ev New Poll: How Do You Feel About the Level Of Education The School Provides Your Child By schoolpsychologistfiles.blogspot.com Published On :: Mon, 08 Feb 2010 23:34:00 +0000 I will be starting a monthly poll to engage the readers of this blog and start some discussion. Feel free to comment on this topic. I'm sure many of you have a lot to say. At the end of the month, I'll share and discuss results in a blog post. I'm curious to see how the readers of this blog feel about your own schools. You can find the poll in the sidebar. Thanks for participating! Full Article
ev Top 5 Questions about ADHD- From Everyday Health By schoolpsychologistfiles.blogspot.com Published On :: Fri, 05 Nov 2010 00:34:00 +0000 Everyday Health is gathering the responses of several professionals of the top 5 questions they get regarding ADHD. They asked me to participate. The following are the questions and my answers. Check in with Everyday Health next week to see the compilation of responses. 1. Why are there so many theories about the causes of ADHD? What are the most common?Any disorder that does not have a known cause is open to a number of theories. People naturally want to know why or want to feel as if it can be prevented in the future. Heredity is believed to be the most commonly accepted cause. 2. How can you explain the value of treatment to resistant parents? For example, “I survived my childhood with ADHD --and I was never diagnosed or treated. Why does my child need ADHD treatment?” Often children with ADHD have gaps in their education. As they are in and out of focus each day, they miss key points in instruction. As new skills build upon old skills, it can be more and more difficult to learn new tasks where there are gaps in the foundation. This difficulty can make focusing even more difficult, further compounding the problem. Treatment can help reduce or prevent this cycle. 3. What role does a child’s school have in helping him or her with ADHD?The school can help by providing support and accommodations specific to the particular needs of your child IF it can be determined that the symptoms of ADHD are significantly impacting his or her education. Of course, each school has different criteria for determining if there is a significant impact.4. Are the medications recommended for ADHD safe for children? What are the potential dangers?There is not a lot of solid research yet on this topic. While the medications are believed to be safe, they have not been around long enough to fully study long term effects. There are also side effects that may make the medications not worth the benefits in some children. All of that being said, I've seen kids who are finally able to focus after starting medication. Taking the medication improves learning, grades, and self esteem, which has numerous positive long term benefits. Medication is not something to take lightly. Parents must think very carefully weigh the unknown risks of taking the medications verses the possible risks of refusing the medications. There is not one answer that fits all children.5. What are the most common side effects of ADHD meds?Weight loss, behavioral changes, and headaches are possible side effects. Full Article ADHD
ev What Parents Need to Know About the Special Education Evaluation By schoolpsychologistfiles.blogspot.com Published On :: Sat, 22 Sep 2012 17:36:00 +0000 I spend most days of my life working with various students who are at different parts in the sped referral process. I attend Child Study Meetings where we decide if we are going to evaluate a student. I observe and screen children and talk with parents and teachers to help the committee make a good decision about whether we should do a special education evaluation. I evaluate those students (this includes Psychological testing, observations, talking with student/teacher/parent, doing rating scales, etc.). I attend eligibility meetings where we determine if the student is eligible for for special education services. All of this is second nature to me and sometimes I need to stop and remember when a parent comes in, that this is NEW. When I talk to parents, I find that many parents do not fully understand the special education referral process, even when they nod and act like they do. We as school staff need to do a better job of helping the parents understand the process. Parents also need to speak up and ask questions when there is not understanding. This is a guide for parents to understand the process of special education testing, the testing components, and some of the test data. It is important to note that schools systems and states will vary to some degree. If you have any questions about the process in your school system, ask your school psychologist, teacher, or principal. Parents have every right to ask questions and usually school personnel are happy to help make this process less anxiety-provoking for you. It is important for parents to understand their rights during the special education process.Special Education ProcessAfter data shows that interventions have been attempted and if a student is suspected of having a disability, a referral is made to evaluate him or her for special education testing. Once the parents sign the Permission for Testing Forms, timelines begin and the schools have 65 business days to complete the assessments and hold the eligibility meeting. Some