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Aim: Some people with type 2 diabetes mellitus (T2D) and declining β‐cell function do require insulin over time. Various laboratory parameters, indices of glucose metabolism or phenotypes of T2D (clusters) have been suggested, which might predict future therapy failure (TF), indicating the need for insulin therapy initiation. This analysis evaluated glycated haemoglobin (HbA1c), homeostatic model assessment (HOMA)2‐B, C‐peptide to glucose ratio (CGR) and diabetes clusters as predictive parameters for the occurrence of glycaemic TF in individuals diagnosed with T2D without previous insulin therapy. Materials and Methods: In total, 159 individuals with T2D [41% female, median age 50 (IQR: 53‐69) years, diabetes duration 9 (5‐15) years], without insulin therapy were prospectively evaluated for the occurrence of a composite primary endpoint, including HbA1c increasing or remaining >8.0% (64 mmol/mol) 3 months after baseline on non‐insulin glucose‐lowering agents, insulin initiation or hospital admissions because of acute hyperglycaemic events. Diabetes clusters were formed according to previously described characteristics. Only severe autoimmune diabetes clusters were excluded because of a small amount of glutamate decarboxylase antibody‐positive participants. The other clusters were distributed as mild age‐related diabetes 33%; severe insulin‐deficient diabetes 31%; mild obesity‐related diabetes 20%; and severe insulin‐resistant diabetes 15%. Results: During a median observation of 57 months, higher tertiles of HbA1c at baseline, HOMA2‐B, as well as a lower CGR were significantly predictive for the occurrence of the primary endpoint. The probability of meeting the primary endpoint was the highest for mild obesity‐related diabetes [hazard ratio 3.28 (95% confidence interval 1.75‐6.2)], followed by severe insulin‐deficient diabetes [hazard ratio 2.03 (95% confidence interval 1.1‐3.7)], mild age‐related diabetes and the lowest for severe insulin‐resistant diabetes. The best performance to predict TF with an area under the curve (AUC) of 0.77 was HbA1c at baseline, followed by HOMA2‐B (AUC 0.69) and CGR (AUC 0.64). Conclusion: HbA1c, indices of insulin secretion capacity (HOMA2‐B and CGR) and T2D clusters might be applicable tools to guide practitioners in the decision of whether insulin is required in people already diagnosed with T2D. These findings need to be validated in prospective studies. [ABSTRACT FROM AUTHOR]

Current guidelines recommend the use of home blood pressure monitoring (HBPM) to screen for and manage hypertension. In this study, a quality improvement project was designed to standardize the use of HBPM in a primary care setting and demonstrate improved blood pressure outcomes. Initial systolic and diastolic values were compared to averages from patient logs. Patient and provider feedback was collected. Only 40% of patients enrolled presented to follow-up with actionable HBPM data. Patients encountered logistical challenges in obtaining and presenting HBPM data. Interprofessional collaboration and improved information technology systems would improve outcomes. This will require increased policy and insurer support to make this possible in small settings. [ABSTRACT FROM AUTHOR]

The acquisition of the function of case-marking is a key step in the development of sentence processing for German-speaking children since case-marking reveals the relations between sentential arguments. In this study, we investigated the development of the processing of case-marking and argument structures in children at 3, 4;6 and 6 years of age, as well as its processing in adults. Using EEG, we measured event-related potentials (ERPs) in response to object-initial compared to subject-initial German sentences including transitive verbs and case-marked noun phrases referring to animate arguments. We also tested children's behavioral competence in a sentence-picture matching task. Word order and case-marking were manipulated in German main clauses. Adults' behavioral performance was close to perfect and their ERPs revealed a negativity for the processing of the topicalized accusative marked noun phrase (NP1) and no effect for the second NP (NP2) in the object-initial structure. Children's behavioral data showed a significant above-chance outcome in the subject-initial condition for all age groups, but not for the object-initial condition. In contrast to adults, the ERPs of 3-year-olds showed a positivity at NP1, indicating difficulties in processing the non-canonical object-initial structures. Children at the age of 4;6 did not differ in the processing patterns of object-initial vs. subject-initial sentences at NP1 but showed a slight positivity at NP2. This positivity at NP2, which implies syntactic integration difficulties, is more pronounced in 6-year-olds but is absent in adults. At NP1, however, 6-year-olds show the same negativity as adults. In sum, the behavioral and electrophysiological findings demonstrate that children in each age group use different strategies, which are indicative of their developmental stage. While 3-year-olds merely detect differences in the two sentence structures without being able to use this information for sentence comprehension, 4;6-year-olds proceed to use mainly a word-order strategy, processing NP1 in both conditions in the same manner, which leads to processing difficulties upon detecting case-marking cues at NP2. At the age of 6, children are able to use case-marking cues for comprehension but still show enhanced effort for correct thematic-role assignment. (Contains 3 tables, 4 footnotes, and 6 figures.)

Over the past decade Social Impact Bonds (SIBs) have attracted much public policy and management research interest and debate. This article draws on the Welfare Conventions Approach to explore the diversity of five SIB-financed Active Labor Market Programs in four European countries using comparative case study methods. We identify a tension between the requirement to align civic and financial interests in SIB-financed programs alongside a drive to reform public sector procurement in a more entrepreneurial direction. We suggest that the diversity of SIBs emanates from the political struggles in implementation processes stemming from a plurality of welfare conventions that actors need to align and compromise. SIBs are built within historically grown "institutional contexts" that are themselves on the move over decades of welfare state reform, and processes of marketization – and thus far from homogenous. [ABSTRACT FROM AUTHOR]