital treatment with glargine U300 resulted in similar glycemic control compared with glargine U100 and may be associated with a lower incidence of clinically significant hypoglycemia. Full Article
an Circulating Retinol-Binding Protein 4 Is Inversely Associated With Pancreatic {beta}-Cell Function Across the Spectrum of Glycemia By care.diabetesjournals.org Published On :: 2020-05-07T08:41:18-07:00 OBJECTIVEThe 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.RESEARCH DESIGN AND METHODSA 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.RESULTSCirculating 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.CONCLUSIONSCirculating 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. Full Article
an Angela's Tips for Handling Your Child's Special Education Needs By schoolpsychologistfiles.blogspot.com Published On :: Fri, 08 Jan 2010 01:22:00 +0000 This guest post is written by Angela Peterson who writes on the topic of Online Psychology Degrees and can be emailed at angela_peterson@rediffmail.comIt’s not easy raising a child, and when he or she is affected by a severe disorder or disease, you have a greater challenge ahead of you. You have to put in extra effort, energy and thought into your child’s development and progress, one aspect of which includes their education. Some parents of children with special needs may be tempted to overprotect by keeping them in cloistered environments and limiting their interaction with the outside world. This usually only hampers the child instead of helping them. If you’re a parent with a child who has special needs, here’s some strategies: * Understand your child: Some children may be able to express themselves while others are limited because of their disability. Whatever the case, understand your child and know that they have a mind of their own even if they are unable to speak it. Instead of forcing your will on them, get to know what they wish to do and cater to their needs as much as possible as long as it does not cause them any harm. * Be patient: It’s a tough task, but you need to have an enormous amount of patience with your child. You need to condition yourself to be patient through practice and experience, otherwise you and your child will be subject to a great deal of stress. * Decide on their education: There are many options for providing education to your special needs child, so look for what is available in your area. If you plan to homeschool, you will need to do some research before you’re up to the task. Many feel that it’s better to let the professionals handle this task who are trained and more experienced. Also, your child gets to mingle with other children and interact with them on a regular basis, which is very important to his or her social development. *Think about inclusive classrooms: Parents often want their special needs children to attend regular schools. Learn about inclusive classrooms and determine if it is a good fit for your child. Consider if your child is up to the task of being educated with general education children and if he/she can cope with the curriculum in such classrooms. Although teachers in inclusive classrooms are trained to deal with children with special needs, there may be times when your child could be bullied or teased by the other kids for not being like them. Take all these facts into consideration before you decide on an inclusive classroom for your child.Children with special needs need all the help and support they can get from parents and teachers, and it’s up to you to decide on the best form of education for them. Full Article
an How Much of Your Child's Special Education Meeting Did You Understand? By schoolpsychologistfiles.blogspot.com Published On :: Tue, 28 Dec 2010 14:43:00 +0000 As a School Psychologist- I attend numerous Special Education Meetings weekly. There are Child Study Meetings, where we discuss interventions and may decide to complete an evaluation. There are eligibility meetings, where we determine if a student is eligible for special education services. There are IEP meetings where we develop a plan for a student who is eligible for special education. Additionally, there are Manifestation Determination meetings, Functional Behavioral Assessments, Behavior Intervention Plans, and 504 Meetings. I may attend around 5-10 meetings a week and I only work part time. Special education teachers, administrators, and a few others will attend these meetings as well. We are VERY used to the process and the terminology. That being said, we constantly have to remind ourselves that parents are often not used to any of it. We went to school for years to learn this, and we've been living it out in our careers. It's second nature to many of us. Parents often come in understanding very little. I try to be conscious of explaining what we are doing to the parents. However, it's a lot of information that gets thrown out very quickly. I want to know how many of the readers feel that you understood what transpired in the meetings you attended? Did you feel rushed? Did you feel supported? Share your comments and please vote in the poll. I'll leave it open through January and then discuss the results. Full Article
an Do You Understand Test Scores? By schoolpsychologistfiles.blogspot.com Published On :: Sat, 15 Jan 2011 18:59:00 +0000 Do you understand the scores from cognitive assessments, academic assessments, and behavior rating scales? Understanding the basics of these assessments and what the test scores mean is extremely important when your child has been evaluated for special education. If you are like most parents and have lots of questions, I've written up the basics and compiled them onto one page. Read all about Understanding Test Scores at School Psychologist Files. Full Article Special Education Assessment
an Teacher's Role in a Successful Behavior Plan By schoolpsychologistfiles.blogspot.com Published On :: Sat, 31 Dec 2011 13:42:00 +0000 Over the last few years I have been very busy working with teachers to create individualized behavior plans for several different elementary school students. There have been amazingly successful plans where some of the most significant behavior problems in the school have turned it around. Children who made daily trips to the office are only there now to receive praise from the administration. Teachers previously brought to tears from the behaviors have stopped me in the hall to say "Oh my goodness, he's like a different kid!" Students who were close to being sent to a day placement school are now succeeding in a regular classroom. It's very encouraging if I focus on those students. However, there have also been some plans that have been revised and revised and revised and the student is still struggling and the teacher is still severely frustrated. I have been reflecting on why some behavior plans work and others don't. Of course one of the biggest factors is the student. All students are different and the motivation for the misbehavior or lacking skill is different in each student. While this is important to consider, this particular article does not focus on this. I'm going to focus today on the teacher's role in making the behavior plan successful.Focus on the Positive!!! The behavior plans that have had the most dramatic success are plans that allow the teacher to focus on the positive. Classroom consequences are still in place, but are not connected to the plan. Here is an example: Johnny's teachers will offer positive reinforcement frequently in the classroom by giving Johnny a “warm fuzzy” pom pom when he is caught engaging in a desired behavior. Johnny will chose the bag to keep the “warm fuzzies” in and carry the bag with him to every class. Once the bag is full, he receives an immediate reward. There is no limit to how many “warm fuzzies” he can earn in a day. He does not loose “warm fuzzies” that he has already earned. All teachers and staff who work with Johnny can give him “warm fuzzies” for his bag. This plan works because Johnny who was used to receiving a lot of negative feedback, is now getting positive attention frequently throughout the day. He receives something tangible (the warm fuzzy) that he can put into his bag. This begins to change his perception of himself, which changes his behavior, which changes his teacher's perception of him, which can potentially change his future. Plans that offer positive rewards completely separate from the classroom consequences seem to have the most significant effects. Be Consistent. Teachers who are able to be consistent and are able to follow through every time have the most success with the plan. Oppositional children are excellent at pushing limits to see how far they can push. Consistent teachers have more success because they don't offer the wiggle room. Be Flexible. This is not the opposite of being consistent. This is having flexibility in your expectations and stating them upfront. If the student was able to behave like everyone else in the class she would be. She may need some flexibility in some areas. For example you may need to have area for her to work in the classroom for times she needs to cool down and get away from a stimulus. The teacher may need to allow her extra time to finish projects if it is the transition that sets her off. Being flexible and willing to make acceptable changes for the student sets everyone up for success. Remember that all students are different. The behaviors may be exactly the same as a student you had two years ago. However, that doesn't mean that the motivation for the behavior or the lacking skills are the same. What works for one student may not work for the next. That is the reason for the individualized plan. I strongly recommend doing a formal Functional Behavioral Assessment and a Behavior Intervention Plan. Teachers have a HUGE part in making the Behavior Plan sucessful. It is the teacher who has to follow through and implement it consistently every day. It is the teacher who has to push forward even when it appears it isn't working at first. It is the teacher who has a tremendous positive impact on the student when the behavior starts turning around. It is the teacher who does the work to change lives! Full Article Interventions
an Why is My Child Defiant or Explosive? By schoolpsychologistfiles.blogspot.com Published On :: Fri, 24 Aug 2012 14:56:00 +0000 Dedicated to the lady at Walmart with the screaming kid and all of us "good parents" who have been that lady at Walmart.One of the most difficult behaviors for parents or teachers to address is explosive behavior, a child who has little control over emotions and "melts down" in the classroom or at home. It is frustrating, it is embarrassing, it is anxiety producing, it causes intense emotions in ourselves. Parents agonize over why it happens or what they did wrong? Often the parents are blamed or judged by bystanders in stores, family members, friends, or school staff. However, I have seen parents with a variety of parenting styles have kids with poor emotional control, including those who are