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Kidney transplant recipients undergo lifelong monitoring of allograft function and evaluation for transplant complications. The current monitoring paradigm utilizes blood, urine, and tissue markers that are insensitive, nonspecific, or invasive to obtain. As a result, problems are detected late, after significant damage has accrued, and often beyond the time at which complete resolution is possible. Indeed, most kidney transplants eventually fail, usually because of chronic rejection and other undetected injury. There is a clear need for a transplant-specific biomarker that enables a proactive approach to monitoring via early detection of reversible pathology. A biomarker that supports timely and personalized treatment would assist in achieving the ultimate goal of improving allograft survival and limiting therapeutic toxicity to the recipient. Donor-derived cell-free DNA (ddcfDNA) has been proposed as one such transplant biomarker. Although the test is presently utilized most in the United States, it is conceivable that its use will become more widespread. This review covers aspects of ddcfDNA that support informed use of the test by general nephrologists, including the basic biology of ddcfDNA, methodological nuances of testing, and general recommendations for use in the kidney transplant population. Clinical contexts are used to illustrate evidence-supported interpretation of ddcfDNA results and subsequent management. Finally, knowledge gaps and areas for further study are discussed.

A 66-YEAR-OLD WHITE WOMAN presented to her primary care clinic with concerns about hair loss, which began 2 years ago. Recently, she had noticed some 'bumps' on her cheeks, as [...]

OBJECTIVE--The structural basis of normoalbuminuric renal insufficiency in patients with type 2 diabetes remains to be elucidated. We compared renal biopsy findings in patients with type 2 diabetes and estimated [...]

Background: Little is known about the prevalence of suicidal ideation among U.S. medical students or how it relates to burnout. Objective: To assess the frequency of suicidal ideation among medical students and explore its relationship with burnout. Design: Cross-sectional 2007 and longitudinal 2006 to 2007 cohort study. Setting: 7 medical schools in the United States. Participants: 4287 medical students at 7 medical schools, with students at 5 institutions studied longitudinally. Measurements: Prevalence of suicidal ideation in the past year and its relationship to burnout, demographic characteristics, and quality of life. Results: Burnout was reported by 49.6% (95% CI, 47.5% to 51.8%) of students, and 11.2% (CI, 9.9% to 12.6%) reported suicidal ideation within the past year. In a sensitivity analysis that assumed all nonresponders did not have suicidal ideation, the prevalence of suicidal ideation in the past 12 months would be 5.8%. In the longitudinal cohort, burnout (P < 0.001 for all domains), quality of life (P < 0.002 for each domain), and depressive symptoms (P < 0.001) at baseline predicted suicidal ideation over the following year. In multivariable analysis, burnout and low mental quality of life at baseline were independent predictors of suicidal ideation over the following year. Of the 370 students who met criteria for burnout in 2006, 99 (26.8%) recovered. Recovery from burnout was associated with markedly less suicidal ideation, which suggests that recovery from burnout decreased suicide risk. Limitation: Although response rates (52% for the cross-sectional study and 65% for the longitudinal cohort study) are typical of physician surveys, nonresponse by some students reduces the precision of the estimated frequency of suicidal ideation and burnout. Conclusion: Approximately 50% of students experience burnout and 10% experience suicidal ideation during medical school. Burnout seems to be associated with increased likelihood of subsequent suicidal ideation, whereas recovery from burnout is associated with less suicidal ideation.

This exploratory research considers the views of 12 introductory accounting lecturers in Scotland regarding their perceptions of how different corporate stakeholders are represented in their recommended introductory accounting texts. The study builds on previous research which suggests that accounting education is embedded in neo-classical economic ideology and instils the notion of shareholder primacy in students. Findings suggest that a majority of the accounting educators interviewed believe pre-eminence is unduly accorded to shareholders in accounting textbooks. Consequently, all but one of the interviewees held the view that students should be presented with 'alternative perspectives' which emphasise the user needs of other stakeholder groups, either by introducing such perspectives in lectures and tutorials or by recommending supplementary reading material. By highlighting the disparity between the issues lecturers want to teach and the values implicit in accounting textbooks this paper draws attention to the potentially limiting role which textbooks can play in the education process. Keywords: Textbooks; Stakeholders; Maximisation of shareholder wealth; Professional accreditation

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.accfor.2006.08.007 Byline: Gwen Hannah, Colin Dey, David Power Keywords: Primary care; Networked organisation; Partnership; Trust Abstract: This paper considers the conditions needed for an organisation to function as an effective network. In particular, the concepts of trust and distrust are explored. Looking at the new labour reforms of 1997, evidence is presented by means of interview responses from GPs, that this powerful group in primary health care lacked sufficient trust in health care managers. In fact GPs seemed to often distrust them. It is unlikely, therefore, that a Scottish local health care co-operative, created as a result of the 1997 reforms to act as an interface between GPs and health care managers could be effective in allocating health care resources. As a result, the reforms did little to improve primary health care services in Scotland despite the increased funding allocated over recent years to this sector. Author Affiliation: School of Accountancy and Business Finance, University of Dundee, Dundee DD1 4HN, Scotland

OBJECTIVE--To investigate the role of intrarenal vascular disease in the pathogenesis of nonalbuminuric renal insufficiency in type 2 diabetes. RESEARCH DESIGN AND METHODS--We studied 325 unselected clinic patients who had [...]

A study examining the relationship between performance of UK's largest companies on financial markets, and their social and environmental disclosures, is presented.

Purpose--This paper seeks to examine the long-run financial and return performance of UK companies which are grouped according to whether or not they have changed their dividends and earnings. Prior research has been conducted using US data and they are limited to extreme dividend changes such as dividend initiations and omissions. They have also arrived at contradicting results; some report a drift in performance, while others document evidence of mean reversion in performance. The current paper hopes to resolve this conflict using data for a large sample of UK firms which disclosed more general changes in dividends and earnings. Design/methodology/approach The aims of the paper are addressed using a stock market-based study of share price performance and a detailed analysis of company performance based on financial ratios. These analyses are conducted from five years before to five years after the announcement of dividend/earnings news. Findings--At the time of the announcements, share returns tend to be positive (negative) where companies have increased (decreased) the dividend and earnings. There is also evidence to suggest that the stock market has anticipated some of this news in the preceding 12 months. However, the dividend/ earnings news does not appear to act as a signal of long-term future company performance; companies which cut this dividend and reported lower earnings achieved the largest excess returns over the next five years. A similar mean-revealing pattern existed in the financial ratios. Finally, most of the future long-term share performance was attributable to the earnings rather than to the dividend news. