Unequal Racial Access to Kidney Transplantation

Access to medical care is an issue of acute and increasing importance in the United States, a country in which the most promising of ground-breaking technologies may be available to only the privileged few. Although debate about the problem of unequal access to medical care typically centers on financial obstacles to advanced therapies and the obvious inequity of allowing patients\u27 ability to pay to drive treatment decisions, issues of equitable access for patients of both genders and all racial and ethnic backgrounds increasingly have come into focus. These concerns about equitable access animate the ongoing debate about how government should regulate the transplantation of kidneys. More than 100,000 people in the United States suffer from kidney failure-what doctors call end-stage renal disease (ESRD). While kidney failure may be treated with dialysis,\u27 kidney transplantation is the preferred treatment: studies show that transplant recipients are more likely to return to work, avoid hospitalization, and enjoy a greater sense of well-being than patients on dialysis. Kidney transplants constitute more than three-fourths of the solid organ transplants performed in this country and have success rates routinely as high as eighty percent. A severe shortage of transplantable kidneys, however, limits the availability of this preferred treatment.\u27 For example, in 1990, while more than 18,000 Americans were registered on waiting lists, fewer than 8200 received renal transplants. Federal regulations control the allocation of scarce donated kidneys among prospective recipients. Since 1972, Medicare has covered the costs of virtually all kidney transplants. To qualify for Medicare reimbursement, transplanting hospitals must abide by rules promulgated by the federal Organ Procurement and Transplantation Network (OPTN). Current OPTN policies for cadaveric kidney allocation give strong preference to potential recipients who are genetically similar to the donor as determined by the identification of antigens located on the surface of cells. For example, if a harvested kidney has all the same antigens as a potential recipient on the waiting list, then that patient will receive the kidney-even if other dialysis patients have waited longer for a transplant

Unequal Racial Access to Kidney Transplantation

Access to medical care is an issue of acute and increasing importance in the United States, a country in which the most promising of ground-breaking technologies may be available to only the privileged few. Although debate about the problem of unequal access to medical care typically centers on financial obstacles to advanced therapies and the obvious inequity of allowing patients\u27 ability to pay to drive treatment decisions, issues of equitable access for patients of both genders and all racial and ethnic backgrounds increasingly have come into focus. These concerns about equitable access animate the ongoing debate about how government should regulate the transplantation of kidneys. More than 100,000 people in the United States suffer from kidney failure-what doctors call end-stage renal disease (ESRD). While kidney failure may be treated with dialysis,\u27 kidney transplantation is the preferred treatment: studies show that transplant recipients are more likely to return to work, avoid hospitalization, and enjoy a greater sense of well-being than patients on dialysis. Kidney transplants constitute more than three-fourths of the solid organ transplants performed in this country and have success rates routinely as high as eighty percent. A severe shortage of transplantable kidneys, however, limits the availability of this preferred treatment.\u27 For example, in 1990, while more than 18,000 Americans were registered on waiting lists, fewer than 8200 received renal transplants. Federal regulations control the allocation of scarce donated kidneys among prospective recipients. Since 1972, Medicare has covered the costs of virtually all kidney transplants. To qualify for Medicare reimbursement, transplanting hospitals must abide by rules promulgated by the federal Organ Procurement and Transplantation Network (OPTN). Current OPTN policies for cadaveric kidney allocation give strong preference to potential recipients who are genetically similar to the donor as determined by the identification of antigens located on the surface of cells. For example, if a harvested kidney has all the same antigens as a potential recipient on the waiting list, then that patient will receive the kidney-even if other dialysis patients have waited longer for a transplant

Detecting Mutations in the Mycobacterium tuberculosis Pyrazinamidase Gene pncA to Improve Infection Control and Decrease Drug Resistance Rates in Human Immunodeficiency Virus Coinfection.

