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Is opt-out the best way to increase organ donation?

As England’s presumed consent law for 2020 clears parliament, Veronica English, head of medical ethics and human rights at the BMA, say that evidence from Wales and other countries shows that it could increase transplantation rates. But Blair L Sadler, physician and senior adviser to California State University, consider such legal changes a...




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Did international accord on tobacco reduce smoking?

WHO Director-General Dr. Tedros recently said “Since it came into force 13 years ago, the Framework Convention on Tobacco Control remains one of the world’s most powerful tools for promoting public health,”. But is it? That’s what a to studies just published on bmj.com try and investigate - one of which pulls together all the data we have on...




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David Williams - everyday discrimination is an independent predictor of mortality

There comes a tipping point in all campaigns when the evidence is overwhelming and the only way to proceed is with action. According to David Williams, it’s time to tackle the disproportionate effects of race on patients in the UK. David Williams, from Harvard University, developed the Everyday Discrimination Scale that, in 1997, launched a new...




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Talk evidence covid-19 update: natural history of covid, include patients in guidelines

For the next few months Talk Evidence is going to focus on the new corona virus pandemic. There is an enormous amount of uncertainty about the disease, what the symptoms are, fatality rate, treatment options, things we shouldn't be doing. We're going to try to get away from the headlines and talk about what we need to know - to hopefully give you...




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Fuel selection in human skeletal muscle in insulin resistance: a reexamination

DE Kelley
May 1, 2000; 49:677-683
Articles




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De Novo Mutations in EIF2B1 Affecting eIF2 Signaling Cause Neonatal/Early-Onset Diabetes and Transient Hepatic Dysfunction

Permanent neonatal diabetes mellitus (PNDM) is caused by reduced β-cell number or impaired β-cell function. Understanding of the genetic basis of this disorder highlights fundamental β-cell mechanisms. We performed trio genome sequencing for 44 patients with PNDM and their unaffected parents to identify causative de novo variants. Replication studies were performed in 188 patients diagnosed with diabetes before 2 years of age without a genetic diagnosis. EIF2B1 (encoding the eIF2B complex α subunit) was the only gene with novel de novo variants (all missense) in at least three patients. Replication studies identified two further patients with de novo EIF2B1 variants. In addition to having diabetes, four of five patients had hepatitis-like episodes in childhood. The EIF2B1 de novo mutations were found to map to the same protein surface. We propose that these variants render the eIF2B complex insensitive to eIF2 phosphorylation, which occurs under stress conditions and triggers expression of stress response genes. Failure of eIF2B to sense eIF2 phosphorylation likely leads to unregulated unfolded protein response and cell death. Our results establish de novo EIF2B1 mutations as a novel cause of permanent diabetes and liver dysfunction. These findings confirm the importance of cell stress regulation for β-cells and highlight EIF2B1’s fundamental role within this pathway.




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St Vincent denies US-based airline from landing with stranded nationals

KINGSTOWN, St Vincent, CMC – The St Vincent and the Grenadines Government has denied a United States-based airline permission to land, dashing hopes that an estimated 300 nationals employed with a US-based cruise line would have arrived home...




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Dominica going ahead with national examinations

ROSEAU, Dominica, CMC –A senior education official Thursday said students would sit the Grade Six National Assessment examinations later this year, despite the disruption caused to the education system by the coronavirus (COVID-19). Dominica...




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Letter of the Day | Discrimination and stigma hurt

THE EDITOR, Madam: The devastating news of Jodian Fearon’s death has resulted in public outrage and concern. The controversy and seemingly negligent actions of the hospitals involved have left many Jamaicans anxious about our health system and...




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Treasures of a proud nation

Lloyd Eubank-Green’s ‘Jamaica’s Gifts to the World’ is concisely and punctiliously delivered. While included in this roster are legendary figures such as Jimmy Cliff, Courtney Walsh, and Michael Norman Manley, others are hardly household names....