states may have a different timeline. During these 65 days, several testing components will be completed with you and your child. The evaluators will write reports and a copy will be given to parents at the eligibility meeting. However, schools are required to have a copy available for parents to pick up two days before the eligibility meeting. It is advised, that parents take advantage of this and read reports before the meeting to help get familiar with the information and to formulate questions. The reports hold a lot of information that can be overwhelming if you are not familiar with this type of testing. Read Understanding Test Scores to understand the types of tests used and what the scores mean.Additionally, the meeting is likely to bring forth strong emotions as your child’s difficulties are discussed openly. It can be overwhelming for parents, especially when not prepared. When parents do not read the reports prior to the eligibility meeting, they are the only people at the table who come to the meeting not knowing what to expect.What if My Child is Found ELIGIBLE for Special Education Services?Once a child is eligible for special education services, the schools have 30 days to develop an Individualized Education Plan (IEP) for the student. This will consist of accommodations, goals, and describe the services offered. Parents are part of a committee to help create this document. Once it is signed, schools are legally required to follow it. It is reviewed once a year, unless parents or teachers feel that changes are necessary. Every three years, the committee will determine if the student should be reevaluated. This is called a triennial evaluation. Sometimes another full evaluation will be conducted, other times a review of records and updated teacher information is used.What if My Child is Found INELIGIBLE for Special Education Services?If your child was found ineligible for special education services and you agree with the eligibility findings, then your child will not receive special education. He or she was evaluated because of a problem that still needs to be addressed within regular education. Ask for a separate meeting with your teacher or a team to determine what accommodations or strategies can be used to help.If you believe that your child requires special education services and has a disability, but was found ineligible for services, make an appointment to meet with the special education director. If an agreement cannot be reached, you may be able to have an Independent Evaluation at the expense of the school. The results of that testing will be brought back to an eligibility meeting. A child MUST have 2 things before they can receive special education services: They must have a disability and there must be a documented educational impact that the student requires special education services to be successful. Full Article
ev Supreme Court puts temporary block on release of evidence in Mueller probe By www.upi.com Published On :: Fri, 08 May 2020 13:17:20 -0400 The Supreme Court on Friday granted a Justice Department request to temporarily block release of secret grand jury material from special counsel Robert Mueller's probe to Congress. Full Article
ev 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
ev 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
ev Will Immigration Reform Ever Succeed Again? The Legacy of IRCA & Its Enduring Lessons By www.migrationpolicy.org Published On :: Wed, 12 Jun 2019 12:34:22 -0400 This provocative discussion showcases Charles Kamasaki's book, Immigration Reform: The Corpse That Will Not Die, and explores the lessons that can be learned from the Immigration Reform and Control Act of 1986, its intended and unintended consequences, and how the law’s legacy has shaped contemporary politics surrounding immigration. Full Article
ev Ask Ariely: On Simple Savings, Better Bonuses, and Revised Resolutions By danariely.com Published On :: Sat, 01 Feb 2020 12:30:50 +0000 Here’s my Q&A column from the WSJ this week — and if you have any questions for me, you can tweet them to @danariely with the hashtag #askariely, post a comment on my Ask Ariely Facebook page, or email them to AskAriely@wsj.com. ___________________________________________________ Dear Dan, My partner and I are students,... Full Article Ask Ariely Blog advice column ask ariely Behavioral Economics & Psychology dear dan wall street journal wsj
ev White House press secretary Kayleigh McEnany: President Donald Trump can revive economy again By www.upi.com Published On :: Fri, 08 May 2020 14:41:16 -0400 Presidential press secretary Kayleigh McEnany said Friday the Trump administration is confident in a major economic recovery after several weeks of closures due to the coronavirus pandemic. Full Article
ev Televangelist Jim Bakker recovering from stroke By www.upi.com Published On :: Fri, 08 May 2020 19:56:46 -0400 Televangelist Jim Bakker is recovering at his North Carolina home after having a stroke, his wife said Friday. Full Article
ev Michael Buble shares rescheduled dates for 'An Evening with' tour By www.upi.com Published On :: Fri, 08 May 2020 11:40:53 -0400 Michael Bublé postponed his "An Evening With" tour to 2021 due to the coronavirus pandemic. Full Article
