Fusion validity assessments employ structural equation models to investigate whether an existing scale functions in accordance with theory. Fusion validity parallels criterion validity by depending on correlations with non-scale variables but differs from criterion validity because it requires at least one theorized effect of the scale, and because both the scale and scaled-items are included in the model. Fusion validity, like construct validity, will be most informative if the scale is embedded in as full a substantive context as theory permits. Appropriate scale functioning in a comprehensive theoretical context greatly enhances a scale's validity. Inappropriate scale functioning questions the scale but the scale's theoretical embedding encourages detailed diagnostic investigations potentially challenging specific items, the procedure used to calculate scale values, or aspects of the theory, but also possibly recommends incorporating additional items into the scale.
The Oxford handbook of psychoneuroimmunology. For example, one author CE was concerned that the demand for parsimony during data collection resulted in omission of causes of leadership, and she was uneasy about employing downstream latents having single indicators instead of similarly Lauura scales having multiple indicators. Combining factor and path structures assessment programs like LISREL, Mplus, and AMOS encouraged causal understanding of the connections between latent factors and their indicators as well as between different latents Hayduk and Glaser, ab ; Hayduk et al. BMC Health Serv. Two of these direct item effects Isobella escorts nullify the corresponding indirect effects, but the third produces a noticeable net negative reversed impact Table 4.
Gangbang squad previews. Methods ARTICLE
It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide. These instruments are most widely used by nurses upon admission to a hospital or long-term care facility and are periodically updated e. Laura cummings assessment and measurement summary, a substantial number Laura cummings assessment and measurement fall risk assessment tools are readily available, most with evidence supporting their reliability and validity. Private p. Laura is living a lavish and standard life. Therefore, nursing assessment scales seem the most appropriate approach for this setting. She has dark brown eyes and lights brown Laurs hairs which outcast her looks. She is living a happy married life with her second husband Matt Adler since Sign In. Because of the frequency of use, these tools tend to be short and do not require intensive assessment of the Laurs. The length of the forms varies considerably, from 4 to 23 questions a median of seven questions for either type of assessment tool. Log in Log in. To continue to develop fall risk assessments unique to individual facilities may be counterproductive Blow job thumb scores will not be comparable across facilities. This requires an assessment that is easy and quick to complete to facilitate repeated assessment without burden to acutely ill patients.
To examine the relationship between the social determinants of health and markers of early renal injury in adolescent patients with type 1 diabetes T1D.
- Karen L.
- Two times Golden Globe Award -winning actress Laura was a professional model before embarking her career as an actress.
- Laura Orsolya is a full-figured Hungarian honey with a set of knockers admired the world over.
The Center for Financial Services Innovation — the national experts on consumer financial health — sought to understand the connections, similarities, and differences between consumer financial health and the financial health of small businesses. Our definition of financial health for a small business is the same as for an individual consumer: Financial health comes about when your daily systems help you build resilience and pursue opportunities.
But are the needs of the small business being met? Are the products and services they use supporting the financial health of the small business? We found that small businesses and the self-employed are a diverse group with a common experience: the U.
Millions of Americans need solutions that recognize the interconnected nature of the individual and the small business. Yet they often must navigate a complex tax and financial system using financial products and services designed either for consumers or larger businesses. These elements provide a starting place to identify and assess gaps in products, services, and support for small business customers.
By addressing these challenges and others, providers have the potential to improve the financial health of millions. We consider this to be a work in progress and invite you to contribute to our thinking and help us turn these initial concepts into practical applications. Our vision is that through further testing and refinement, we can better understand these elements and create a toolkit for providers to successfully measure and improve the financial health of small businesses and the self-employed.
Download the paper and use these elements to understand the financial health of the small businesses you serve. The Intuit Financial Freedom Foundation sponsored the research for this paper. The authors would like to thank the numerous financial services providers and other organizations that contributed to this report by providing feedback and suggested resources to inform this work.
Share this research. Subscribe Now!
Inter-Oral Office Antics. Karen L. Typically, these measures do not assess intrinsic factors related to falls other than gait and balance. She is living a happy married life with her second husband Matt Adler since Injury due to falls is the leading cause of death in older adults 6. Several scales with superior diagnostic characteristics were identified.
