Effectiveness and cost-efficiency of phosphate binders in hemodialysis

Health political background: In 2006, the prevalence of chronic renal insufficiency in Germany was 91,718, of which 66,508 patients were on dialysis. The tendency is clearly growing. Scientific background: Chronic renal insufficiency results in a disturbance of the mineral balance. It leads to hyperphosphataemia, which is the strongest independent risk factor for mortality in renal patients. Usually, a reduction in the phosphate intake through nutrition and the amount of phosphate filtered out during dialysis are not sufficient to reduce the serum phosphate values to the recommended value. Therefore, phosphate binders are used to bind ingested phosphate in the digestive tract in order to lower the phosphate concentration in the serum. Four different groups of phosphate binders are available: calcium- and aluminium salts are the traditional therapies. Sevelamer and Lanthanum are recent developments on the market. In varying doses, all phosphate binders are able to effectively lower phosphate concentrations. However, drug therapies have achieved recommended phosphate levels in only 50 percent of patients during the last years. Research questions: How effective and efficient are the different phosphate binders in chronic renal insufficient patients? Methods: The systematic literature search yielded 1,251 abstracts. Following a two-part selection process with predefined criteria 18 publications were included in the assessment. Results: All studies evaluated conclude that serum phosphate, serum calcium and intact parathyroid hormone can be controlled effectively with all phosphate binders. Only the number of episodes of hypercalcaemia is higher when using calcium-containing phosphatebinders compared to Sevelamer and Lanthanum. Regarding the mortality rate, the cardiovascular artery calcification and bone metabolism no definite conclusions can be drawn. In any case, the amount of calcification at study start seems to be crucial for the further development of the cardiovascular calcification. Economic studies show higher costs for Sevelamer and Lanthanum compared to calcium-containing phosphate binders. Discussion: Only a few well documented primary studies on the effectiveness of phosphate binders are available. Particularly long-term studies with a robust study design and transparent documentation are lacking. Ten of the eleven primary studies included in this report were conducted in only 539 patients from five patient collectives. Conclusions: From a medical point of view, Sevelamer shows some superiority over calcium-containing phosphate binders based on the current data, at least for special indications. The validity of the present Health Technology Assessment (HTA) report is significantly limited due to the limited number of available publications, the low sample size of treated patients, as well as the fact that the majority of studies are based on the same patient collectives. Prospective long-term studies not funded by the industry with adequate sample sizes and comparable study designs are called for to make authoritative statements regarding the medical effectiveness and safety of Sevelamer and Lanthanum, as well as regarding their economic efficiency

BULLYING E AS RELAÇÕES DE GÊNERO PRESENTES NA ESCOLA

The aim of this study was to analyze the interfaces between bullying and gender relations in the school context. We identified this manifestation in 95 boys and girls from 4th to 8th grade from a public school. The triangulation of data consisted of a questionnaire answered by the students, the school context observations and informal conversations with the board team and students. Results showed that bullying stands out by verbal aggression and its protagonists are mostly male. Gender representations that permeate the daily lives of students show that boys and girls are educated in different ways.  Analizamos las interfaces entre el “Bullying” y las relaciones del género en el contexto de la escuela, identificando esa manifestación entre 95 chicos y chicas de 4º a 8º año de una escuela pública. La triangulación de los datos se constituye de un cuestionario contestado por los/las estudiantes, observaciones del contexto de la escuela y charlas informales con el equipo directivo y alumnos/as. Los resultados apuntan que el  “Bullying” se destaca a través de la agresión verbal y sus protagonistas son en su mayoría del sexo masculino. Las representaciones del género que permean el cotidiano de los estudiantes evidenció que chicos y chicas son educados de modos diferentes. Analisamos as interfaces entre o Bullying e as relações de gênero no contexto escolar, identificando essa manifestação entre 95 meninos e meninas de 4º a 8º séries de uma escola pública. A triangulação dos dados foi constituída por um questionário respondido pelos/as estudantes, observações do contexto escolar e conversas informais com a equipe diretiva e alunos/as. Os resultados apontam que o Bullying se destaca através da agressão verbal e seus protagonistas são, em sua maioria, do sexo masculino. As representações de gênero que permeiam o cotidiano dos estudantes evidenciam que meninos e meninas são educados de modos diferentes.