strict, those who are quick to give in, those who spank, those who use time out, those who take away privileges, and a whole lot of parents who feel like they have tried everything. I know children with very little emotional control from homes that are falling apart, from homes that are loving and supportive, from poor families, from affluent families, from parents who have no clue how to parent, from parents with excellent skills, even from School Psychologists. This is not to say that parenting styles do not have a role in this, but there IS more to it. We have to stop judging each other and get to the root of the problem. What is the Root of the Problem?The problem, the reason some children "explode" or act out with little emotional control, is because he or she is lacking a skill. Emotional control is a skill. Most kids will learn this skill through consistent discipline strategies, but some do not. Another way to look at it.We don't tell our kids how to read and then expect them to do it. We show them step by step. Some kids will pick it up easy, others will need to be taught and retaught and retaught and will need extensive help in doing so. Do we blame ourselves? Do we look at our friends judgementally and think to ourselves "look at the book she is using, it's all wrong?" No, we assume the child has a problem learning to read and we find a way to teach him. WE HAVE TO START LOOKING AT BEHAVIOR IN THE SAME WAY. When a child is exploding, the first step should not be to label the child or blame the parent. Lets start looking for the skill that is lacking. When we find that skill, lets teach it.It's NOT always a control issue. Sometimes kids act out because they have not been taught to obey and respect authority, but sometimes they act out in spite of good training at home. The explosions lead to self esteem problems in the child and the child feeling like a "bad kid," which in turn makes explosions bigger and more frequent. Have you ever looked at a screaming child and demanded he control himself right now or "act your age." It's a common thing to do. Have you ever looked at a child with a Learning Disability and said "read on your grade level, now!" or "I have told you and told you how to read, why aren't you reading?" Of course you haven't. We work with the reader at his level and patiently try different strategies to improve reading. We can't demand them to be good readers and we can't demand that a child who does not have the skills to control his emotions "act his age." These explosive kids need skills and truth be told, we who work with these kids need skills. If you are a parent with a child who acts "out of control" stop blaming yourself. It isn't necessarily because you spanked or didn't spank or were too strict or too lenient. Your child is lacking the skills she needs to control her emotions. Also, realize you are going to need to learn new skills to help your child learn the lacking skills. You are no longer in the Parenting 101 class, you need to move on to the Advanced skill- teaching parenting class. The BEST book I have read on this topic is The Explosive Child by Ross Greene. He addresses the skills these children might be lacking and he has great strategies to address the issue. (see Amazon link below)If you are a teacher and have an "explosive child" in your class, rethink your perspective of the student. The child needs to learn skills, so lets focus on teaching the skills and being patient with the children who are slower to learn emotional control. We as school staff can not make excuses or blame the parents. We have to reach the child at her level. We teach a child to read at her level. We must teach a child to control emotions at her level as well. Challenge for EveryoneLet us stop labeling these kids with emotional skill deficits as "bad kids" and stop judging the parents. Let's be honest with ourselves and recognize we all have shortcomings and could use skills in certain areas. Maybe our kids need skills in emotional control, maybe we do, maybe we need skills in teaching emotional control, or maybe we need skills in some other area all together. Let's be patient with our children and our peers and ourselves. Let's stop criticizing ourselves and others and start learning and teaching new skills. We don't live in a world with bad kids, we live in a world will kids who need skills, so let's teach. Full Article Interventions
an A Profile of Current DACA Recipients by Education, Industry, and Occupation By www.migrationpolicy.org Published On :: Thu, 09 Nov 2017 13:10:56 -0500 An average of 915 DACA recipients every day will lose their work authorization and protection from deportation once the phaseout of the program moves into full force in spring 2018, MPI estimates. This fact sheet also offers U.S. and state estimates of the school enrollment and educational attainment, workforce participation, and industries and occupations of employment for the nearly 690,000 current DACA holders. Full Article
an Mainstreaming 2.0: How Europe’s Education Systems Can Boost Migrant Inclusion By www.migrationpolicy.org Published On :: Mon, 05 Feb 2018 12:22:18 -0500 Rising numbers of young immigrants and refugees entering European schools following the 2015–16 migration crisis strained system capacity and injected new urgency into debates about how to support diverse learners and their families. This report examines the challenges facing European education systems and identifies key lessons to improve migrant inclusion in schools and integration more broadly. Full Article