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Addressing Resource Conflicts: Working Towards More Effective Resolution of Natural Resource Disputes

Invitation Only Research Event

26 June 2014 - 9:00am to 5:00pm

Chatham House, London

Disputes over resources are a persistent challenge to international peace and security. Natural resources (such as oil, natural gas, minerals, timber and water) are a major source of national income for many countries and, alongside land, are essential to the livelihoods of many millions of people. There is a growing recognition among researchers and decision-makers that in many fragile states disputes over these resources have fed into, and underpinned, violent conflict and instability. 

Although international engagement in national resource disputes is not always desirable or feasible, where it is necessary and possible to support, supplement (or even substitute) national dispute resolution processes it is important to think through the parameters of such action: Who gets involved? With what financial resources? When does an intervention begin? How do they act? 

This one-day roundtable will bring together around 30 experts from policy, academia and business to discuss these questions and more.

The event will be held under the Chatham House Rule. Attendance is by invitation only.

Event attributes

Chatham House Rule

Owen Grafham

Manager, Energy, Environment and Resources Programme
+44 (0)20 7957 5708




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The Economics of Natural Capital

Members Event

24 June 2015 - 1:00pm to 2:00pm

Chatham House, London

Event participants

Professor Dieter Helm CBE, Professor of Energy Policy, University of Oxford

Chair: David Shukman, Science Editor, BBC News

As the global population and economy continues to grow, the international community faces the challenge of accommodating significant growth over the coming decades without a major loss of biodiversity and natural capital, the world’s stock of natural resources. Presenting an economic analysis of these natural assets, Dieter Helm will argue that natural capital and environmental concerns should be placed at the core of economic policy. He will set out a framework for sustainable growth, outlining key measures that could help to preserve the environment while also enabling economic growth. 

Members Events Team




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Nigeria’s Solid Minerals Sector: Alternative Investment Opportunities

Research Event

19 May 2016 - 2:00pm to 4:00pm

UK Houses of Parliament, Westminster, London

Event participants

HE Dr Kayode Fayemi, Minister of Solid Minerals Development, Nigeria
HE Aminu Bello Masari, Governor of Katsina State, Nigeria
Chair: Chi Onwurah MP, Vice Chair, All Party Parliamentary Group on Nigeria

As Nigeria seeks to diversify its economy, the federal government is prioritizing the development of the solid minerals sector, in order to enhance foreign investment, create local job opportunities and build technological capacity and expertise in mining.

At this event, Minister for Solid Minerals Development HE Dr Kayode Fayemi, will discuss plans and priorities for the solid minerals sector including the strengthening of regulatory frameworks and opportunities for investment. Following this, HE Aminu Bello Masari, governor of Katsina State, will discuss state initiatives for solid minerals sector development in northern Nigeria.

This event is now full and registration is closed.

Department/project




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Mining and National Development in the New Global Context

Research Event

1 December 2016 - 5:30pm to 7:00pm

Chatham House, London

Event participants

Tom Butler, Chief Executive Officer, International Council for Mining and Metals (ICMM)
Evelyn Dietsche, Associate Fellow, Energy, Environment and Resources, Chatham House
Chair: Bernice Lee, Executive Director, Hoffman Centre, Chatham House 

During the resources boom of the last decade, countries, companies and communities alike were quick to highlight the transformative potential of the mining sector. With appropriate governance advice and capacity-building support, it seemed the ‘resource curse’ could be overcome. Yet as companies have adjusted their spending in response to declining global commodities prices and longer-term supply and demand projections, low- and middle-income resource-rich economies appear to have increased their dependence on the minerals sector. But how far has the potential of the mining sector been realised to date, and how different does this potential look today?

Taking ICMM’s third edition of the ‘Role of Mining in National Economies’ as the starting point, this meeting will critically assess the contribution that mining has made to development over the past decade, the prospects for ‘mining-led’ growth in the new global context, and the relevance of classic fiscal, employment and governance prescriptions.