Laura cummings assessment and measurement. Early Life-Laura San Giacomo
Two times Golden Globe Award -winning actress Laura was a professional model before embarking her career as an actress. Regarding her nationality, San is an American and belongs to white ethnicity. As of , she is 56 years of age and her star sign is Scorpio. As a child, she grew up in Denville, New Jersey. Laura is living a lavish and standard life. She is still active in the field of acting and has starred in numerous movies and television series.
From her acting career, she is earning a decent amount of money. Likewise, Giacomo earns a decent amount of salary from her acting career.
So, she also makes somewhere in the above ranges. Till the date, most of her movies and TV series are successfully hit through which San receives an astonishing amount of money. So, the net value she possesses is very appreciable. Being still active in the industry, the increment in her property is sure in the coming years.
Laura San married twice in her life. She is living a happy married life with her second husband Matt Adler since He is a famous actor, best known for his role in the movies like White Water Summer, Team Wolf a nd much more. At present, San Giacomo resides in the San Fernando Valley with her spouse and son from her first marriage.
Since their wedding, they have managed a peaceful relationship without facing any rumors of divorce. Previously, she shared vows with actor Cameron Dye from They tied a knot in the year 1 but they failed to continue their relationship. And the former couple finally divorced after eight years of their marriage relationship in Much work has been done to identify risk factors for falls; these fall risk factors are generally categorized into intrinsic and extrinsic factors.
Intrinsic, or patient-related, risk factors include advanced age, chronic diseases, muscle weakness, gait disorders, mental status alternations, and medications, and these factors can have additive effects 10 Rawsky 3 reviewed over articles published from through related to falls in the elderly population in a variety of settings e. Rawsky's review, however, did not assess the relative risk or odds ratios of these risk factors.
Rubenstein and Josephson 12 13 analyzed the 16 studies that quantitatively reported the relative risk RR or odds ratios for multiple risk factors. Mahoney and colleagues 15 identified the following factors upon discharge from the hospital as factors for falls posthospitalization: decline in mobility, use of assistive device, cognitive impairment, and self-report of confusion.
In general, factors related to cognitive impairment, functional decline, and chronic disorders result in the greater risk of falls. Extrinsic factors e. In a review of 20 articles, Connell 16 found that environmental hazards e. Additionally, the risk from hazardous activities can be aggravated by behavioral risk factors e. Within inpatient facilities, commonly reported extrinsic factors are related use of bedrails, height and stability of seating e.
Additionally, common locations for inpatient falls are resident rooms or bathrooms, with the falls often involving problems with ambulation and transfers Because of the extreme cost both to the patient and to society, much work has been done to develop preventive programs throughout the continuum of care. Although there are many interventions proposed for fall prevention depending on the patient population, the initial step for virtually all of these programs is the fall risk assessment, which is performed to identify persons at highest risk upon whom to target specific interventions.
Fall risk assessment, however, is not standardized within or across settings. Traditionally, three types of assessments relevant to falls and mobility have been done, usually on the basis of setting or specific discipline factors.
These include i comprehensive medical assessments performed by geriatricians or nurse practitioners in the outpatient or nursing home setting, ii nursing fall risk assessments completed in hospital and nursing home settings, and iii functional mobility assessments completed by physical therapists or physicians in an outpatient setting.
The first approach comprehensive assessment is generally used by geriatricians and nurse practitioners to evaluate and treat patients at risk for falls or who have recently fallen The assessment can be part of an overall geriatric assessment or specific to risk factors for falling as part of the postfall assessment.
This type of assessment entails in-depth medical evaluation of previous falls, cognition, balance, gait, strength, chronic diseases, mobility, nutrition, and medications Such assessment is time consuming 19 and often involves a team of clinicians Although this assessment focuses on identifying intrinsic risk factors that can be treated to reduce the likelihood of a fall 17 , it does not provide a fall risk index per se and will not be addressed further in this analysis.
The nursing assessment of a patient's risk of falling has been widely performed in hospital and nursing home settings for several decades and typically employs specific screening instruments or forms. These instruments [e. These instruments are most widely used by nurses upon admission to a hospital or long-term care facility and are periodically updated e.
Because of the frequency of use, these tools tend to be short and do not require intensive assessment of the patient. Poor scores tend to trigger either further assessment or anticipatory nursing interventions e. Risk assessment of community-dwelling, elderly individuals based on functional assessment instruments has also become common.