ev Look: Netflix shares teaser for 'Baby-Sitters Club' revival By www.upi.com Published On :: Fri, 08 May 2020 12:42:32 -0400 Netflix shared a premiere date and teaser trailer for its "Baby-Sitters Club" series, based on the Ann M. Martin book series. Full Article
ev YoungBoy Never Broke Again's '38 Baby 2' tops U.S. album chart By www.upi.com Published On :: Sat, 09 May 2020 09:51:28 -0400 Rapper YoungBoy Never Broke Again's "38 Baby 2" is No. 1 on the U.S. album chart. Full Article
ev Can Return Migration Revitalize the Baltics? Estonia, Latvia, and Lithuania Engage Their Diasporas, with Mixed Results By www.migrationpolicy.org Published On :: Tue, 07 May 2019 13:59:43 -0400 Faced with high emigration rates and shrinking, aging populations, the Baltic states—Estonia, Latvia, and Lithuania—are exploring different ways to lure back nationals who have emigrated and establish or solidify ties with members of the diaspora. Of the three countries, Estonia is proving the most successful, while Latvia appears to be ignoring the looming demographic crisis and lacks an immigration plan. Full Article
ev “Merit-Based” Immigration: Trump Proposal Would Dramatically Revamp Immigrant Selection Criteria, But with Modest Effects on Numbers By www.migrationpolicy.org Published On :: Thu, 30 May 2019 10:20:09 -0400 The Trump administration’s plan to create a "merit-based" U.S. immigration system, lessening the longstanding focus on family reunification in favor of more economic migrants, has met with a lackluster response from Democrats and Republicans alike. This Policy Beat article explores how the Trump proposal would reshape immigration to the United States, and how it compares to selection systems in other countries and past debates about changing the U.S. system. Full Article
ev [ Polls & Surveys ] Open Question : Did you ever take your cat on the tube/subway and listen to music with him? By answers.yahoo.com Published On :: Sat, 09 May 2020 17:19:39 +0000 Full Article
ev [ Politics ] Open Question : Why hasn't there ever been a great Democrat presidents' face on Mount Rushmore? By answers.yahoo.com Published On :: Sat, 09 May 2020 17:20:24 +0000 Maybe because there's never been a great Democrat president? And never will be. They're all horrible. Full Article
ev [ Politics ] Open Question : Trump supporters: Do you watch Disney and Pixar movies even though they carry hidden liberal agendas? By answers.yahoo.com Published On :: Sat, 09 May 2020 17:23:37 +0000 Do you let your kids watch Disney and Pixar movies? They're all created by liberals. Full Article
ev [ Engineering ] Open Question : How can I determine data rate of wireless device given this information? By answers.yahoo.com Published On :: Sat, 09 May 2020 17:24:21 +0000 802.11n device 20 MHz band 32 QAM 1/2 coding rate What's formula? Full Article
ev The Evolution of the Australian System for Selecting Economic Immigrants By www.migrationpolicy.org Published On :: Wed, 22 May 2019 13:48:04 -0400 Since the mid-1990s, Australia has moved away from a focus on family reunification to place greater emphasis on workers coming via temporary and permanent channels. The evolution of the country's points-based model for selecting economic migrants and move to a predominately employer-driven system offer lessons for other countries that seek to develop a tailored and targeted immigration selection system. Full Article
ev New Opportunities? ESSA and Its Implications for Dual Language Learners and ECEC Workforce Development By www.migrationpolicy.org Published On :: Wed, 20 Dec 2017 18:01:19 -0500 Enactment of the Every Student Succeeds Act (ESSA) in 2015 introduced opportunities to use federal funds to strengthen the early childhood education and care (ECEC) workforce as a means of better meeting the needs of the growing and increasingly diverse young child population. Full Article
ev "Event" Cells in the Brain Help Organize Memory into Meaningful Segments By rss.sciam.com Published On :: Mon, 13 Apr 2020 14:15:00 GMT Neurons in the hippocampus categorize what we experience into abstract, discrete events, such as taking a walk versus having lunch -- Read more on ScientificAmerican.com Full Article Mind Cognition Neuroscience Biology
ev Longevity Gene May Protect against a Notorious Alzheimer's Risk Gene By rss.sciam.com Published On :: Tue, 14 Apr 2020 14:30:00 GMT Some nominally high-risk individuals may have a lower chance of developing dementia than once thought -- Read more on ScientificAmerican.com Full Article Mind Neurological Health The Sciences Biology
ev Almost Everyone Lies, Often Seeing It as a Kindness By www.washingtonpost.com Published On :: Mon, 19 Feb 2007 00:00:00 EST The perjury trial of I. Lewis "Scooter" Libby goes to the jury this week. The case speaks to several issues -- how the Bush administration deals with critics of the war in Iraq, and the games that Washington's reporters and politicians play with each other. As far as the jury is concerned, however,... Full Article Opinions Almost Everyone Lies Often Seeing It as a Kindness
ev Disagree About Iraq? You're Not Just Wrong -- You're Evil. By www.washingtonpost.com Published On :: Mon, 12 Mar 2007 00:00:00 EDT The conviction of I. Lewis "Scooter" Libby last week gave Americans a chance to pick at the scab of what has become a favored obsession -- the debate over the motives of the Bush administration in the run-up to the war in Iraq. Full Article Opinions Disagree About Iraq? You're Not Just Wrong -- You're Evil.