Owen Grafham

Manager, Energy, Environment and Resources Programme
+44 (0)20 7957 5708




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Global, regional, and national burden of neck pain in the general population, 1990-2017: systematic analysis of the Global Burden of Disease Study 2017




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Infectious diseases in children and adolescents in China: analysis of national surveillance data from 2008 to 2017




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Association between maternal and paternal mental illness and risk of injuries in children and adolescents: nationwide register based cohort study in Sweden




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Prevalence of diabetes recorded in mainland China using 2018 diagnostic criteria from the American Diabetes Association: national cross sectional study




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Iran Workshop Series: Domestic, Regional and International Outlook

Invitation Only Research Event

17 December 2019 - 10:00am to 3:30pm

Chatham House | 10 St James's Square | London | SW1Y 4LE

After a summer of regional tensions and continued uncertainty regarding the future of the JCPOA, the Chatham House MENA Programme held a closed workshop to examine the impact of the Trump administration’s maximum pressure campaign.

Discussions focused on the domestic developments and challenges inside Iran, prospects for new negotiations with Iran, and the regional issues facing the country. Participants also considered the differences between American and European approaches towards Iran.

 

Event attributes

Chatham House Rule

Reni Zhelyazkova

Programme Coordinator, Middle East and North Africa Programme
+44 (0)20 7314 3624




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Webinar: Labour, Foreign Policy and Internationalism

Members Event Webinar Online Event

25 March 2020 - 6:00pm to 6:45pm

Event participants

Lisa Nandy MP, Member of Parliament for Wigan

Chair: Thomas Raines, Director, Europe Programme, Chatham House

Labour leadership candidate, Lisa Nandy, reflects on the party's foreign policy priorities and makes the case for a foreign policy underpinned by internationalism.

In recent years, the Labour party has struggled to reach cross-party consensus on its foreign policy agenda. While the current leadership election offers the party an opportunity to debate and redefine its position on issues such as immigration, security and Brexit, the extent to which Labour can reconcile its factionalism remains unclear. As Labour undergoes a process of reflection, what kind of foreign policy agenda should the party rally behind that will also appeal to voters outside of its traditional base?

Can the Labour party be unified on its approach to international issues? Is an internationalist foreign policy an attractive choice for voters? And as Brexit tensions persist, what might the party's framework be to ensure new trade deals and partnerships align with fundamental Labour priorities such as workers' rights?




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Delivering Sustainable Food and Land Use Systems: The Role of International Trade

20 September 2019

This paper explores a set of core trade-related issues affecting the food and land use system, and proposes constructive ways forward in reconfiguring the global trading system towards delivering a more sustainable and healthy diet for all.

Bernice Lee OBE

Research Director; Executive Director, Hoffmann Centre for Sustainable Resource Economy

Christophe Bellmann

Associate Fellow, Hoffmann Centre for Sustainable Resource Economy, Chatham House