These instruments focus on functional limitations in gait and balance [e. Only some have specifically tested the ability to predict falls, but all provide standardized measures of disability and functional limitations. Typically, these measures do not assess intrinsic factors related to falls other than gait and balance.
These functional assessment tools are most widely performed by physical therapists for outpatient, community-dwelling patients regardless of medical diagnosis. Additionally, some are used by geriatricians as part of a comprehensive geriatric assessment. In clinical settings, poor scores typically trigger functional interventions e. Despite the many fall risk assessment tools available in the literature, assessing both intrinsic risk factors and functional limitations, there often is a lack of awareness of existing scales among clinicians and uncertainty regarding how to select a scale appropriate to their patient population.
Quite often an individual hospital or long-term care facility will develop its own fall risk assessment scale on the basis of intrinsic risk factors from the literature or retrospective chart reviews of their own patient falls. These instruments, however, often lack psychometric standardization such as reliability or validity determination.
The objective of this paper is to summarize information regarding existing nursing and functional fall assessment scales so that clinicians can make more informed choices. Medical assessment was not a focus of this review because this approach does not usually involve the use of specific scales. Information was obtained through a comprehensive search of the English language medical literature to identify articles that described new scales or evaluated existing scales.
The specific search terms were the same for the three databases and included accidental falls, falls, experimental risk assessment, experimental risk management, geriatric assessment, experimental questionnaires, and risk assessment. The search yielded 21 articles published from through that described 20 fall risk assessment scales. These were reviewed independently by a panel of five reviewers; each article was reviewed independently by two reviewers, and each reviewer reviewed approximately eight articles.
All reviews were done using a standardized review form Table 1. There was a high interrater reliability between reviewers, and all differences were discussed until consensus was achieved. The findings from the literature review are summarized in Table 2. The articles described 14 nursing assessment tools and six functional assessment scales. The majority all six of the functional assessments and 8 of the 14 nursing assessments of the articles were developed on older populations over the age of All of the nursing assessments were developed within the hospital or nursing home setting, as were two of the functional assessments 28 Sample size varied widely from 26 to subjects assessed per study , but the median sample size for the functional assessment scales 79 subjects was less than half of the median sample size for the nursing assessments subjects.
All form developers used empirically derived patient characteristics based on previous literature or data obtained retrospectively from incident reports or patient medical records intended to illuminate key characteristics of fallers. Some form developers employed a two-stage development validation process with a small pilot sample using patient characteristics obtained from incident reports or medical records to derive the scale followed by a larger prospective confirmation study of the reliability and validity of these characteristics in a separate population 21 22 23 24 35 Multiple choice is employed in two functional assessment scales 29 31 and 3 of the 14 nursing assessment scales 27 35 A combination of objective and subjective questions is used in all but two functional assessment instruments [subjective only 34 ; objective only 37 ] and one nursing assessment instrument The length of the forms varies considerably, from 4 to 23 questions a median of seven questions for either type of assessment tool.
All but two 23 38 articles illustrate the actual tool used, whereas the other two provide detailed description. The patient characteristics assessed are quite similar across nursing assessment forms Table 3.
The following intrinsic risk factors appear most often in the 14 nursing assessment tools within this review Table 3 : mental status 13 tools , mobility 10 tools , history of previous fall 10 tools , secondary or specific diagnoses 8 tools , incontinence or toileting issues 8 tools , medications 7 tools , and sensory deficits e. These parameters functional decline, cognitive impairment, and previous history of falls are also within the five most commonly cited risk factors for falls observed in the Rawsky 3 review, demonstrating the strong similarity of the tools to risk factors identified in the research literature, as well as to each other.
The time to complete the form was reported for 11 instruments and varied widely, from less than 1 minute to 80 minutes the latter being the time for the entire RAI. The median time to complete the functional assessment tools was much longer 15 minutes than to complete the nursing assessment tools 1 minute , although only five of the nursing assessments reported the actual time. The burden to the patient was not reported for any of the instruments.
Procedures for using the form were not explicitly outlined in 6 of the 14 nursing assessment tools but were explicitly outlined in all but one of the six functional assessment tools.
Data on interrater reliability was provided for seven nursing and four functional assessment tools. Information on predictive validity was included for seven nursing and five functional assessment studies. An operational definition to identify a threshold or cut-off score above which the patient would be described as being at high risk was provided for 10 nursing and five functional assessments.