Hospital infection control measures are crucial to tuberculosis (TB) control strategies within settings caring for human immunodeficiency virus (HIV)-positive patients, as these patients are at heightened risk of developing TB. Pyrazinamide (PZA) is a potent drug that effectively sterilizes persistent Mycobacterium tuberculosis bacilli. However, PZA resistance associated with mutations in the nicotinamidase/pyrazinamidase coding gene, pncA, is increasing. A total of 794 patient isolates obtained from four sites in Lima, Peru, underwent spoligotyping and drug resistance testing. In one of these sites, the HIV unit of Hospital Dos de Mayo (HDM), an isolation ward for HIV/TB coinfected patients opened during the study as an infection control intervention: circulating genotypes and drug resistance pre- and postintervention were compared. All other sites cared for HIV-negative outpatients: genotypes and drug resistance rates from these sites were compared with those from HDM. HDM patients showed high concordance between multidrug resistance, PZA resistance according to the Wayne method, the two most common genotypes (spoligotype international type [SIT] 42 of the Latino American-Mediterranean (LAM)-9 clade and SIT 53 of the T1 clade), and the two most common pncA mutations (G145A and A403C). These associations were absent among community isolates. The infection control intervention was associated with 58-92% reductions in TB caused by SIT 42 or SIT 53 genotypes (odds ratio [OR] = 0.420, P = 0.003); multidrug-resistant TB (OR = 0.349, P < 0.001); and PZA-resistant TB (OR = 0.076, P < 0.001). In conclusion, pncA mutation typing, with resistance testing and spoligotyping, was useful in identifying a nosocomial TB outbreak and demonstrating its resolution after implementation of infection control measures

No. 4 - Agriculture and the WTO: Subsidies in the Cross Hairs

September 2003 saw trade talks pursuing the Doha Development Agenda at the Cancún WTO Ministerial Meeting collapse, primarily over the disagreements between rich and developing countries regarding agriculture. Despite the great pessimism that ensued, on August 1, 2004, WTO negotiators from 147 countries announced a breakthrough in negotiations to liberalize trade in agricultural products. The most striking aspect of this new framework agreement is the proposed elimination of agricultural subsidies by rich countries in return for developing countries opening up their markets to more imports. At the same time, WTO dispute resolution panels have delivered stunning decisions against the U.S. cotton subsidy program and the European Union\u27s sugar subsidies. Clearly agriculture trade policy will be a pivotal issue determining the failure or success of the Doha round. This conference featured noted experts from senior levels of government, the private sector, and the legal profession addressing current developments in multilateral negotiations and the WTO cases on agriculture and analyzing their impact on the future of the world agricultural market. It was presented on November 16, 2004, at the University of Georgia School of Law by the Dean Rusk Center–International, Comparative, and Graduate Legal Studies and the College of Agricultural and Environmental Sciences

Rounding of low serum creatinine levels and consequent impact on accuracy of bedside estimates of renal function in cancer patients

To compare glomerular filtration rate measured by technetium-99m ([Tc(99m)]) DTPA clearance with estimated creatinine clearance (CrCl) (Cockcroft and Gault (C&G) method) in patients with serum creatinine (Scr) levels 100 ml min(-1). This work indicates that when bedside estimates of renal function are calculated using the C&G formula actual Scr should be used first to estimate CrCl. If the resultant CrCl is </=100 ml min(-1), then the Scr should be rounded up to 0.06 mmol l(-1) and CrCl recalculated. Further assessment of this approach is warranted in a larger cohort of patients

