Representation of people of South Asian origin in cardiovascular outcome trials of glucose-lowering therapies in Type 2 diabetes

Aims : Our aim was to investigate the proportional representation of people of South Asian origin in cardiovascular outcome trials of glucose-lowering drugs or strategies in Type 2 diabetes, noting that these are among the most significant pieces of evidence used to formulate the guidelines on which clinical practice is largely based. Methods : We searched for cardiovascular outcome trials in Type 2 diabetes published before January 2015, and extracted data on the ethnicity of participants. These were compared against expected values for proportional representation of South Asian individuals, based on population data from the USA, from the UK, and globally. Results : Twelve studies met our inclusion criteria and, of these, eight presented a sufficiently detailed breakdown of participant ethnicity to permit numerical analysis. In general, people of South Asian origin were found to be under-represented in trials compared with UK and global expectations and over-represented compared with US expectations. Among the eight trials for which South Asian representation could be reliably estimated, seven under-represented this group relative to the 11.2% of the UK diabetes population estimated to be South Asian, with the representation in these trials ranging from 0.0% to 10.0%. Conclusions : Clinicians should exercise caution when generalizing the results of trials to their own practice, with regard to the ethnicity of individuals. Efforts should be made to improve reporting of ethnicity and improve diversity in trial recruitment, although we acknowledge that there are challenges that must be overcome to make this a reality

Using traditional knowledge for commercial innovations : incentives, bargaining and community profits

This paper examines the nature of economic incentives required for protecting and sustainably using traditional knowledge (TK). A mathematical formulation of the problem of sharing profits from TK based innovations is developed, using an approach of bargaining between the community with the TK and the pharmaceutical company with R&D technology. Factors that can affect profits and relative bargaining strengths include contributions of the different parties and partners in developing an innovation, the availability of alternative sources and options, expectations regarding future revenues and expenditures, and the involvement of a third party in negotiations

The ‘integrative approach’ and labour regulation and Indonesia: prospects and challenges

In contrast to theories of regulation which bypass the state and cede regulatory authority to private regimes, the scholar Kevin Kolben makes a cogent argument for the state to be brought back to centre stage in labour regulation, but envisages that private actors can develop and strengthen its capacity. This article considers the utility of what he terms an integrative approach for Indonesia. In line with what the approach advocates, the article examines the relationships between private actors and the state and considers the extent to which the former can communicate, interact with and incentivise the latter in ways which strengthen its regulatory capacity. Several challenges are identified. Finally, the potential of the Better Work Programme in Indonesia to further the goals of the approach is assessed

Higher education in Indonesia: Contemporary challenges in governance, access, and quality

This chapter presents the development of Indonesian higher education since its origins to current challenges in the fields of governance, autonomy, access, equity, quality, and internationalization. Indonesia has a massive and diversified tertiary education, including experiments in community colleges and online programs. The higher educational system remains mainly centralized, with the exception of some reforms towards financial autonomy. Insufficient public funding hinders the capacity to provide adequate teaching, research, and facilities among other aspects. The consequential rise in student fees contributes to an overrepresentation of students from Java, urban centers, and higher social classes

Asian American College Student Activism and Social Justice in Midwest Contexts

The Midwest regional context complicates Asian American college student activism and social justice efforts; so understanding these dynamics can equip higher education practitioners to better support these students.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/149515/1/he20321.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/149515/2/he20321_am.pd

Genetically Determined Plasma Lipid Levels and Risk of Diabetic Retinopathy: A Mendelian Randomization Study.

Results from observational studies examining dyslipidemia as a risk factor for diabetic retinopathy (DR) have been inconsistent. We evaluated the causal relationship between plasma lipids and DR using a Mendelian randomization approach. We pooled genome-wide association studies summary statistics from 18 studies for two DR phenotypes: any DR (N = 2,969 case and 4,096 control subjects) and severe DR (N = 1,277 case and 3,980 control subjects). Previously identified lipid-associated single nucleotide polymorphisms served as instrumental variables. Meta-analysis to combine the Mendelian randomization estimates from different cohorts was conducted. There was no statistically significant change in odds ratios of having any DR or severe DR for any of the lipid fractions in the primary analysis that used single nucleotide polymorphisms that did not have a pleiotropic effect on another lipid fraction. Similarly, there was no significant association in the Caucasian and Chinese subgroup analyses. This study did not show evidence of a causal role of the four lipid fractions on DR. However, the study had limited power to detect odds ratios less than 1.23 per SD in genetically induced increase in plasma lipid levels, thus we cannot exclude that causal relationships with more modest effect sizes exist

Farmers’ Perceptions of and Adaptations to Climate Change in Southeast Asia: The Case Study from Thailand and Vietnam

The perceptions of climate change and adaptation choices made by farmers are important considerations in the design of adaptation strategies by policy makers and agricultural extension services. This paper seeks to determine these perceptions and choices by farmers in already poor environmental regions of Thailand and Vietnam especially vulnerable to climate change. Overall findings were that farmers do perceive climate change, but describe it in quite distinct ways and that location influences how farmers recognize climate change. Our 2007 and 2013 surveys show that farmers are adapting, but it is difficult to determine if specific practices are “climate smart”. Further, adaptation measures are informed by perception and, at least in the case of Vietnam, perceptions are shaped by the respondent’s characteristics, location variables and recent climate related shocks. Finally, the three climate variables of rainfall, temperature, and wind are the most important factors in explaining specific adaptation measures chosen by farmers. Farmer participation is an essential part of public actions designed to allow adaptation to climate change. Our research can also contribute to understanding farmer constraints and tailoring good overall strategies to the local heterogeneity of vulnerable locations