Jonathan Hepburn

Senior Policy Advisor, International Institute for Sustainable Development

2019-09-20-China-Port.jpg

Aerial view of containers sitting stacked at Qingdao Port in the Shandong province of China. Photo by Han Jiajun/Visual China Group via Getty Images.
  • Meeting future global food security requirements is not just about quantity; it is also about meeting growing needs in a way that safeguards human as well as planetary health. But national priorities and policies often remain out of sync with aspirations for more sustainable and healthy food systems.
  • International trade and trade policies play an ambiguous role in the current food system. With 80 per cent of the world’s population depending on imports to meet at least part of their food and nutritional requirements, trade has a unique function in offsetting imbalances between supply and demand. However, in the absence of effective regulatory frameworks or pricing frameworks that internalize environmental, social or health costs, trade can exacerbate and globalize challenges associated with food production and land use trends such as deforestation, land degradation, greenhouse gas emissions, biodiversity loss and the shift to unhealthy diets.
  • Over the last two decades, trade in agricultural products (excluding intra-EU flows) has more than tripled in value, to reach $1.33 trillion. The geography of global food trade flows has also shifted, primarily towards South–South trade, which now accounts for roughly a quarter of total agricultural trade flows. The nature of global trade has changed drastically, with traditional exports such as wheat and coffee growing slowly at around 2 per cent per year, while products such as palm oil, fruit juice, soft drinks and other processed products have grown at 8 per cent or more annually.
  • This overall increase in trade in agricultural products raises questions about the growing utilization of resources, such as water or soil nutrients, that are embedded in those products through production and processing. Trade itself also causes negative environmental impacts, starting with greenhouse gas emissions associated with transport and storage. If the environmental cost associated with production and trade is not reflected in the final price of goods, trade may accelerate the depletion of resources or their unsustainable use.
  • It is critical to ensure that trade policy options pursued by producing and consuming countries alike will support a transition to more sustainable and healthier food and land use systems. The first step in addressing trade-related food systems challenges must involve rebuilding trust among policy actors. There is a need for new spaces for informal dialogue among actors, and ‘soft’ governance mechanisms that can help rebuild consensus on the best ways forward. Meeting these challenges also requires an appreciation of the complex interactions between sectoral policies (e.g. on water, land, food, etc.) and their multiple interfaces with trade policies. 
  • Conditioning the use of subsidies on their sustainability and/or health impacts encourages the delivery of essential public goods in ways that are consistent with sustainability and health goals. A first step therefore is the removal of perverse incentives (e.g. subsidies encouraging the overuse of fertilizers or pesticides or the overproduction of certain commodities, as well as certain biofuels subsidies) and replacing them with market-correcting subsidies.
  • Trade facilitation measures for fruits and vegetables that are aimed at easing transit at the border, by cutting unnecessary bureaucracy and reducing waiting times, can improve their availability, reduce costs and improve food quality and safety for consumers. Similarly, measures aimed at improving sustainable cold storage and upgrading value chains can support better diets and consumption by increasing the availability of fresh produce on markets, especially in developing countries.
  • A global food stamps programme developed through the G20 and facilitated by the UN’s food agencies could address purchasing power imbalances and tackle malnutrition in developing countries. If carefully designed, such ‘safety net’ schemes can not only contribute to improving calorific intakes but also help deliver more balanced and healthier diets. Careful attention must be given to how such a scheme would work in practice, building on experience to date with similar initiatives.
  • Integrating the notion of sustainable food and inputs trade in the post-2020 global biodiversity framework can help to deliver more sustainable and healthier food and land use systems. This could be achieved by likeminded countries introducing a set of goals or targets aimed at mitigating the role of trade in placing indirect pressure on biodiversity, and to encourage trade in biodiversity-based products including natural ingredients produced ethically and following sustainability principles and criteria.
  • An SDG-oriented agenda for agricultural trade is needed. It could be formed by countries seeking to remove perverse incentives, guaranteeing a safe harbour for market-correcting measures, clarifying existing rules and establishing plurilateral negotiations among subsets of the WTO membership, or sectoral approaches, to address specific challenges.
  • Greenhouse gas emissions resulting from trade need to be addressed. Governments could seek to achieve this through ensuring the carbon neutrality of existing and new trade deals, either by connecting carbon markets among contracting parties or by developing joint initiatives to tax international maritime and air transport emissions.




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12th International Forum on Illegal, Unreported and Unregulated Fishing

Research Event

18 May 2020 - 2:00pm to 22 May 2020 - 3:30pm
Add to Calendar
The 12th International Forum on Illegal, Unreported and Unregulated Fishing was originally scheduled to take place 19-20 March 2020 at Chatham House in London, but was postponed due to COVID-19. We are excited to announce that we have decided to transform the 2020 conference into a series of webinars, delivering the forum discussions over the course of a week (18-22 May 2020). The foci of these exciting sessions include a discussion on the importance of international cooperation to end IUU fishing; the interplay between subsidies and IUU practices; the particular impact of IUU fishing on women and gender relations; transparency; new technologies, and a contextual exploration of IUU fishing in Southeast Asia.
 
Many of the excellent panellists confirmed for the in-person event in March have agreed to participate in this digital version of the IUU Fishing Forum. The online format also provides new opportunities; we hope to reach new, larger and more geographically diverse audiences around the world.
 
The agenda, along with the registration links for the sessions, will be published shortly.