ev Bettors and Pundits: Never Wrong, Just Unlucky By www.washingtonpost.com Published On :: Mon, 26 Mar 2007 00:00:00 EDT The NCAA men's college basketball championship game was on the line. People in office pools around the country were holding their breath. Louisville was down by four points with a few minutes left on the clock. A UCLA player stole a pass and raced down the court where, after being bumped by a... Full Article Opinions Bettors and Pundits: Never Wrong Just Unlucky
ev When Seeing Is Disbelieving By www.washingtonpost.com Published On :: Mon, 30 Apr 2007 00:00:00 EDT Four years ago tomorrow, President Bush landed on the USS Abraham Lincoln and dramatically strode onto the deck in a flight suit, a crash helmet tucked under one arm. Even without the giant banner that hung from the ship's tower, the president's message about the progress of the war in Iraq was u... Full Article Opinions When Seeing Is Disbelieving
ev Bush: Naturally, Never Wrong By www.washingtonpost.com Published On :: Mon, 09 Jul 2007 00:00:00 EDT Psychologists once conducted a simple experiment with far-reaching implications: They asked people to describe an instance in their lives when they had hurt someone and another instance when they had been hurt by someone else. The incidents that people described were similar whether they saw... Full Article Opinions Bush: Naturally Never Wrong
ev Hoping Someone Else Fixes Everyone's Problem By www.washingtonpost.com Published On :: Mon, 22 Oct 2007 00:00:00 EDT Let's say there are 10 houses on your street and a giant pothole develops right in the middle of the block. Everyone benefits if the pothole gets fixed, but that might require multiple calls to municipal authorities and a lot of hassle. Since every resident benefits even if he or she does nothing... Full Article Opinions Hoping Someone Else Fixes Everyone's Problem
ev For Political Candidates, Saying Can Become Believing By www.washingtonpost.com Published On :: Mon, 25 Feb 2008 00:00:00 EST John McCain once called televangelists Pat Robertson and Jerry Falwell "agents of intolerance," but now the Republican senator from Arizona is currying favor with social conservatives. Sen. Hillary Rodham Clinton (D-N.Y.) now opposes the Iraq war, although she used to support it. Sen. Barack Obama... Full Article Opinions For Political Candidates Saying Can Become Believing
ev Why Fluff-Over-Substance Makes Perfect Evolutionary Sense By www.washingtonpost.com Published On :: Mon, 25 Aug 2008 00:00:00 EDT Consider these scenarios. Scandal A: A prominent politician gets caught sleeping with a campaign aide and plunges himself into an ugly paternity dispute -- all while his cancer-stricken wife is fighting for her life. Full Article Opinions Why Fluff-Over-Substance Makes Perfect Evolutionary Sense
ev Taking Stock of Refugee Resettlement: Policy Objectives, Practical Tradeoffs, and the Evidence Base By www.migrationpolicy.org Published On :: Mon, 22 May 2017 10:51:38 -0400 With displacement at a record high, governments around the world are looking for ways to jumpstart, expand, or maximize the impact of their refugee resettlement programs. Yet the evidence base regarding the effectiveness of such programs is particularly thin. This report maps the monitoring and evaluation gaps that exist and identifies areas where further research could help inform policymakers' actions. Full Article
ev Building an Evidence Base to Support Refugee Resettlement By www.migrationpolicy.org Published On :: Wed, 24 May 2017 12:16:08 -0400 Marking the release of an MPI Europe report commissioned as part of the EU-FRANK project, this webinar examines critical gaps in the research and evaluation of refugee resettlement programs and recommendations for improving evidence gathering and knowledge sharing between resettlement countries. Full Article
ev Borderline Irrelevant: Why Reforming the Dublin Regulation Misses the Point By www.migrationpolicy.org Published On :: Fri, 26 Jan 2018 14:50:37 -0500 European policymakers are fixated on reform of the Dublin Regulation, the contentious rules that carve up responsibility for asylum claims between EU states. They see it not only as a long-term prophylactic against future fluctuations in irregular migration, but as a marker of the success or failure of solidarity in Europe overall. Yet rather than doggedly working to salvage Dublin, policymakers need to stop and consider why they regard it as so integral to European cooperation, as this commentary explores. Full Article
