Talk Evidence is back, with your monthly take on the world of EBM with Duncan Jarvies and GPs Carl Heneghan (also director for the Centre of Evidence Based Medicine at the University of Oxford) and Helen Macdonald (also The BMJ's UK research Editor). This month Carl talks about evidence that restricting your diet might improve health at a...

The NHS Practitioner Health Programme - once only for doctors in London, now it’s being rolled out across the NHS to provide the largest, publicly funded, comprehensive physician health service, in the world. However, while helping the individual is essential, systemic change needs to be made to support doctors in our healthcare system. Clare...

A UK general election has been called - polling day is on the 12th of December, and from now until then we’re going to be bringing you a weekly election-themed podcast. We want to help you make sense of the promises and pledges, claims and counter-claims, that are being made around healthcare and the NHS out on the campaign trail. This week has...

Wellbeing might not seem the obvious place to talk about PPE - but lack of appropriate PPE is causing healthcare staff a great deal of stress now. Mary Brindle is a pediatric surgeon and the director of The EQuIS (Efficiency Quality Innovation and Safety) Research platform at Alberta Children’s hospital. In this podcast she reflects on the use...

How can we help frontline clinicians? Sometimes medics may feel uneasy or even guilty and that they could be doing more. That was what a junior doctor in Abergavenny in Wales felt and she did something about it. In this podcast, we speak to Josie Cheetham about how she started her initiative to provide support boxes in hospitals for her...

Samar I. Itani
Jul 1, 2002; 51:2005-2011
Rapid Publications

Norikazu Maeda
Sep 1, 2001; 50:2094-2099
Pathophysiology

BM Spiegelman
Apr 1, 1998; 47:507-514
Articles

Children at increased genetic risk for type 1 diabetes (T1D) after environmental exposures may develop pancreatic islet autoantibodies (IA) at a very young age. Metabolic profile changes over time may imply responses to exposures and signal development of the first IA. Our present research in The Environmental Determinants of Diabetes in the Young (TEDDY) study aimed to identify metabolome-wide signals preceding the first IA against GAD (GADA-first) or against insulin (IAA-first). We profiled metabolomes by mass spectrometry from children’s plasma at 3-month intervals after birth until appearance of the first IA. A trajectory analysis discovered each first IA preceded by reduced amino acid proline and branched-chain amino acids (BCAAs), respectively. With independent time point analysis following birth, we discovered dehydroascorbic acid (DHAA) contributing to the risk of each first IA, and -aminobutyric acid (GABAs) associated with the first autoantibody against insulin (IAA-first). Methionine and alanine, compounds produced in BCAA metabolism and fatty acids, also preceded IA at different time points. Unsaturated triglycerides and phosphatidylethanolamines decreased in abundance before appearance of either autoantibody. Our findings suggest that IAA-first and GADA-first are heralded by different patterns of DHAA, GABA, multiple amino acids, and fatty acids, which may be important to primary prevention of T1D.

The cardiovascular benefits of fibrates have been shown to be heterogeneous and to depend on the presence of atherogenic dyslipidemia. We investigated whether genetic variability in the PPARA gene, coding for the pharmacological target of fibrates (PPAR-α), could be used to improve the selection of patients with type 2 diabetes who may derive cardiovascular benefit from addition of this treatment to statins. We identified a common variant at the PPARA locus (rs6008845, C/T) displaying a study-wide significant influence on the effect of fenofibrate on major cardiovascular events (MACE) among 3,065 self-reported white subjects treated with simvastatin and randomized to fenofibrate or placebo in the ACCORD-Lipid trial. T/T homozygotes (36% of participants) experienced a 51% MACE reduction in response to fenofibrate (hazard ratio 0.49; 95% CI 0.34–0.72), whereas no benefit was observed for other genotypes (P_interaction = 3.7 x 10^–4). The rs6008845-by-fenofibrate interaction on MACE was replicated in African Americans from ACCORD (N = 585, P = 0.02) and in external cohorts (ACCORD-BP, ORIGIN, and TRIUMPH, total N = 3059, P = 0.005). Remarkably, rs6008845 T/T homozygotes experienced a cardiovascular benefit from fibrate even in the absence of atherogenic dyslipidemia. Among these individuals, but not among carriers of other genotypes, fenofibrate treatment was associated with lower circulating levels of CCL11—a proinflammatory and atherogenic chemokine also known as eotaxin (P for rs6008845-by-fenofibrate interaction = 0.003). The GTEx data set revealed regulatory functions of rs6008845 on PPARA expression in many tissues. In summary, we have found a common PPARA regulatory variant that influences the cardiovascular effects of fenofibrate and that could be used to identify patients with type 2 diabetes who would derive benefit from fenofibrate treatment, in addition to those with atherogenic dyslipidemia.