Anna Aberg

Research Analyst, Energy, Environment and Resources Programme
020 7314 3629




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The International Forum on Illegal, Unreported and Unregulated Fishing

The International Forum on Illegal, Unreported and Unregulated (IUU) Fishing brings together over 100 leading policymakers, researchers, industry representatives and civil society groups from across the world to discuss the latest initiatives, regulations and research in the areas of fisheries governance and trade in illegal fish products.

Department contact

Anna Aberg

Research Analyst, Energy, Environment and Resources Programme
020 7314 3629




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COP26 Diplomatic Briefing Series: Climate Change and National Security

Research Event

25 March 2020 - 9:00am to 10:30am

Event participants

Lieutenant General Richard Nugee, Departmental Lead for Climate Change and Sustainability in the UK Ministry of Defence
Rear Admiral Neil Morisetti, Vice Dean (Public Policy) Engineering Sciences at the University College London and Associate Fellow at Chatham House
Dr. Patricia Lewis, Research Director for Conflict, Science and Technology, and Director of the International Security Programme at Chatham House
Professor Yacob Mulugetta, Professor of Energy and Development Policy at the University College London
Chair: Glada Lahn, Senior Research Fellow, Chatham House
Extreme weather, rising sea levels and a melting Arctic - the effects of climate change are posing an increasingly large threat to national security worldwide. Although the issue has gained traction within the international community in recent years, including within the UN Security Council, it is urgent that governments act more decisively to mitigate and respond to the threat, not least given that climate change is happening faster and in a more powerful way than originally anticipated.
 
The third event in the Chatham House COP26 Diplomatic Briefing Series – 'Climate Change and National Security' - will analyze how climate change acts as a threat multiplier, fuelling instability and endangering economic, social and political systems across the globe. The briefing will also provide recommendations of what governments and other stakeholders should do to develop effective responses.
 

Anna Aberg

Research Analyst, Energy, Environment and Resources Programme
020 7314 3629




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The histone H4 basic patch regulates SAGA-mediated H2B deubiquitination and histone acetylation [DNA and Chromosomes]

Histone H2B monoubiquitylation (H2Bub1) has central functions in multiple DNA-templated processes, including gene transcription, DNA repair, and replication. H2Bub1 also is required for the trans-histone regulation of H3K4 and H3K79 methylation. Although previous studies have elucidated the basic mechanisms that establish and remove H2Bub1, we have only an incomplete understanding of how H2Bub1 is regulated. We report here that the histone H4 basic patch regulates H2Bub1. Yeast cells with arginine-to-alanine mutations in the H4 basic patch (H42RA) exhibited a significant loss of global H2Bub1. H42RA mutant yeast strains also displayed chemotoxin sensitivities similar to, but less severe than, strains containing a complete loss of H2Bub1. We found that the H4 basic patch regulates H2Bub1 levels independently of interactions with chromatin remodelers and separately from its regulation of H3K79 methylation. To measure H2B ubiquitylation and deubiquitination kinetics in vivo, we used a rapid and reversible optogenetic tool, the light-inducible nuclear exporter, to control the subcellular location of the H2Bub1 E3 ligase, Bre1. The ability of Bre1 to ubiquitylate H2B was unaffected in the H42RA mutant. In contrast, H2Bub1 deubiquitination by SAGA-associated Ubp8, but not by Ubp10, increased in the H42RA mutant. Consistent with a function for the H4 basic patch in regulating SAGA deubiquitinase activity, we also detected increased SAGA-mediated histone acetylation in H4 basic patch mutants. Our findings uncover that the H4 basic patch has a regulatory function in SAGA-mediated histone modifications.




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International Students in the United States

The number of international students enrolled in U.S. colleges and universities has risen steadily since the mid-20th century. Today, the United States represents the top destination for international students worldwide. Learn more about where these students come from, which universities they attend, and the subjects they study in this Spotlight article.




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To Stay or Not To Stay: The Calculus for International STEM Students in the United States

More than 1 million international students were in the United States in 2015-16, a significant share of them in science, technology, engineering, or math (STEM) fields. While countries increasingly are vying for this population, these individuals face a complex choice upon graduation: to stay or leave? This article examines international STEM students in the United States and the motivations underlying their postgraduation plans.