Crop Updates 2000 - Cereals part 2

This session covers twenty papers from different authors: DISEASE 1. Forecasting aphid and virus risk in cereals, Debbie Thackray, Jenny Hawkes and Roger Jones, Agriculture Western Australia and Centre for Legumes in Mediterranean Agriculture 2. Cereal Diagnostics, Dominie Wright, Agriculture Western Australia 3. The economic returns from spraying for leaf rust in the central wheatbelt in 1999, Peter Carlton, Trials Coordinator, Elders Limited 4. Impact and Management of Yellow Spot and Leaf Rust in the Northern Agricultural Region, Jat Bhathal and Robert Loughman, Agriculture Western Australia 5. Leaf disease management in wheat and barley in the southern agricultural region, K. Jayasena, R. Loughman and J. Majewski, Agriculture Western Australia 6. Root nematode update, R. Loughman1, S. Kelly1, G. Holloway2, N. Venn1 and D. Diepeveen1 1 Agriculture Western Australia, 2Agriculture Victoria WHEAT AGRONOMY 7. Small Grain Screenings in wheat - the agronomic issues, Brenda Shackley, Agriculture Western Australia, 8. Response of New Wheat Varieties to Seed Rate and applied Nitrogen in the North, Darshan Sharma and Wal Anderson, Agriculture Western Australia 9. Seen vigour in wheat, Darshan Sharma and Wal Anderson, Agriculture Western Australia 10. Influence of the Time of Sowing on New Wheat Varieties in the North, Darshan Sharma and Wal Anderson, Agriculture Western Australia 11, Wheat performance in a high disease season on the South Coast. 1. Disease and grain quality on the Esperance sandplain, Mohammad Amjad, Vanessa Dooley and Wal Anderson, Agriculture Western Australia 12. Wheat performance in a high disease season on the South Coast. 2. Leaf area, disease and yield at Gibson and Salmon Gums, Mohammad Amjad, Vanessa Dooley and Wal Anderson, Agriculture Western Australia 13. Agronomic Evaluation of Wheat in the Central Wheatbelt of Western Australia, Peter Burgess and Ashley Bacon, Agritech Crop Research 14. Mechanisms influencing grain susceptibility to black point in wheat, Frances Hoyle, University of Western Australia and Agriculture Western Australia 15. Improving paddock productivity using renovation cropping techniques on heavier soils, Frances Hoyle, Agriculture Western Australia 16. Improving paddock productivity using renovation cropping techniques on sandplain soils, Frances Hoyle and Keith Devenish, Agriculture Western Australia 17. Increasing profit - Is it possible using high input package approach for cereal production? M. Appelbee, IAMA Agri Services 18. Improving wheat yield, soil physical and chemical fertility by a package of deep ripping, gypsum and complete nutrients, M.A. Hamza and W.K. Anderson, Agriculture Western Australia 19. Organic Wheat - Production System Guidelines, Steven McCoy, Centre for New Industries Development 20. Durum wheat obtains a premium over bread wheat, Steven Penny, Agriculture Western Australi

A review of new and existing non-extractive techniques for monitoring marine protected areas

Publication history: Accepted - 23 June 2023; Published - 19 July 2023.Ocean biodiversity loss is being driven by several anthropogenic threats and significant efforts are required to halt losses and promote healthy marine ecosystems. The establishment of a network of Marine Protected Areas (MPAs) can help restrict damaging activities and have been recognised as a potential solution to aid marine conservation. When managed correctly they can deliver both ecological and socio-economic benefits. In recent times, MPA designations have increased rapidly while many countries have set future MPA targets for the decades ahead. An integral element of MPA management is adequate monitoring that collects data to assess if conservation objectives are being achieved. Data acquired by monitoring can vary widely as can the techniques employed to collect such data. Ideally, non-destructive and non-invasive methods are preferred to prevent damage to habitats and species, though this may rule out a number of traditional extractive sampling approaches such as dredges and trawls. Moreover, advances in ocean observation technologies enable the collection of large amounts of data at high resolutions, while automated data processing is beginning to make analyses more logistically feasible and less time-consuming. Therefore, developments to existing marine monitoring techniques and new emerging technologies have led to a diverse array of options when choosing to implement an MPA monitoring programme. Here, we present a review of new and existing non-extractive techniques which can be applied to MPA monitoring. We summarise their capabilities, applications, advantages, limitations and possible future developments. The review is intended to aid MPA managers and researchers in determining the suitability of available monitoring techniques based on data requirements and site conditions.This research was funded through the Marine Protected Area Monitoring and Management (MarPAMM) project, which is supported by the European Union’s INTERREG VA Programme, managed by the Special EU Programmes Body (SEUPB) with matching funding from the Government of Ireland, the Northern Ireland Executive, and the Scottish Government. This research was also carried out with the support of the Marine Institute under the Marine Research Programme with the support of the Irish Government

