Selecting renal replacement therapies: what do African American and non-African American patients and their families think others should know? A mixed methods study.

BACKGROUND: Little is known regarding the types of information African American and non-African American patients with chronic kidney disease (CKD) and their families need to inform renal replacement therapy (RRT) decisions. METHODS: In 20 structured group interviews, we elicited views of African American and non-African American patients with CKD and their families about factors that should be addressed in educational materials informing patients' RRT selection decisions. We asked participants to select factors from a list and obtained their open-ended feedback. RESULTS: Ten groups of patients (5 African American, 5 non-African American; total 68 individuals) and ten groups of family members (5 African American, 5 non-African American; total 62 individuals) participated. Patients and families had a range (none to extensive) of experiences with various RRTs. Patients identified morbidity or mortality, autonomy, treatment delivery, and symptoms as important factors to address. Family members identified similar factors but also cited the effects of RRT decisions on patients' psychological well-being and finances. Views of African American and non-African American participants were largely similar. CONCLUSIONS: Educational resources addressing the influence of RRT selection on patients' morbidity and mortality, autonomy, treatment delivery, and symptoms could help patients and their families select RRT options closely aligned with their values. Including information about the influence of RRT selection on patients' personal relationships and finances could enhance resources' cultural relevance for African Americans.

Sociocultural and socioeconomic influences on type 2 diabetes risk in overweight/obese African-American and Latino-American children and adolescents.

PURPOSE: It is unclear whether sociocultural and socioeconomic factors are directly linked to type 2 diabetes risk in overweight/obese ethnic minority children and adolescents. This study examines the relationships between sociocultural orientation, household social position, and type 2 diabetes risk in overweight/obese African-American (n = 43) and Latino-American (n = 113) children and adolescents. METHODS: Sociocultural orientation was assessed using the Acculturation, Habits, and Interests Multicultural Scale for Adolescents (AHIMSA) questionnaire. Household social position was calculated using the Hollingshead Two-Factor Index of Social Position. Insulin sensitivity (SI), acute insulin response (AIRG) and disposition index (DI) were derived from a frequently sampled intravenous glucose tolerance test (FSIGT). The relationships between AHIMSA subscales (i.e., integration, assimilation, separation, and marginalization), household social position and FSIGT parameters were assessed using multiple linear regression. RESULTS: For African-Americans, integration (integrating their family's culture with those of mainstream white-American culture) was positively associated with AIRG (β = 0.27 ± 0.09, r = 0.48, P < 0.01) and DI (β = 0.28 ± 0.09, r = 0.55, P < 0.01). For Latino-Americans, household social position was inversely associated with AIRG (β = -0.010 ± 0.004, r = -0.19, P = 0.02) and DI (β = -20.44 ± 7.50, r = -0.27, P < 0.01). CONCLUSIONS: Sociocultural orientation and household social position play distinct and opposing roles in shaping type 2 diabetes risk in African-American and Latino-American children and adolescents.

SUPERNOVA 2009kf: AN ULTRAVIOLET BRIGHT TYPE IIP SUPERNOVA DISCOVERED WITH PAN-STARRS 1 AND GALEX

We present photometric and spectroscopic observations of a luminous Type IIP Supernova (SN) 2009kf discovered by the Pan-STARRS 1 (PS1) survey and also detected by the Galaxy Evolution Explorer. The SN shows a plateau in its optical and bolometric light curves, lasting approximately 70 days in the rest frame, with an absolute magnitude of M-V = - 18.4 mag. The P-Cygni profiles of hydrogen indicate expansion velocities of 9000 km s(-1) at 61 days after discovery which is extremely high for a Type IIP SN. SN 2009kf is also remarkably bright in the near-ultraviolet (NUV) and shows a slow evolution 10-20 days after optical discovery. The NUV and optical luminosity at these epochs can be modeled with a blackbody with a hot effective temperature (T similar to 16,000 K) and a large radius (R similar to 1 x 10(15) cm). The bright bolometric and NUV luminosity, the light curve peak and plateau duration, the high velocities, and temperatures suggest that 2009kf is a Type IIP SN powered by a larger than normal explosion energy. Recently discovered high-z SNe (0.7

Pan-retinal photocoagulation and other forms of laser treatment and drug therapies for non-proliferative diabetic retinopathy: systematic review and economic evaluation

BACKGROUND: Diabetic retinopathy is an important cause of visual loss. Laser photocoagulation preserves vision in diabetic retinopathy but is currently used at the stage of proliferative diabetic retinopathy (PDR).

OBJECTIVES: The primary aim was to assess the clinical effectiveness and cost-effectiveness of pan-retinal photocoagulation (PRP) given at the non-proliferative stage of diabetic retinopathy (NPDR) compared with waiting until the high-risk PDR (HR-PDR) stage was reached. There have been recent advances in laser photocoagulation techniques, and in the use of laser treatments combined with anti-vascular endothelial growth factor (VEGF) drugs or injected steroids. Our secondary questions were: (1) If PRP were to be used in NPDR, which form of laser treatment should be used? and (2) Is adjuvant therapy with intravitreal drugs clinically effective and cost-effective in PRP?

ELIGIBILITY CRITERIA: Randomised controlled trials (RCTs) for efficacy but other designs also used.

REVIEW METHODS: Systematic review and economic modelling.

RESULTS: The Early Treatment Diabetic Retinopathy Study (ETDRS), published in 1991, was the only trial designed to determine the best time to initiate PRP. It randomised one eye of 3711 patients with mild-to-severe NPDR or early PDR to early photocoagulation, and the other to deferral of PRP until HR-PDR developed. The risk of severe visual loss after 5 years for eyes assigned to PRP for NPDR or early PDR compared with deferral of PRP was reduced by 23% (relative risk 0.77, 99% confidence interval 0.56 to 1.06). However, the ETDRS did not provide results separately for NPDR and early PDR. In economic modelling, the base case found that early PRP could be more effective and less costly than deferred PRP. Sensitivity analyses gave similar results, with early PRP continuing to dominate or having low incremental cost-effectiveness ratio. However, there are substantial uncertainties. For our secondary aims we found 12 trials of lasers in DR, with 982 patients in total, ranging from 40 to 150. Most were in PDR but five included some patients with severe NPDR. Three compared multi-spot pattern lasers against argon laser. RCTs comparing laser applied in a lighter manner (less-intensive burns) with conventional methods (more intense burns) reported little difference in efficacy but fewer adverse effects. One RCT suggested that selective laser treatment targeting only ischaemic areas was effective. Observational studies showed that the most important adverse effect of PRP was macular oedema (MO), which can cause visual impairment, usually temporary. Ten trials of laser and anti-VEGF or steroid drug combinations were consistent in reporting a reduction in risk of PRP-induced MO.

LIMITATION: The current evidence is insufficient to recommend PRP for severe NPDR.

CONCLUSIONS: There is, as yet, no convincing evidence that modern laser systems are more effective than the argon laser used in ETDRS, but they appear to have fewer adverse effects. We recommend a trial of PRP for severe NPDR and early PDR compared with deferring PRP till the HR-PDR stage. The trial would use modern laser technologies, and investigate the value adjuvant prophylactic anti-VEGF or steroid drugs.

STUDY REGISTRATION: This study is registered as PROSPERO CRD42013005408.

FUNDING: The National Institute for Health Research Health Technology Assessment programme.

Has Regionalism Peaked? The Latin American Quagmire and its Lessons

Since 1960, Latin American attempts at regionalism have undergone distinct phases. More notably, they have tended to diverge across space, gradually giving birth to separate blocs that seem to be tearing South, Central and North America apart. Additionally, within and across these regions several overlapping projects coexist. This article focuses on the dynamics of segmented and overlapping regionalism in order to describe what they look like, analyse how they articulate with one another, and explain why member states have pushed for such a messy outcome. This situation, linked to the evolution of the global context, might be indicating that regionalism in Latin America has reached its peak, beyond which it may be difficult to achieve further progress. Two conclusions are elicited: first, economic integration is becoming a geographically diffused phenomenon rather than a regional one; second, regionalism is still a compelling foreign policy but its causes, goals and outcomes are no longer what they used to be.

Has Regionalism Peaked? The Latin American Quagmire and its Lessons

The chapters in this book were originally published in the The International Spectator, volume 47, issue 1 (February 2012).

Should the U.S. adapt to the world? The first debate on american exceptionalism and its impact on the founding of the United States

This paper aims at putting into perspective the recent, post 9/11 debate on the United States‘ alleged exceptionalism and its impact on the definition of American foreign policy. It reminds the readers that the United States was born as a result of a similar debate, at a time when a crucial choice for its future was to be made. Indeed, the Founding Fathers discarded the revolutionary idea that America was altogether different from other (European) nations and, as such, could succeed in saving republicanism and concentrate on domestic affairs. As Gordon Wood and Harvey Mansfield have shown, the 1787 version of republicanism stood as a departure from its earlier version, and such a change was necessary to the creation of a full-fledged federation, therefore paving the way to the current powerful Federal Republic. The early failure of the exceptionalist creed did not cause its disappearance, as the contemporary form of exceptionalism demonstrates, but created conditions that made an enduring and powerful influence very difficult.

Limiting rights, Canadian style : the Supreme Court of Canada, American jurisprudence and section 1 of the Charter /

The addition of the Charter of Rights and Freedoms represented a fundamental shift in Canadian governance. Many saw the tabling of such a document as a further, even fmal, step towards the Americanization of the Canadian polity. While the Charter's presence has significantly altered the relationship between citizens, government and the courts, it has done so by maintaining the traditional values and experiences that has been the hallmarks of Canadian constitutionalism. This is in contrast to the fears harboured by critics suggesting that the Charter was a further Americanization of the Canadian Polity, notwithstanding the very different natures of the American Bill of Rights and the Canadian Charter. Analyzing American Supreme Court precedent use by the Canadian Supreme Court has demonstrated that such an Americanization has not, in fact, occurred. In the present analysis of American precedent use in section 1 limitation of rights cases, the citation of these precedents are at best episodic, at least on the quantitative level. Qualitatively, the Canadian Supreme Court generally uses American jurisprudence to further support broad definitions of 'great rights' . As for the more intricate details of rights limitations and the process involved in detennining how Charter rights are limited, one would be hard pressed to find even cursory references to American case law.

The American Naval and Patriotic Songster: As Sung at Various Places of Amusement, in Honour of Hull, Jones, Decatur, Perry, Bainbridge, Lawrence, Etc. Etc. Etc. (1834)

Volume of songs sung in praise of celebrated American War of 1812 heroes.

The Systematics, Distribution and Bionomics of Deep sea fishes beyond depth 200m along the South west coast of India

Reducing fishing pressure in coastal waters is the need of the day in the Indian marine fisheries sector of the country which is fast changing from a mere vocational activity to a capital intensive industry. It requires continuous monitoring of the resource exploitation through a scientifically acceptable methodology, data on production of each species stock, the number and characteristics of the fishing gears of the fleet, various biological characteristics of each stock, the impact of fishing on the environment and the role of fishery—independent on availability and abundance. Besides this, there are issues relating to capabilities in stock assessment, taxonomy research, biodiversity, conservation and fisheries management. Generation of reliable data base over a fixed time frame, their analysis and interpretation are necessary before drawing conclusions on the stock size, maximum sustainable yield, maximum economic yield and to further implement various fishing regulatory measures. India being a signatory to several treaties and conventions, is obliged to carry out assessments of the exploited stocks and manage them at sustainable levels. Besides, the nation is bound by its obligation of protein food security to people and livelihood security to those engaged in marine fishing related activities. Also, there are regional variabilities in fishing technology and fishery resources. All these make it mandatory for India to continue and strengthen its marine capture fisheries research in general and deep sea fisheries in particular. Against this background, an attempt is made to strengthen the deep sea fish biodiversity and also to generate data on the distribution, abundance, catch per unit effort of fishery resources available beyond 200 m in the EEZ of southwest coast ofIndia and also unravel some of the aspects of life history traits of potentially important non conventional fish species inhabiting in the depth beyond 200 m. This study was carried out as part of the Project on Stock Assessment and Biology of Deep Sea Fishes of Indian EEZ (MoES, Govt. of India).