Cosmologies and Regionalisms from "Above' and "Below' in the Post-Cold War Americas: the Relevance of Karl Polanyi for the 21st Century

Drawing on a Polanyian analysis of the land question, this article aims to analyse both Western and Indigenous cosmologies of Abya Yalathe name that indigenous peoples give to the American continentto understand the relationship between human beings and land and nature. These cosmologies are at the heart of the way in which two distinct societies construct their regional space, one from above', the other from below', and they are therefore key to understanding today's climate change problematique. Following this nexus it is argued that, since the end of the Cold War, a new regional double-movement', unleashed by the quest for land and natural resources has been in the making. This is a superstructural or legal battle between Western transnational regime-making and a law that originated at the centre of the Earth'. The article explains both regionalisms and the dialectical interaction between them and demonstrates that Karl Polanyi's legacy remains relevant for the 21st century.

Current state of evidence on 'off-label' therapeutic options for systemic lupus erythematosus, including biological immunosuppressive agents, in Germany, Austria and Switzerland--a consensus report

Systemic lupus erythematosus (SLE) can be a severe and potentially life-threatening disease that often represents a therapeutic challenge because of its heterogeneous organ manifestations. Only glucocorticoids, chloroquine and hydroxychloroquine, azathioprine, cyclophosphamide and very recently belimumab have been approved for SLE therapy in Germany, Austria and Switzerland. Dependence on glucocorticoids and resistance to the approved therapeutic agents, as well as substantial toxicity, are frequent. Therefore, treatment considerations will include 'off-label' use of medication approved for other indications. In this consensus approach, an effort has been undertaken to delineate the limits of the current evidence on therapeutic options for SLE organ disease, and to agree on common practice. This has been based on the best available evidence obtained by a rigorous literature review and the authors' own experience with available drugs derived under very similar health care conditions. Preparation of this consensus document included an initial meeting to agree upon the core agenda, a systematic literature review with subsequent formulation of a consensus and determination of the evidence level followed by collecting the level of agreement from the panel members. In addition to overarching principles, the panel have focused on the treatment of major SLE organ manifestations (lupus nephritis, arthritis, lung disease, neuropsychiatric and haematological manifestations, antiphospholipid syndrome and serositis). This consensus report is intended to support clinicians involved in the care of patients with difficult courses of SLE not responding to standard therapies by providing up-to-date information on the best available evidence.