an Preparing Newcomers for the Jobs of Today and the Labor Markets of Tomorrow By www.migrationpolicy.org Published On :: Fri, 05 Oct 2018 14:34:24 -0400 This Migration Policy Institute Europe webinar examines possible scenarios for how social, economic, and technological trends could affect jobs, labor market policy, education and social policies, and migrant integration. Speakers also explored the potential of coding schools for refugees to help alleviate skills shortages and provide a pathway to work. Full Article
an Settling In: A Profile of the Unauthorized Immigrant Population in the United States By www.migrationpolicy.org Published On :: Tue, 13 Nov 2018 16:34:24 -0500 This fact sheet and accompanying interactive data tools provide characteristics of the estimated 11.3 million unauthorized immigrants in the United States, using a unique MPI methodology that assigns legal status to U.S. Census Bureau data. The fact sheet and tools offer statistics on these immigrants’ origins, U.S. destinations, educational attainment, English proficiency, employment, income, home ownership, and more. Full Article
an Frequently Requested Statistics on Immigrants and Immigration in the United States By www.migrationpolicy.org Published On :: Mon, 11 Mar 2019 12:00:22 -0400 Immigrant arrivals to the United States and the makeup of the foreign-born population have been changing in significant ways: Recent immigrants are more likely to be from Asia than from Mexico and the overall immigrant population is growing at a slower rate than before the 2008-09 recession. This useful article collects in one place some of the most sought-after statistics on immigrants in the United States. Full Article
an Mexican Migration to Canada: Temporary Worker Programs, Visa Imposition, and NAFTA Shape Flows By www.migrationpolicy.org Published On :: Tue, 19 Mar 2019 11:06:16 -0400 Mexicans migrate to Canada in much smaller numbers than to the United States, yet over the last 30 years the country has become an increasingly attractive destination. Canada prioritizes highly skilled, educated Mexicans for permanent residency, but also attracts temporary workers from Mexico. This article examines Mexican migration to Canada and how it has been shaped by visa requirements, trade policy, and more. Full Article
an Federal judge declines to block COVID-19 abortion ban in Arkansas By www.upi.com Published On :: Thu, 07 May 2020 23:41:21 -0400 A federal court on Thursday denied a motion to block an Arkansas directive preventing patients from receiving abortion care. Full Article
an Fourth person charged in shooting death of Michigan security guard By www.upi.com Published On :: Fri, 08 May 2020 01:20:54 -0400 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. Full Article
an UPI News Quiz: Asian baseball, Grimes' baby, scary insects By www.upi.com Published On :: Fri, 08 May 2020 03:00:08 -0400 Asian baseball, Grimes' baby, scary invasive insects -- how well did you follow the news this week? Take the UPI News Quiz for May 8, 2020. Full Article
an Introducing wolves leads to fewer wildland coyotes, researchers find By www.upi.com Published On :: Fri, 08 May 2020 03:00:09 -0400 As the population of gray wolves expands across the northern United States, researchers are finding a surprising side-effect: Their presence appears to lead to a reduction in the coyote population. Full Article
an Pennsylvania, Texas, California among states lifting coronavirus restrictions Friday By www.upi.com Published On :: Fri, 08 May 2020 10:22:48 -0400 California, Iowa, Pennsylvania and Rhode Island are among states that are loosening coronavirus restrictions Friday to gradually revive their economies. Full Article
an U.S. copes with COVID-19 pandemic By www.upi.com Published On :: Fri, 08 May 2020 20:26:41 -0400 The novel coronavirus, COVID-19, pandemic is spreading across the United States. People are discouraged (even banned in some places) from large gatherings, public spaces are closed, store shelves are empty, with long lines in grocery stores, and travel is limited. Here are some scenes from across America. Full Article
an Gujarat university, second MBBS examination, forensic medicine question papers, January 2015 By resources.medipacademy.com Published On :: 11 March 2015 11:02:28 Gujarat university, second MBBS examination, forensic medicine question papers, January 2015 Full Article
an Gujarat university, second MBBS examination, microbiology question papers, January 2015 By resources.medipacademy.com Published On :: 11 March 2015 11:07:49 Gujarat university, second MBBS examination, microbiology question papers, January 2015 Full Article
an Gujarat university, second MBBS examination, pathology question papers, January 2015 By resources.medipacademy.com Published On :: 11 March 2015 11:19:34 Gujarat university, second MBBS examination, pathology question papers, January 2015 Full Article
an Gujarat university, second MBBS examination, pharmacology question papers, January 2015 By resources.medipacademy.com Published On :: 11 March 2015 11:05:58 Gujarat university, second MBBS examination, pharmacology question papers, January 2015 Full Article
an Resources for Medical Students and Professionals By resources.medipacademy.com Published On :: 21 February 2015 11:55:25 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 Full Article
an Honey bees face chronic paralysis pandemic in Britain By www.upi.com Published On :: Fri, 01 May 2020 12:06:18 -0400 The virus responsible for chronic bee paralysis is spreading rapidly among honey bee colonies in Britain, according to a new study. Full Article