Dichotomizing patients into high- and low-risk categories allows for the calculation of sensitivity and specificity of the scale. Five functional assessment studies reported sensitivity and specificity, whereas eight of the 15 nursing studies reported them. Classifying patients into risk categories also enables clinicians to link risk assessment with specific interventions.
Seven of the 14 nursing assessment studies 21 24 25 26 27 35 36 suggested interventions linked to risk assessment scores to varying degrees. Use of quick, reliable, and valid fall risk screens to identify high-risk patients and to trigger further fall-related assessments and interventions is important for each clinical practice setting. They can play a crucial first step in implementing an effective and efficient fall prevention program. We recommend using the following criteria for choosing the most appropriate assessment tool for a specific setting: high sensitivity, specificity, and interrater reliability; similarity of patient population to ones in which the instrument was developed or studied; written procedures explicitly outlining appropriate use of the form; reasonable time required to administer the scale; and established thresholds identifying when to initiate interventions.
These criteria apply regardless of setting, but the specific instrument chosen might vary depending on the setting and professionals responsible for completing the forms. In the acute care settings, time to complete the form is a critical criterion due to the repeated assessment required during an inpatient stay.
Acuity of illness and medication changes will affect mobility, physical status, and cognition, and these parameters will vary considerably within and between shifts. This requires an assessment that is easy and quick to complete to facilitate repeated assessment without burden to acutely ill patients. Therefore, nursing assessment scales seem the most appropriate approach for this setting. In outpatient settings, acuity of illness and medications do not generally vary much within short time periods, but mobility and balance are quite predictive of falls.
Consequently, functional assessment tools may be more appropriate within outpatient settings. In the extended care setting e.
To examine the relationship between the social determinants of health and markers of early renal injury in adolescent patients with type 1 diabetes T1D. Differences in urinary and serum inflammatory markers also were assessed in relation to social determinants of health. Regression analysis was used to evaluate the association between the Ontario Marginalization Index ON-Marg as a measure of the social determinants of health, patient characteristics, ACR, eGFR, and renal filtration status hyperfiltration vs normofiltration.
Mean eGFR was ON-Marg was significantly associated with eGFR after we controlled for age, sex, body mass index z score, ethnicity, serum glucose, and hemoglobin A1c in linear regression. A similar association between hyperfiltration and ON-Marg score was observed in multivariable logistic regression. Increasing marginalization is significantly associated with both eGFR and hyperfiltration in adolescents with T1D and is associated with significant changes in urinary inflammatory biomarkers.
These findings highlight a potentially important interaction between social and biological determinants of health in adolescents with T1D. Diabetic nephropathy is associated with morbidity and mortality in patients with type 1 diabetes T1D 1 and will develop in approximately one-third of patients with T1D. Diabetic nephropathy is a progressive disease that begins with microalbuminuria and later progresses to overt nephropathy, rapid renal decline, and end-stage renal disease.
Newer studies have demonstrated that many patients with microalbuminuria do not progress and may even revert to normoalbuminuria. Beyond traditional physiological factors associated with diabetic kidney disease, social determinants of health have a powerful influence on outcomes.
Many behavioral and biological outcomes in children with T1D track along a social gradient, 17 including poorer psychosocial functioning, 18 worsened glycemic control, 19 , 20 greater risk of acute complications including diabetic ketoacidosis and acute care use, 21 increased prevalence of modifiable cardiovascular risk factors, and early signs of cardiovascular dysfunction. We also sought to examine potential differences in urinary and serum inflammatory markers in relation to social determinants of health as a potential biological mediator linking marginalization with early renal changes.
This study evaluated participant data from an existing cohort of adolescents with T1D from the observational arm of the Canadian Adolescent Diabetes Cardiorenal Intervention Trial AdDIT , 22 , 23 linked to population-level census data from Ontario, Canada. Patient-level data were obtained from participants with T1D receiving care at the Hospital for Sick Children and affiliated regional diabetes care centers in Toronto, Ontario, who were enrolled in the observational arm of the AdDIT clinical trial.
All data used for this study were obtained at the participants' baseline study visit. Detailed descriptions of the AdDIT study population and methods have been published previously. The ON-Marg is a census-based index developed to assess levels of marginalization across residential areas in Ontario, Canada. This measure has been validated across time and geographic areas and has proven to be a useful tool for the study of health disparities, being associated with numerous health outcomes.
The primary outcomes of this study were markers of early renal injury, assessed by participants' baseline estimated glomerular filtration rate eGFR and albumin:creatinine ratio ACR. The secondary outcome of this study was baseline inflammation, assessed by serum and urinary levels of 15 inflammatory markers.
Selection was based on analytes previously associated with hyperfiltration in similar populations 5 , 30 , 31 or with socioeconomic status. Biochemical data outside assay limits of detection were not included for statistical analysis. Other variables included in our analysis as potential modifiers were sex, age at baseline, duration of T1D, ethnicity white vs nonwhite , treatment regime pump vs injection therapy , glycemic control hemoglobin A1c [HbA1c] , height, weight, waist circumference, body mass index BMI z scores, lipids high-density lipoprotein, low-density lipoprotein, triglycerides, cholesterol , blood pressure, and smoking status.
All variables were recorded from baseline clinic visits. Although more detailed data regarding patient ethnicity were available white, black, Chinese, South Asian, and other , ethnicity was dichotomized as white vs nonwhite, given the relatively small sample size of the other ethnic groups in this cohort.
The low statistical power associated with the analysis of individual ethnic groups limited the opportunity to extrapolate meaningful conclusions from participant data, such that dichotomization of the ethnicity variable was used for analytical purposes. Statistical analysis was carried out with R Statistics v. For correlations with a consistent directionality across ON-Marg dimensions, we further assessed correlations between outcomes and ON-Marg composite score, as per ON-Marg user guidelines.
P values for correlation tests between cytokines and ON-Marg were adjusted with the Benjamini—Hochberg correction for multiple comparisons. All variables in the final model were assessed for interaction. To further describe the potential influence of clinical variables and social determinants of health on clinically relevant differences in eGFR, patients were stratified based on filtration status normofiltration vs hyperfiltration.
The eGFR used herein to define hyperfiltration corresponds to the 95th percentile for eGFR based on this representative dataset.
Clinical characteristics and social determinants of health variables were compared between hyperfiltering vs normofiltering patients via the use of 2-sample t tests or nonparametric tests; Welch t tests or Fisher exact tests were used where applicable.
We also compared levels of serum and inflammatory markers between normofiltering vs hyperfiltering patients using 2-sample Wilcoxon tests to further explore potential biological pathways that may have influenced observed relationships between social factors and renal function.
Logistic regression using the same backward stepwise approach as for our linear model was used to develop a model linking clinical factors and social determinants of health to hyperfiltration. Our final logistic regression model was confirmed via a best subset selection.
The average age was Average HbA1c was 8. Patient characteristics and urinary markers of inflammation from the AdDIT observational cohort, with comparison of normofiltring vs hyperfiltering patients.
In comparison, no individual ethnic groups within the nonwhite group ie, black, Chinese, South Asian, and other were found to be significantly different from one another with respects to ON-Marg and Zappitelli eGFR.
Linear regression was undertaken to further explore the relationship between eGFR and ON-Marg summary score while we controlled for other variables. Although HbA1c was not significantly associated with eGFR when step-wise regression was used, it was retained in the final model as a potential confounder, given its association with socioeconomic status.
Step-wise backwards multivariable linear and logistic regression modeling to assess the relationship between eGFR, ON-Marg summary score, and other variables of interest.
Remaining serum and urinary markers were inconsistently related with ON-Marg dimensions and therefore were not assessed for correlations with ON-Marg summary scores. A sensitivity analysis was conducted to evaluate the relationships between filtration rate and ON-Marg scores using the Larsson equation, another cystatin C—derived method of GFR estimation validated for use in pediatric populations.
Renal hyperfiltration has been associated with changes in cardiovascular function, including endothelial dysfunction, arterial stiffness and calcification, and reduced exercise capacity. The inflammatory changes which we observed in association with ON-Marg scores are consistent with the inflammatory profile of renal hyperfiltration in T1D that has been described previously.
Although differences in serum markers based after eGFR stratification were less robust, serum sCD40L was increased in patients with hyperfiltration, which has been identified as a marker of microvascular complication risk.
Nonetheless, further longitudinal evaluation remains a valuable avenue for future research to assess whether inflammatory changes precede clinical hyperfiltration or microalbuminuria. Socioeconomic deprivation is a potential risk factor for the development of nondiabetic renal disease.
Given the recognized role of hyperfiltration as an early indicator of nephropathy, our findings highlight the potential influence of social factors on renal risk in pediatric diabetes. Previous findings from the AdDIT patient cohort also have linked poorer social determinants of health with cardiovascular risk factors and early vascular dysfunction. Our analyses also identified associations between eGFR, filtration status, and variables other than marginalization.
Although male sex has been associated previously with an increased risk of renal complications in adults with T1D, studies in children suggest that the risk of hyperfiltration, persistent microalbuminuria, and end-stage renal disease is greater in young females. Similarly, although glucose levels were significantly greater in patients with hyperfiltration, controlling for glucose in logistic regression did not negate the association between ON-Marg summary scores and hyperfiltration.
HbA1c was not significantly different between normofiltering vs hyperfiltering patients, and associations between eGFR and hyperfiltration with ON-Marg persisted when HbA1c was added in both models. Minority youth are disproportionately at risk for diabetes-related complications and mortality. We recognize that evaluations of patient cohorts with detailed descriptions of ethnicity are important to understand potential racial and ethnic disparities in early renal injury.
We observed an inverse association between BMI z scores and eGFR Zappitelli in both univariable vs multivariable analysis, although it only reached significance in multivariable modelling. Although several authors have noted a similar inverse relationship between BMI scores and eGFR Zappitelli in healthy children and adolescents, 29 , 48 more data are needed to assess how BMI affects the distribution of equations for GFR estimation in pediatric T1D cohorts.
We also did not observe a significant association between hyperfiltration and BMI, consistent with findings in adult populations. This study has limitations. We acknowledge that using ON-Marg as a proxy for individual socioeconomic status may fail to capture individual-level heterogeneity; however, the ON-Marg provides a robust and valid assessment of social determinants for our population.
In summary, we report that marginalization, as a measure of social determinants of health, is associated with both eGFR and hyperfiltration in adolescents with T1D and with significant changes in urinary inflammatory profile. The aim of this study was further to describe the influence of social factors on relevant diabetes risk markers. By examining social determinants of health through this lens, this study supports the recognition of social circumstance as a risk factor for the development of later complications and adverse outcomes in chronic disease.
The authors declare no conflicts of interest. National Center for Biotechnology Information , U. Sponsored Document from. J Pediatr. Laura A. Dunger , MD, 3 and Farid H. David Z. Heather N. James W. David B. Farid H. Author information Article notes Copyright and License information Disclaimer. Mahmud: ac. Abstract Objective To examine the relationship between the social determinants of health and markers of early renal injury in adolescent patients with type 1 diabetes T1D.
Conclusion Increasing marginalization is significantly associated with both eGFR and hyperfiltration in adolescents with T1D and is associated with significant changes in urinary inflammatory biomarkers. Keywords: type 1 diabetes, diabetic kidney disease, social determinants. Primary and Secondary Outcomes The primary outcomes of this study were markers of early renal injury, assessed by participants' baseline estimated glomerular filtration rate eGFR and albumin:creatinine ratio ACR.
Other Variables of Interest Other variables included in our analysis as potential modifiers were sex, age at baseline, duration of T1D, ethnicity white vs nonwhite , treatment regime pump vs injection therapy , glycemic control hemoglobin A1c [HbA1c] , height, weight, waist circumference, body mass index BMI z scores, lipids high-density lipoprotein, low-density lipoprotein, triglycerides, cholesterol , blood pressure, and smoking status.
Statistical Analyses Statistical analysis was carried out with R Statistics v. Open in a separate window. Linear Regression Linear regression was undertaken to further explore the relationship between eGFR and ON-Marg summary score while we controlled for other variables.
Sensitivity Analysis A sensitivity analysis was conducted to evaluate the relationships between filtration rate and ON-Marg scores using the Larsson equation, another cystatin C—derived method of GFR estimation validated for use in pediatric populations. Discussion Renal hyperfiltration has been associated with changes in cardiovascular function, including endothelial dysfunction, arterial stiffness and calcification, and reduced exercise capacity.
References 1. Groop P. The presence and severity of chronic kidney disease predicts all-cause mortality in type 1 diabetes. Thomas M. Diabetic kidney disease. Nat Rev Dis Primers. Perkins B. Regression of microalbuminuria in type 1 diabetes.