Gravitational Waves From Known Pulsars: Results From The Initial Detector Era

We present the results of searches for gravitational waves from a large selection of pulsars using data from the most recent science runs (S6, VSR2 and VSR4) of the initial generation of interferometric gravitational wave detectors LIGO (Laser Interferometric Gravitational-wave Observatory) and Virgo. We do not see evidence for gravitational wave emission from any of the targeted sources but produce upper limits on the emission amplitude. We highlight the results from seven young pulsars with large spin-down luminosities. We reach within a factor of five of the canonical spin-down limit for all seven of these, whilst for the Crab and Vela pulsars we further surpass their spin-down limits. We present new or updated limits for 172 other pulsars (including both young and millisecond pulsars). Now that the detectors are undergoing major upgrades, and, for completeness, we bring together all of the most up-to-date results from all pulsars searched for during the operations of the first-generation LIGO, Virgo and GEO600 detectors. This gives a total of 195 pulsars including the most recent results described in this paper.United States National Science FoundationScience and Technology Facilities Council of the United KingdomMax-Planck-SocietyState of Niedersachsen/GermanyAustralian Research CouncilInternational Science Linkages program of the Commonwealth of AustraliaCouncil of Scientific and Industrial Research of IndiaIstituto Nazionale di Fisica Nucleare of ItalySpanish Ministerio de Economia y CompetitividadConselleria d'Economia Hisenda i Innovacio of the Govern de les Illes BalearsNetherlands Organisation for Scientific ResearchPolish Ministry of Science and Higher EducationFOCUS Programme of Foundation for Polish ScienceRoyal SocietyScottish Funding CouncilScottish Universities Physics AllianceNational Aeronautics and Space AdministrationOTKA of HungaryLyon Institute of Origins (LIO)National Research Foundation of KoreaIndustry CanadaProvince of Ontario through the Ministry of Economic Development and InnovationNational Science and Engineering Research Council CanadaCarnegie TrustLeverhulme TrustDavid and Lucile Packard FoundationResearch CorporationAlfred P. Sloan FoundationAstronom

The Frequency of Malaria Is Similar among Women Receiving either Lopinavir/Ritonavir or Nevirapine-based Antiretroviral Treatment

HIV protease inhibitors (PIs) show antimalarial activity in vitro and in animals. Whether this translates into a clinical benefit in HIV-infected patients residing in malaria-endemic regions is unknown. We studied the incidence of malaria, as defined by blood smear positivity or a positive Plasmodium falciparum histidine-rich protein 2 antigen test, among 444 HIV-infected women initiating antiretroviral treatment (ART) in the OCTANE trial (A5208; ClinicalTrials.gov: NCT00089505). Participants were randomized to treatment with PI-containing vs. PI-sparing ART, and were followed prospectively for ≥48 weeks; 73% also received cotrimoxazole prophylaxis. PI-containing treatment was not associated with protection against malaria in this study population

A First Search for coincident Gravitational Waves and High Energy Neutrinos using LIGO, Virgo and ANTARES data from 2007

We present the results of the first search for gravitational wave bursts associated with high energy neutrinos. Together, these messengers could reveal new, hidden sources that are not observed by conventional photon astronomy, particularly at high energy. Our search uses neutrinos detected by the underwater neutrino telescope ANTARES in its 5 line configuration during the period January - September 2007, which coincided with the fifth and first science runs of LIGO and Virgo, respectively. The LIGO-Virgo data were analysed for candidate gravitational-wave signals coincident in time and direction with the neutrino events. No significant coincident events were observed. We place limits on the density of joint high energy neutrino - gravitational wave emission events in the local universe, and compare them with densities of merger and core-collapse events.Comment: 19 pages, 8 figures, science summary page at http://www.ligo.org/science/Publication-S5LV_ANTARES/index.php. Public access area to figures, tables at https://dcc.ligo.org/cgi-bin/DocDB/ShowDocument?docid=p120000