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Immigrants and WIOA Services: Comparison of Sociodemographic Characteristics of Native- and Foreign-Born Adults in the United States

As federal and state governments ramp up efforts to implement the Workforce Innovation and Opportunity Act, these fact sheets compare key characteristics of the foreign born and the U.S. born that are relevant to understanding needs for adult education and workforce training services. The fact sheets cover the United States, the 20 states and 25 counties with the largest immigrant populations, and New York City.




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Dual Language Learners: A National Demographic and Policy Profile

As the share of U.S. children under age 8 who are Dual Language Learners (DLLs) increases, state policies have an important role to play in ensuring all young learners are able to get their education off to a good start. These fact sheets compare key characteristics of DLLs and their peers nationwide and in 30 states, and identify state policies that support equitable access to high-quality early childhood education and care programs.




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Noncitizens in the U.S. Military: Navigating National Security Concerns and Recruitment Needs

Noncitizens have long served in the U.S. military, often encouraged by the promise of a fast track to U.S. citizenship. In recent years, however, Congress and the Defense Department have made it more difficult for noncitizens to enlist. This brief give context to these policy changes and explores ways the military could better balance concerns about national security and the need for recruits with key cultural and professional skills.




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Examining the Adequacy and Enforcement of Our Nation’s Immigration Laws

Testimony of Marc R. Rosenblum, Deputy Director, U.S. Immigration Program, before the House Judiciary Committee on the efficacy of immigration enforcement at the U.S. border and in the interior.




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A Growing Destination for Sub-Saharan Africans, Morocco Wrestles with Immigrant Integration

Long a country of emigration and a springboard for migrants aiming to reach Europe, Morocco has emerged as a destination for many sub-Saharan Africans. As more migrants remain in Morocco, the kingdom has implemented policies to aid with integration. But challenges remain, with most of the estimated 700,000 sub-Saharan Africans living in precarious conditions and irregular status despite some legalization programs.




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A Conversation with António Vitorino, the Director General of the International Organization for Migration

In his first public address on his inaugural official visit to Washington, DC, IOM Director General António Vitorino discusses his vision for IOM; reforms in the UN system; coordination with other organizations in addressing humanitarian protection; and the operational steps IOM is taking to respond to forced migration and displacement.




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Global Governance of International Migration 2.0: What Lies Ahead?

The vast majority of UN Member States in December 2018 adopted the first-ever international agreement to cooperate on migration. This policy brief traces the trajectory of the Global Compact for Safe, Orderly, and Regular Migration's negotiation and endorsement. It also explores the factors that will determine whether the compact lives up to its aim of improving how states cooperate on international migration.   




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The Road Ahead: Coordination Challenges of Implementing the GCM

The Member States of the United Nations convened in December to adopt the Global Compact for Safe, Orderly, and Regular Migration (GCM). Ahead of the adoption, this side event in Marrakech (open only to those with GFMD credentials) considered the coordination and mechanisms most needed to achieve the commitments laid out in the GCM.




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Australia: A Welcoming Destination for Some

Immigration has driven economic and social development in Australia for more than two centuries. Even as more than one-fourth of the country’s population is foreign born and Australia ranks third among top refugee resettlement countries worldwide, controversy surrounding its hardline treatment of asylum seekers arriving by boat has cast a shadow on its reputation as a welcoming country, as this article explores.




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El Salvador: Civil War, Natural Disasters, and Gang Violence Drive Migration

El Salvador is the smallest country in Central America yet the most densely populated. A stagnant economy, high levels of crime and violence, and natural disasters have pushed growing numbers of people to migrate without authorization or seek asylum abroad, mostly in the United States. This article explores historical and contemporary emigration from El Salvador.