It was not the landing the Jamaicans who arrived at Kingston’s Norman Manley International Airport on Wednesday evening would want again. The 43 Jamaican ship workers of the Marella Discovery 2 were among the 115 people aboard the TUI charter flight that touched down amid the Kingston breeze and evening sunset.

PORT OF SPAIN, Trinidad, CMC – Prime Minister Dr Keith Rowley Saturday dismissed as a “dishonest last gasp and gamble of a dangerously delusional woman” a statement by Opposition Leader Kamla Persad Bissessar calling for him...

PORT OF SPAIN, Trinidad, CMC – The Trinidad and Tobago government Saturday said it had uncovered a plot by persons to defraud the state and that a new mechanism would be put in place Monday in providing rental assistance to people impacted by...

Beat reporter Mark Sheldon answers questions about David Bell's managing style, free agents and who will play center field.

THE EDITOR, Madam May is Child Month, and we, as parents, would show love and appreciation by taking out our kids for recreation, but instead, we have to keep them indoors because of a bush tiger called coronavirus. Every year at this time, I...

THE EDITOR, Madam: THE JAMAICAN economy has been underperforming for the last 40 years, during which economic growth averaged approximately one per cent per annum. One of the main reasons for this poor performance is the non-competitive nature of...

Invitation Only Research Event

Event participants

Dr Ashwini Swain, Fellow, CUTS Institute for Regulation and Competition
Glada Lahn, Senior Research Fellow, Energy, Environment and Resources, Chatham House
Dr Gareth Price, Senior Research Fellow, Asia Programme, Chatham House

Invitation Only Research Event

2 September 2015

This paper explores the potential of using public procurement policy to promote the uptake of sustainable food products in order to reduce imports of agricultural products associated with deforestation.

28 January 2016

Private-sector commitments and government policies, a loss of support for biofuels, and health concerns over the consumption of palm oil and beef, are factors that may help to restrict the further expansion of agricultural land into forest areas.

Research Event

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

Treatment of patients with advanced medullary thyroid carcinoma (MTC) is still a challenge. For more than 2 decades, it has been known that the cholecystokinin 2 receptor is a promising target for the treatment of MTC with radiolabeled minigastrin analogs. Unfortunately, kidney toxicity has precluded their therapeutic application so far. In 6 consecutive patients, we evaluated with advanced 3-dimensional dosimetry whether improved minigastrin analog ¹⁷⁷Lu-DOTA-(d-Glu)₆-Ala-Tyr-Gly-Trp-Nle-Asp-PheNH₂ (¹⁷⁷Lu-PP-F11N) is a suitable agent for the treatment of MTC. Methods: Patients received 2 injections of about 1 GBq (~80 μg) of ¹⁷⁷Lu-PP-F11N with and without a solution of succinylated gelatin (SG, a plasma expander used for nephroprotection) in a random crossover sequence to evaluate biodistribution, pharmacokinetics, and tumor and organ dosimetry. An electrocardiogram was obtained and blood count and blood chemistry were measured up to 12 wk after the administration of ¹⁷⁷Lu-PP-F11N to assess safety. Results: In all patients, ¹⁷⁷Lu-PP-F11N accumulation was visible in tumor tissue, stomach, and kidneys. Altogether, 13 tumors were eligible for dosimetry. The median absorbed doses for tumors, stomach, kidneys, and bone marrow were 0.88 (interquartile range [IQR]: 0.85–1.04), 0.42 (IQR: 0.25–1.01), 0.11 (IQR: 0.07–0.13), and 0.028 (IQR: 0.026–0.034) Gy/GBq, respectively. These doses resulted in median tumor-to-kidney dose ratios of 11.6 (IQR: 8.11–14.4) without SG and 13.0 (IQR: 10.2–18.6) with SG; these values were not significantly different (P = 1.0). The median tumor-to-stomach dose ratio was 3.34 (IQR: 1.14–4.70). Adverse reactions (mainly hypotension, flushing, and hypokalemia) were self-limiting and not higher than grade 1. Conclusion: ¹⁷⁷Lu-PP-F11N accumulates specifically in MTC at a dose that is sufficient for a therapeutic approach. With a low kidney and bone marrow radiation dose, ¹⁷⁷Lu-PP-F11N shows a promising biodistribution. The dose-limiting organ is most likely the stomach. Further clinical studies are necessary to evaluate the maximum tolerated dose and the efficacy of ¹⁷⁷Lu-PP-F11N.

FOUR MORE applicants are vying to provide mobile payment services in various formats, including one applicant seeking to use phone credit as a cash equivalent, but successful applicants will fall under a new framework the regulator calls its “...