ev A Needed Evidence Revolution: Using Cost-Benefit Analysis to Improve Refugee Integration Programming By www.migrationpolicy.org Published On :: Wed, 11 Jul 2018 09:46:20 -0400 European countries have ramped up their investments in helping refugees find work and integrate into society. Yet little hard evidence exists of what programs and policies work best. This report proposes a new framework for thinking smartly about integration programming, using cost-benefit analysis to look beyond short-term, economic outcomes to also measure indirect benefits through a social-value concept. Full Article
ev Immigrants and the New Brain Gain: Ways to Leverage Rising Educational Attainment By www.migrationpolicy.org Published On :: Fri, 09 Jun 2017 13:24:43 -0400 A recent MPI study reveals that 48 percent of recent immigrants to the United States were college graduates, a sharp increase over earlier periods. How can the United States better leverage this brain gain? This commentary outlines some policies that could allow the United States to more fully utilize the professional and academic credentials that highly skilled immigrants have, for their benefit and that of the U.S. economy. Full Article
ev Two- and three-color STORM analysis reveals higher-order assembly of leukotriene synthetic complexes on the nuclear envelope of murine neutrophils [Computational Biology] By www.jbc.org Published On :: 2020-04-24T06:08:45-07:00 Over the last several years it has become clear that higher order assemblies on membranes, exemplified by signalosomes, are a paradigm for the regulation of many membrane signaling processes. We have recently combined two-color direct stochastic optical reconstruction microscopy (dSTORM) with the (Clus-DoC) algorithm that combines cluster detection and colocalization analysis to observe the organization of 5-lipoxygenase (5-LO) and 5-lipoxygenase–activating protein (FLAP) into higher order assemblies on the nuclear envelope of mast cells; these assemblies were linked to leukotriene (LT) C4 production. In this study we investigated whether higher order assemblies of 5-LO and FLAP included cytosolic phospholipase A2 (cPLA2) and were linked to LTB4 production in murine neutrophils. Using two- and three-color dSTORM supported by fluorescence lifetime imaging microscopy we identified higher order assemblies containing 40 molecules (median) (IQR: 23, 87) of 5-LO, and 53 molecules (62, 156) of FLAP monomer. 98 (18, 154) molecules of cPLA2 were clustered with 5-LO, and 77 (33, 114) molecules of cPLA2 were associated with FLAP. These assemblies were tightly linked to LTB4 formation. The activation-dependent close associations of cPLA2, FLAP, and 5-LO in higher order assemblies on the nuclear envelope support a model in which arachidonic acid is generated by cPLA2 in apposition to FLAP, facilitating its transfer to 5-LO to initiate LT synthesis. Full Article
ev Latinos & Immigrants in Kansas City Metro Area Face Higher Health Insurance Coverage Gaps, Even as They Represent Fast-Growing Share of Workforce By www.migrationpolicy.org Published On :: Tue, 19 Nov 2019 09:31:19 -0500 WASHINGTON — Latinos and immigrants are at least twice as likely to lack health insurance coverage as the overall population in three central Kansas City metro counties, a new Migration Policy Institute (MPI) study reveals. In fact, they are four times as likely to be uninsured in Johnson County, Kansas. Full Article
ev Is a U.S. Immigration System Rebuilt after 9/11 Prepared to Tackle Ever-Evolving Security Threats, Including Pandemics? Report Assesses Successes, Gaps By www.migrationpolicy.org Published On :: Thu, 09 Apr 2020 09:11:12 -0400 WASHINGTON — The U.S. immigration system was dramatically reshaped by the terrorist attacks of September 11, 2001, which shone a harsh spotlight on weaknesses in visa and immigration screening processes. From the creation of the Department of Homeland Security (DHS) to expanded national security protections in immigration and tourism policies, countless changes in the immigration arena have unfolded over the past 19 years. Full Article
ev Integrating Refugees and Asylum Seekers into the German Economy and Society: Empirical Evidence and Policy Objectives By www.migrationpolicy.org Published On :: Tue, 17 Dec 2019 10:32:57 -0500 As the top destination in Europe for asylum seekers in recent years, Germany has rolled out a number of integration policy changes. Based on an early look at how newcomers’ integration is progressing, the report finds the policies have had ambiguous implications. The report also provides insights into the demographic and socioeconomic characteristics of the asylum seeker and refugee population. Full Article
ev Employment Services for Refugees: Leveraging Mainstream U.S. Systems and Funding By www.migrationpolicy.org Published On :: Wed, 08 Jan 2020 13:22:28 -0500 On this webinar, experts and state refugee resettlement program leaders discuss two activities that can be key parts of a broader strategy for sustaining and improving employment services for refugees: Partnerships with experts in workforce development strategies, and access to federal workforce development funding. Full Article
ev An Uneven Landscape: The Differing State Approaches to English Learner Policies under ESSA By www.migrationpolicy.org Published On :: Wed, 29 Jan 2020 13:09:18 -0500 Experts share how states have approached Every Student Succeeds Act (ESSA) implementation, and areas where the law and state efforts to support English Learners can be improved. Full Article
ev An Uneven Welcome: Latin American and Caribbean Responses to Venezuelan and Nicaraguan Migration By www.migrationpolicy.org Published On :: Mon, 03 Feb 2020 17:19:48 -0500 Large-scale displacement from Venezuela and Nicaragua is reshaping the migration landscape in much of Latin America and the Caribbean. This report, accompanied by the launch of a new Migration Portal offering research and analysis on the region, examines the immigration and integration policy responses of 11 countries, including pathways to legal status and measures to integrate newcomers into schools, health-care systems, and labor markets. Full Article
ev Performance of the ESC 0/1-h and 0/3-h Algorithm for the Rapid Identification of Myocardial Infarction Without ST-Elevation in Patients With Diabetes By care.diabetesjournals.org Published On :: 2020-01-20T12:00:30-08:00 OBJECTIVE Patients with diabetes mellitus (DM) have elevated levels of high-sensitivity cardiac troponin (hs-cTn). We investigated the diagnostic performance of the European Society of Cardiology (ESC) algorithms to rule out or rule in acute myocardial infarction (AMI) without ST-elevation in patients with DM. RESEARCH DESIGN AND METHODS We prospectively enrolled 3,681 patients with suspected AMI and stratified those by the presence of DM. The ESC 0/1-h and 0/3-h algorithms were used to calculate negative and positive predictive values (NPV, PPV). In addition, alternative cutoffs were calculated and externally validated in 2,895 patients. RESULTS In total, 563 patients (15.3%) had DM, and 137 (24.3%) of these had AMI. When the ESC 0/1-h algorithm was used, the NPV was comparable in patients with and without DM (absolute difference [AD] –1.50 [95% CI –5.95, 2.96]). In contrast, the ESC 0/3-h algorithm resulted in a significantly lower NPV in patients with DM (AD –2.27 [95% CI –4.47, –0.07]). The diagnostic performance for rule-in of AMI (PPV) was comparable in both groups: 0/1-h (AD 6.59 [95% CI –19.53, 6.35]) and 0/3-h (AD 1.03 [95% CI –7.63, 9.7]). Alternative cutoffs increased the PPV in both algorithms significantly, while improvements in NPV were only subtle. CONCLUSIONS Application of the ESC 0/1-h algorithm revealed comparable safety to rule out AMI comparing patients with and without DM, while this was not observed with the ESC 0/3-h algorithm. Although alternative cutoffs might be helpful, patients with DM remain a high-risk population in whom identification of AMI is challenging and who require careful clinical evaluation. Full Article
ev The Prevalence and Determinants of Cognitive Deficits and Traditional Diabetic Complications in the Severely Obese By care.diabetesjournals.org Published On :: 2020-02-20T11:55:30-08:00 OBJECTIVE To determine the prevalence of cognitive deficits and traditional diabetic complications and the association between metabolic factors and these outcomes. RESEARCH DESIGN AND METHODS We performed a cross-sectional study in severely obese individuals before bariatric surgery. Lean control subjects were recruited from a research website. Cognitive deficits were defined by the National Institutes of Health (NIH) Toolbox (<5th percentile for lean control subjects). Cardiovascular autonomic neuropathy (CAN) was defined by an expiration-to-inspiration (E-to-I) ratio of <5th percentile for lean control subjects. Retinopathy was based on retinal photographs and nephropathy on the estimated glomerular filtration rate (<60 mg/dL) and/or the albumin-to-creatinine ratio (ACR) (≥30 mg/g). NIH Toolbox, E-to-I ratio, mean deviation on frequency doubling technology testing, and ACR were used as sensitive measures of these outcomes. We used multivariable linear