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Improving the Governance of International Migration

This volume from MPI's Transatlantic Council on Migration aims to fill the analytical gap regarding the question of what greater global cooperation on governing the flow of international migrants could achieve. The book focuses on a set of fundamental questions: What are the key steps to building a better, more cooperative system of governance? What are the goals that can be achieved through greater international cooperation? And, most fundamentally, who (or what) is to be governed?




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Climate Change and Natural Disasters Displace Millions, Affect Migration Flows

From earthquakes to drought, natural disasters and climate change played a key role in migration flows in 2015. Climate-induced migration surfaced as a concern at the United Nations Climate Change Conference (known as COP21) as international organizations and policymakers have begun to recognize the growing challenges, and potential protection obligations, of such movement.




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A Conversation with António Vitorino, the Director General of the International Organization for Migration

In his first public address during his inaugural formal visit to Washington, DC. International Organization for Migration (IOM) Director General António Vitorino discussed his vision for the agency; reforms in the UN system designed to address migration matters better; the coordination of efforts between IOM, the UN High Commissioner for Refugees, and other international partners in addressing humanitarian protection; and the operational steps IOM is taking to respond to forced migration and displacement in hotspots around the world, including Venezuela, Bangladesh, and Libya.




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Navajo Nation Reels Under Weight of Coronavirus and History of Neglect

Source:

The Navajo Nation now has the highest per-capita coronavirus infection rate after New York and New Jersey, but it has a fraction of the resources to treat and prevent the pandemic. "This has got to end," said president Jonathan Nez after federal relief funds arrived six weeks after they were promised and a week after the U.S. government missed a congressional deadline for distribution.






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The Germany-Turkey Migration Corridor: Refitting Policies for a Transnational Age

This Transatlantic Council on Migration report describes how the migration of nationals between Germany and Turkey has developed over recent decades; examines the economic, social, and political factors behind this development; and discusses the policy implications and lessons that can be drawn.




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Superior Long-term Survival for Simultaneous Pancreas-Kidney Transplantation as Renal Replacement Therapy: 30-Year Follow-up of a Nationwide Cohort

OBJECTIVE

In patients with type 1 diabetes and end-stage renal disease, it is controversial whether a simultaneous pancreas-kidney (SPK) transplantation improves survival compared with kidney transplantation alone. We compared long-term survival in SPK and living- or deceased-donor kidney transplant recipients.

RESEARCH DESIGN AND METHODS

We included all 2,796 patients with type 1 diabetes in the Netherlands who started renal replacement therapy between 1986 and 2016. We used multivariable Cox regression analyses adjusted for recipient age and sex, dialysis modality and vintage, transplantation era, and donor age to compare all-cause mortality between deceased- or living-donor kidney and SPK transplant recipients. Separately, we analyzed mortality between regions where SPK transplant was the preferred intervention (80% SPK) versus regions where a kidney transplant alone was favored (30% SPK).

RESULTS

Of 996 transplanted patients, 42%, 16%, and 42% received a deceased- or living-donor kidney or SPK transplant, respectively. Mean (SD) age at transplantation was 50 (11), 48 (11), and 42 (8) years, respectively. Median (95% CI) survival time was 7.3 (6.2; 8.3), 10.5 (7.2; 13.7), and 16.5 (15.1; 17.9) years, respectively. SPK recipients with a functioning pancreas graft at 1 year (91%) had the highest survival (median 17.4 years). Compared with deceased-donor kidney transplant recipients, adjusted hazard ratios (95% CI) for 10- and 20-year all-cause mortality were 0.79 (0.49; 1.29) and 0.98 (0.69; 1.39) for living-donor kidney and 0.67 (0.46; 0.98) and 0.79 (0.60; 1.05) for SPK recipients, respectively. A treatment strategy favoring SPK over kidney transplantation alone showed 10- and 20-year mortality hazard ratios of 0.56 (0.40; 0.78) and 0.69 (0.52; 0.90), respectively.

CONCLUSIONS

Compared with living- or deceased-donor kidney transplantation, SPK transplant was associated with improved patient survival, especially in recipients with a long-term functioning pancreatic graft, and resulted in an almost twofold lower 10-year mortality rate.