Quantifying Smartphone “Use”: Choice of Measurement Impacts Relationships Between “Usage” and Health

Problematic smartphone scales and duration estimates of use dominate research that considers the impact of smartphones on people and society. However, issues with conceptualization and subsequent measurement can obscure genuine associations between technology use and health. Here, we consider whether different ways of measuring “smartphone use,” notably through problematic smartphone use (PSU) scales, subjective estimates, or objective logs, lead to contrasting associations between mental and physical health. Across two samples including iPhone (n = 199) and Android (n = 46) users, we observed that measuring smartphone interactions with PSU scales produced larger associations between mental health when compared with subjective estimates or objective logs. Notably, the size of the relationship was fourfold in Study 1, and almost three times as large in Study 2, when relying on a PSU scale that measured smartphone “addiction” instead of objective use. Further, in regression models, only smartphone “addiction” scores predicted mental health outcomes, whereas objective logs or estimates were not significant predictors. We conclude that addressing people’s appraisals including worries about their technology usage is likely to have greater mental health benefits than reducing their overall smartphone use. Reducing general smartphone use should therefore not be a priority for public health interventions at this time

The Identification of the X-ray Counterpart to PSR J2021+4026

We report the probable identification of the X-ray counterpart to the gamma-ray pulsar PSR J2021+4026 using imaging with the Chandra X-ray Observatory ACIS and timing analysis with the Fermi satellite. Given the statistical and systematic errors, the positions determined by both satellites are coincident. The X-ray source position is R.A. 20h21m30.733s, Decl. +40 deg 26 min 46.04sec (J2000) with an estimated uncertainty of 1.3 arsec combined statistical and systematic error. Moreover, both the X-ray to gamma-ray and the X-ray to optical flux ratios are sensible assuming a neutron star origin for the X-ray flux. The X-ray source has no cataloged infrared-to-visible counterpart and, through new observations, we set upper limits to its optical emission of i' >23.0 mag and r' > 25.2mag. The source exhibits an X-ray spectrum with most likely both a powerlaw and a thermal component. We also report on the X-ray and visible light properties of the 43 other sources detected in our Chandra observation.Comment: Accepted for publication in the Astrophysical Journa

Potential of Airborne LiDAR Derived Vegetation Structure for the Prediction of Animal Species Richness at Mount Kilimanjaro

The monitoring of species and functional diversity is of increasing relevance for the development of strategies for the conservation and management of biodiversity. Therefore, reliable estimates of the performance of monitoring techniques across taxa become important. Using a unique dataset, this study investigates the potential of airborne LiDAR-derived variables characterizing vegetation structure as predictors for animal species richness at the southern slopes of Mount Kilimanjaro. To disentangle the structural LiDAR information from co-factors related to elevational vegetation zones, LiDAR-based models were compared to the predictive power of elevation models. 17 taxa and 4 feeding guilds were modeled and the standardized study design allowed for a comparison across the assemblages. Results show that most taxa (14) and feeding guilds (3) can be predicted best by elevation with normalized RMSE values but only for three of those taxa and two of those feeding guilds the difference to other models is significant. Generally, modeling performances between different models vary only slightly for each assemblage. For the remaining, structural information at most showed little additional contribution to the performance. In summary, LiDAR observations can be used for animal species prediction. However, the effort and cost of aerial surveys are not always in proportion with the prediction quality, especially when the species distribution follows zonal patterns, and elevation information yields similar results

An Anti-CD3 Antibody, Teplizumab, in Relatives at Risk for Type 1 Diabetes.