regression to explore associations between metabolic factors and these outcomes. RESULTS We recruited 138 severely obese individuals and 46 lean control subjects. The prevalence of cognitive deficits, CAN, retinopathy, and nephropathy were 6.5%, 4.4%, 0%, and 6.5% in lean control subjects; 22.2%, 18.2%, 0%, and 6.1% in obese participants with normoglycemia; 17.7%, 21.4%, 1.9%, and 17.9% in obese participants with prediabetes; and 25.6%, 31.9%, 6.1%, and 16.3% in obese participants with diabetes. Waist circumference was significantly associated with cognitive function (–1.48; 95% CI –2.38, –0.57) and E-to-I ratio (–0.007; 95% CI –0.012, –0.002). Prediabetes was significantly associated with retinal function (–1.78; 95% CI –3.56, –0.002). CONCLUSIONS Obesity alone is likely sufficient to cause cognitive deficits but not retinopathy or nephropathy. Central obesity is the key metabolic risk factor. Full Article
ev Association of BMI, Fitness, and Mortality in Patients With Diabetes: Evaluating the Obesity Paradox in the Henry Ford Exercise Testing Project (FIT Project) Cohort By care.diabetesjournals.org Published On :: 2020-02-20T11:55:30-08:00 OBJECTIVE To determine the effect of fitness on the association between BMI and mortality among patients with diabetes. RESEARCH DESIGN AND METHODS We identified 8,528 patients with diabetes (self-report, medication use, or electronic medical record diagnosis) from the Henry Ford Exercise Testing Project (FIT Project). Patients with a BMI <18.5 kg/m2 or cancer were excluded. Fitness was measured as the METs achieved during a physician-referred treadmill stress test and categorized as low (<6), moderate (6–9.9), or high (≥10). Adjusted hazard ratios for mortality were calculated using standard BMI (kilograms per meter squared) cutoffs of normal (18.5–24.9), overweight (25–29.9), and obese (≥30). Adjusted splines centered at 22.5 kg/m2 were used to examine BMI as a continuous variable. RESULTS Patients had a mean age of 58 ± 11 years (49% women) with 1,319 deaths over a mean follow-up of 10.0 ± 4.1 years. Overall, obese patients had a 30% lower mortality hazard (P < 0.001) compared with normal-weight patients. In adjusted spline modeling, higher BMI as a continuous variable was predominantly associated with a lower mortality risk in the lowest fitness group and among patients with moderate fitness and BMI ≥30 kg/m2. Compared with the lowest fitness group, patients with higher fitness had an ~50% (6–9.9 METs) and 70% (≥10 METs) lower mortality hazard regardless of BMI (P < 0.001). CONCLUSIONS Among patients with diabetes, the obesity paradox was less pronounced for patients with the highest fitness level, and these patients also had the lowest risk of mortality. Full Article
ev Confirming the Bidirectional Nature of the Association Between Severe Hypoglycemic and Cardiovascular Events in Type 2 Diabetes: Insights From EXSCEL By care.diabetesjournals.org Published On :: 2020-02-20T11:55:30-08:00 OBJECTIVE We sought to confirm a bidirectional association between severe hypoglycemic events (SHEs) and cardiovascular (CV) event risk and to characterize individuals at dual risk. RESEARCH DESIGN AND METHODS In a post hoc analysis of 14,752 Exenatide Study of Cardiovascular Event Lowering (EXSCEL) participants, we examined time-dependent associations between SHEs and subsequent major adverse cardiac events (CV death, nonfatal myocardial infarction [MI] or stroke), fatal/nonfatal MI, fatal/nonfatal stroke, hospitalization for acute coronary syndrome (hACS), hospitalization for heart failure (hHF), and all-cause mortality (ACM), as well as time-dependent associations between nonfatal CV events and subsequent SHEs. RESULTS SHEs were uncommon and not associated with once-weekly exenatide therapy (hazard ratio 1.13 [95% CI 0.94–1.36], P = 0.179). In fully adjusted models, SHEs were associated with an increased risk of subsequent ACM (1.83 [1.38–2.42], P < 0.001), CV death (1.60 [1.11–2.30], P = 0.012), and hHF (2.09 [1.37–3.17], P = 0.001), while nonfatal MI (2.02 [1.35–3.01], P = 0.001), nonfatal stroke (2.30 [1.25–4.23], P = 0.007), hACS (2.00 [1.39–2.90], P < 0.001), and hHF (3.24 [1.98–5.30], P < 0.001) were all associated with a subsequent increased risk of SHEs. The elevated bidirectional time-dependent hazards linking SHEs and a composite of all CV events were approximately constant over time, with those individuals at dual risk showing higher comorbidity scores compared with those without. CONCLUSIONS These findings, showing greater risk of SHEs after CV events as well as greater risk of CV events after SHEs, validate a bidirectional relationship between CV events and SHEs in patients with high comorbidity scores. Full Article