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Intellectual Disability in KATP Channel Neonatal Diabetes

OBJECTIVE

Neonatal diabetes has been shown to be associated with high neuropsychiatric morbidity in a genotype-phenotype–dependent manner. However, the specific impact of different mutations on intellectual functioning is still insufficiently characterized. Specifically, only a small number of subjects with developmental delay have been comprehensively assessed, creating a knowledge gap about patients carrying the heaviest burden.

RESEARCH DESIGN AND METHODS

We assessed the intellectual functioning and mental health of the complete Norwegian population with KATP channel neonatal diabetes. Eight sulfonylurea-treated children (five with the p.V59M genotype [KCNJ11]) were assessed using age-matched control subjects with type 1 diabetes. The investigations included a physical and motor developmental examination, cerebral MRI, psychometrical examination, and questionnaires assessing intellectual capabilities and psychiatric morbidity.

RESULTS

A strong genotype-phenotype correlation was found, revealing the p.V59M genotype as highly associated with substantial intellectual disability, with no significant correlation with the time of sulfonylurea initiation. Consistent with previous studies, other genotypes were associated with minor cognitive impairment. Cerebral MRI verified normal brain anatomy in all but one child.

CONCLUSIONS

We here presented a comprehensive assessment of intellectual functioning in the largest cohort of p.V59M subjects to date. The level of intellectual disability revealed not only changes the interpretation of other psychological measures but downplays a strong protective effect of sulfonylurea. Within the scope of this study, we could not find evidence supporting an early treatment start to be beneficial, although a weaker effect cannot be ruled out.




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International Classification of Diseases, 10th Revision, Coding for Diabetes

Joy Dugan
Oct 1, 2017; 35:232-238
Practical Pointers




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The Diabetes Code: Prevent and Reverse Type 2 Diabetes Naturally

Renza Scibilia
Jul 1, 2019; 37:302-303
Book Reviews




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Within-Trial Evaluation of Medical Resources, Costs, and Quality of Life Among Patients With Type 2 Diabetes Participating in the Exenatide Study of Cardiovascular Event Lowering (EXSCEL)

OBJECTIVE

To compare medical resource use, costs, and health utilities for 14,752 patients with type 2 diabetes who were randomized to once-weekly exenatide (EQW) or placebo in addition to usual diabetes care in the Exenatide Study of Cardiovascular Event Lowering (EXSCEL).

RESEARCH DESIGN AND METHODS

Medical resource use data and responses to the EuroQol 5-Dimension (EQ-5D) instrument were collected at baseline and throughout the trial. Medical resources and medications were assigned values by using U.S. Medicare payments and wholesale acquisition costs, respectively. Secondary analyses used English costs.

RESULTS

Patients were followed for an average of 3.3 years, during which time those randomized to EQW experienced 0.41 fewer inpatient days (7.05 vs. 7.46 days; relative rate ratio 0.91; P = 0.05). Rates of outpatient medical visits were similar, as were total inpatient and outpatient costs. Mean costs for nonstudy diabetes medications over the study period were ~$1,600 lower with EQW than with placebo (P = 0.01). Total within-study costs, excluding study medication, were lower in the EQW arm than in the placebo arm ($28,907 vs. $30,914; P ≤ 0.01). When including the estimated cost of EQW, total mean costs were significantly higher in the EQW group than in the placebo group ($42,697 vs. $30,914; P < 0.01). With English costs applied, mean total costs, including exenatide costs, were £1,670 higher in the EQW group than the placebo group (£10,874 vs. £9,204; P < 0.01). There were no significant differences in EQ-5D health utilities between arms over time.

CONCLUSIONS

Medical costs were lower in the EQW arm than the placebo arm, but total costs were significantly higher once the cost of branded exenatide was incorporated.




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National Standards for Diabetes Self-Management Education and Support

Linda Haas
Jan 1, 2014; 37:S144-S153
National Standards




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Prevalence of Hyper- and Hypoglycemia Among Inpatients With Diabetes: A national survey of 44 U.S. hospitals

Deborah J. Wexler
Feb 1, 2007; 30:367-369
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