THE ACQUISITION of Epping resulted in Total Jamaica controlling nearly a third of the retail gasolene market, but that’s not enough to lessen competition, the Fair Trading Commission, FTC, has found. “The acquisition is unlikely to have either the...

WITH THE productive sector experiencing a shortage of foreign exchange for the past two months, the Jamaican Manufacturers and Exporters Association, JMEA, says it has appealed to the Bank of Jamaica, BOJ, for direct access to US currency for three...

Members Event

Event participants

Rory Stewart, Member of Parliament for Penrith and The Border (2010-19); Secretary of State for International Development (2019)

Chair: Daniel Bruce, Chief Executive, Transparency International UK

Invitation Only Research Event

Event participants

Professor Keun-Wook Paik, Associate Fellow, Energy, Environment and Resources Department, Chatham House
Chair: John Lough, Associate Fellow, Russia and Eurasia Programme, Chatham House

As the U.S. health-care system sags under the strain of the COVID-19 pandemic, health-care workers are not only on the frontlines fighting the virus, they are also some of the most at-risk individuals, making it more essential than ever to have sufficient numbers of qualified health professionals. While 1.5 million immigrants and refugees are already working in the U.S. health-care system, an additional 263,000 immigrants and refugees in the U.S. with health-related college degrees are working in low-skilled jobs or are out of work.

About 2.1 million immigrants work in jobs growing, harvesting, processing, and selling food in the United States, serving an essential role in feeding America. While immigrants accounted for 17 percent of all civilian employed workers in the United States between 2014-18, they played an outsized role in food production, making up 22 percent of workers in the U.S. food supply chain. They represent far larger shares in certain food-related occupations, and in particular states, as this infographic shows.

Faced with a lack of employment opportunities and recurrent poverty, Albanian youth migrate to Italy alone in the hopes of improving their educational prospects or making money for their families. Yet upon arrival, they face many vulnerabilities. While some protections for unaccompanied minors exist in the Italy, the system is greatly fragmented and challenges, including how to return them to Albania, remain persistent.

In the Philippines, a pervasive culture of migration has led millions to seek opportunities abroad, particularly since an economic downturn in the 1970s. The government has long embraced exporting labor as official economic policy, but over time, the focus has shifted: first to protecting workers overseas and much more recently to linking migration and development. This article explores the evolution of Filipino migration policy and trends.

This policy brief explores the relationship between environmental change and migration to Europe in light of recent scholarship challenging the notion that environmental change triggers mass migration. It presents an overview of European policy response in this area and summarizes the spectrum of proposed solutions.

Indonesia, which has a long history as a major origin for migrant labor in the Asia-Pacific and beyond, more recently has reluctantly found itself a transit and destination country, including for asylum seekers. Still, policymakers remain focused on protection of its nationals abroad rather than on assuring the status of Chinese and other foreigners in the country. This country profile explores Indonesia's rich migration history. 

This report by MPI and the Asian Development Bank lays out a realistic roadmap toward freer movement among skilled professionals within the ASEAN Economic Community (AEC), encouraging cooperation among ASEAN Member States in recognizing foreign qualifications and making government investments in training and educations systems that prepare workers in accordance with common standards.

While partnerships to facilitate skilled migration have had mixed success in the past, the Global Compact for Migration is advancing a new approach that may change this. This policy brief compares this new partnership model with the traditional one, highlighting the questions policymakers will need to answer if they are to encourage mobility, sustain employer engagement, and see development benefits in countries of origin.

For a growing population of migrants deported from Mexico and the United States to Central America, the conditions upon return typically are worse than when they left, setting up a revolving-door cycle of migration, deportation, and remigration. This report provides a detailed profile of reception and reintegration services offered in El Salvador, Guatemala, and Honduras to deported migrants, examining their challenges and opportunities for improvement. 

Apple (date: 5/9/2020 - Rank: 9)

Abbe Herzig, AMS Director of Education In the midst of the upheaval due to the Coronavirus, students and faculty are transitioning to new virtual classrooms. Many of us haven’t chosen to learn or teach, but here we are, making the … Continue reading →

The Bundesliga -- Germany's top soccer league -- will be allowed to resume in May after German Chancellor Angela Merkel lifted some lockdown restrictions in the country on Wednesday amid the coronavirus pandemic.

Joseph Tran
Oct 1, 2012; 30:173-178
Practical Pointers

Lisa S. Rotenstein
Oct 1, 2012; 30:138-150
Features

Mayer B. Davidson
Jul 1, 2015; 33:123-135
Feature Articles

Timothy J. Church
Apr 1, 2016; 34:97-104
Feature Articles