ev Impact of Glucose Level on Micro- and Macrovascular Disease in the General Population: A Mendelian Randomization Study By care.diabetesjournals.org Published On :: 2020-03-20T11:50:34-07:00 OBJECTIVE To evaluate whether high glucose levels in the normoglycemic range and higher have a causal genetic effect on risk of retinopathy, neuropathy, nephropathy, chronic kidney disease (CKD), peripheral arterial disease (PAD), and myocardial infarction (MI; positive control) in the general population. RESEARCH DESIGN AND METHODS This study applied observational and one-sample Mendelian randomization (MR) analyses to individual-level data from 117,193 Danish individuals, and validation by two-sample MR analyses on summary-level data from 133,010 individuals from the Meta-Analyses of Glucose and Insulin-Related Traits Consortium (MAGIC), 117,165 from the CKDGen Consortium, and 452,264 from the UK Biobank. RESULTS Observationally, glucose levels in the normoglycemic range and higher were associated with high risks of retinopathy, neuropathy, diabetic nephropathy, PAD, and MI (all P for trend <0.001). In genetic causal analyses, the risk ratio for a 1 mmol/L higher glucose level was 2.01 (95% CI 1.18–3.41) for retinopathy, 2.15 (1.38–3.35) for neuropathy, 1.58 (1.04–2.40) for diabetic nephropathy, 0.97 (0.84–1.12) for estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2, 1.19 (0.90–1.58) for PAD, and 1.49 (1.02–2.17) for MI. Summary-level data from the MAGIC, the CKDGen Consortium, and the UK Biobank gave a genetic risk ratio of 4.55 (95% CI 2.26–9.15) for retinopathy, 1.48 (0.83–2.66) for peripheral neuropathy, 0.98 (0.94–1.01) for eGFR <60 mL/min/1.73 m2, and 1.23 (0.57–2.67) for PAD per 1 mmol/L higher glucose level. CONCLUSIONS Glucose levels in the normoglycemic range and higher were prospectively associated with a high risk of retinopathy, neuropathy, diabetic nephropathy, eGFR <60 mL/min/1.73 m2, PAD, and MI. These associations were confirmed in genetic causal analyses for retinopathy, neuropathy, diabetic nephropathy, and MI, but they could not be confirmed for PAD and seemed to be refuted for eGFR <60 mL/min/1.73 m2. Full Article
ev Risk Factors for First and Subsequent CVD Events in Type 1 Diabetes: The DCCT/EDIC Study By care.diabetesjournals.org Published On :: 2020-03-20T11:50:34-07:00 OBJECTIVE The Diabetes Control and Complications Trial (DCCT) and its observational follow-up Epidemiology of Diabetes Interventions and Complications (EDIC) demonstrated the dominant role of glycemia, second only to age, as a risk factor for a first cardiovascular event in type 1 diabetes (T1D). We now investigate the association between established risk factors and the total cardiovascular disease (CVD) burden, including subsequent (i.e., recurrent) events. RESEARCH DESIGN AND METHODS CVD events in the 1,441 DCCT/EDIC participants were analyzed separately by type (CVD death, acute myocardial infarction [MI], stroke, silent MI, angina, percutaneous transluminal coronary angioplasty/coronary artery bypass graft [PTCA/CABG], and congestive heart failure [CHF]) or as composite outcomes (CVD or major adverse cardiovascular events [MACE]). Proportional rate models and conditional models assessed associations between risk factors and CVD outcomes. RESULTS Over a median follow-up of 29 years, 239 participants had 421 CVD events, and 120 individuals had 149 MACE. Age was the strongest risk factor for acute MI, silent MI, stroke, and PTCA/CABG, while glycemia was the strongest risk factor for CVD death, CHF, and angina, second strongest for acute MI and PTCA/CABG, third strongest for stroke, and not associated with silent MI. HbA1c was the strongest modifiable risk factor for a first CVD event (CVD: HR 1.38 [95% CI 1.21, 1.56] per 1% higher HbA1c; MACE: HR 1.54 [1.30, 1.82]) and also for subsequent CVD events (CVD: incidence ratio [IR] 1.28 [95% CI 1.09, 1.51]; MACE: IR 1.89 [1.36, 2.61]). CONCLUSIONS Intensive glycemic management is recommended to lower the risk of initial CVD events in T1D. After a first event, optimal glycemic control may reduce the risk of recurrent CVD events and should be maintained. Full Article
ev Send Daily Email Digests to Friends, Colleagues or Even to Yourself By blog.inoreader.com Published On :: Tue, 25 Feb 2020 08:15:13 +0000 When we announced our v13 update, we mentioned a new feature called Email Digests that we’ll explain further in this… Full Article Uncategorized