an Mars' magnetic field emerged earlier and lasted longer than previously thought By www.upi.com Published On :: Fri, 01 May 2020 17:11:42 -0400 Mars' ancient magnetic field emerged earlier and persisted for longer than scientists previously thought, according to a new study. Full Article
an Astronauts anticipate first crewed launch from U.S. soil in nine years By www.upi.com Published On :: Fri, 01 May 2020 18:15:49 -0400 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. Full Article
an Global warming fuels algal bloom disrupting fisheries in Arabian Sea By www.upi.com Published On :: Mon, 04 May 2020 14:47:01 -0400 A new scientific study published Monday found that global warming is fueling a destructive algal bloom that is disrupting fisheries in the Arabian sea. Full Article
an Trade can spread economic toll of local disasters globally, study finds By www.upi.com Published On :: Mon, 04 May 2020 17:50:09 -0400 Damage from a natural disaster in one place can spread globally due to urban trade networks, a Yale study said Monday. Full Article
an Climate change is influencing where tropical cyclones are formed By www.upi.com Published On :: Tue, 05 May 2020 12:30:50 -0400 Over the last 40 years, climate change has been influencing where tropical cyclones form, according to a new study. Full Article
an Cannibalism helps comb jellies survive harsh conditions, invade new environs By www.upi.com Published On :: Fri, 08 May 2020 14:57:57 -0400 The warty comb jelly is native to the western Atlantic, but in recent decades, it has invaded the waters of Eurasia. New research suggests cannibalism is key to the species' ability to move into new environs. Full Article
an Neanderthals preferred bovine bones for leather-making tools By www.upi.com Published On :: Fri, 08 May 2020 16:14:58 -0400 When it came to selecting bones for leather-making tools, Neanderthals were surprisingly choosy. New archaeological analysis shows Neanderthals preferentially selected bovine rib bones to make a tool called a lissoir. Full Article
an Migration & Coronavirus: A Complicated Nexus Between Migration Management and Public Health By www.migrationpolicy.org Published On :: Thu, 19 Mar 2020 10:35:46 -0400 This webinar, organized by MPI and the Zolberg Institute on Migration and Mobility at The New School, discussed the state of play around the globe surrounding COVID-19 and examined where migration management and enforcement tools may be useful and where they may be ill-suited to advancing public health goals. Full Article
an Africa Deepens its Approach to Migration Governance, But Are Policies Translating to Action? By www.migrationpolicy.org Published On :: Thu, 02 Apr 2020 11:41:21 -0400 While migration once was a lower-priority topic for African governments, the last decade has seen a deepening in governance. Policymakers have integrated migration into their national development strategies and mainstreamed it across policy domains such as health and education. The actions are promising on paper, yet questions remain about the extent to which they will translate to more effective migration management. Full Article
an Key Immigration Laws and Policy Developments Since 1986 By www.migrationpolicy.org Published On :: Fri, 01 Mar 2013 00:00:00 -0500 A timeline of key immigration laws and policy developments between 1986 and 2013. Full Article
an Side-by-Side Comparison of 2013 Senate Immigration Bill with 2006 and 2007 Senate Legislation By www.migrationpolicy.org Published On :: Mon, 01 Apr 2013 00:00:00 -0400 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. Full Article
an Side-by-Side Comparison of the 2013 Senate Immigration Framework with 2006 and 2007 Senate Legislation By www.migrationpolicy.org Published On :: Mon, 01 Apr 2013 00:00:00 -0400 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. Full Article
an 10th Annual Immigration Law and Policy Conference By www.migrationpolicy.org Published On :: Thu, 31 Oct 2013 00:00:00 -0400 The 10th annual Immigration Law and Policy Conference featured keynotes by U.S. Senator John McCain (R-AZ) and former Mississippi Governor Haley Barbour, as well as panel discussions covering a range of key immigration topics. Full Article
an A Strategic Framework for Creating Legality and Order in Immigration By www.migrationpolicy.org Published On :: Wed, 01 Jan 2014 00:00:00 -0500 This report analyzes how governments ought to best allocate their resources to address the risks associated with migration—the "immigration harms" that undermine the positive economic and social benefits of immigration—including choosing which threats to tackle and where to prioritize enforcement efforts. Immigration policymakers can learn from other public policy regulation efforts to ensure that regulatory actions advance the public interest. Full Article
an Curbing the Influence of "Bad Actors" in International Migration (Transatlantic Council Statement) By www.migrationpolicy.org Published On :: Sat, 01 Feb 2014 00:00:00 -0500 This Transatlantic Council on Migration Statement assesses the continuum of policies needed to disrupt illegal migration-related activities and addresses the conditions that make them possible. It examines the role of migration "bad actors"—human traffickers and unscrupulous employers, among them—who operate and profit in this environment, and considers how governments can deploy resources to discourage their actions. Full Article