BackgroundType 1 diabetes is a chronic autoimmune disease that leads to destruction of insulin-producing beta cells and dependence on exogenous insulin for survival. Some interventions have delayed the loss of insulin production in patients with type 1 diabetes, but interventions that might affect clinical progression before diagnosis are needed.MethodsWe conducted a phase 2, randomized, placebo-controlled, double-blind trial of teplizumab (an Fc receptor-nonbinding anti-CD3 monoclonal antibody) involving relatives of patients with type 1 diabetes who did not have diabetes but were at high risk for development of clinical disease. Patients were randomly assigned to a single 14-day course of teplizumab or placebo, and follow-up for progression to clinical type 1 diabetes was performed with the use of oral glucose-tolerance tests at 6-month intervals.ResultsA total of 76 participants (55 [72%] of whom were ≤18 years of age) underwent randomization - 44 to the teplizumab group and 32 to the placebo group. The median time to the diagnosis of type 1 diabetes was 48.4 months in the teplizumab group and 24.4 months in the placebo group; the disease was diagnosed in 19 (43%) of the participants who received teplizumab and in 23 (72%) of those who received placebo. The hazard ratio for the diagnosis of type 1 diabetes (teplizumab vs. placebo) was 0.41 (95% confidence interval, 0.22 to 0.78; P = 0.006 by adjusted Cox proportional-hazards model). The annualized rates of diagnosis of diabetes were 14.9% per year in the teplizumab group and 35.9% per year in the placebo group. There were expected adverse events of rash and transient lymphopenia. KLRG1+TIGIT+CD8+ T cells were more common in the teplizumab group than in the placebo group. Among the participants who were HLA-DR3-negative, HLA-DR4-positive, or anti-zinc transporter 8 antibody-negative, fewer participants in the teplizumab group than in the placebo group had diabetes diagnosed.ConclusionsTeplizumab delayed progression to clinical type 1 diabetes in high-risk participants. (Funded by the National Institutes of Health and others; ClinicalTrials.gov number, NCT01030861.)

A population of gamma-ray emitting globular clusters seen with the Fermi Large Area Telescope

Globular clusters with their large populations of millisecond pulsars (MSPs) are believed to be potential emitters of high-energy gamma-ray emission. Our goal is to constrain the millisecond pulsar populations in globular clusters from analysis of gamma-ray observations. We use 546 days of continuous sky-survey observations obtained with the Large Area Telescope aboard the Fermi Gamma-ray Space Telescope to study the gamma-ray emission towards 13 globular clusters. Steady point-like high-energy gamma-ray emission has been significantly detected towards 8 globular clusters. Five of them (47 Tucanae, Omega Cen, NGC 6388, Terzan 5, and M 28) show hard spectral power indices $(0.7 < \Gamma <1.4)$ and clear evidence for an exponential cut-off in the range 1.0-2.6 GeV, which is the characteristic signature of magnetospheric emission from MSPs. Three of them (M 62, NGC 6440 and NGC 6652) also show hard spectral indices $(1.0 < \Gamma < 1.7)$, however the presence of an exponential cut-off can not be unambiguously established. Three of them (Omega Cen, NGC 6388, NGC 6652) have no known radio or X-ray MSPs yet still exhibit MSP spectral properties. From the observed gamma-ray luminosities, we estimate the total number of MSPs that is expected to be present in these globular clusters. We show that our estimates of the MSP population correlate with the stellar encounter rate and we estimate 2600-4700 MSPs in Galactic globular clusters, commensurate with previous estimates. The observation of high-energy gamma-ray emission from a globular cluster thus provides a reliable independent method to assess their millisecond pulsar populations that can be used to make constraints on the original neutron star X-ray binary population, essential for understanding the importance of binary systems in slowing the inevitable core collapse of globular clusters.Comment: Accepted for publication in A&A. Corresponding authors: J. Kn\"odlseder, N. Webb, B. Pancraz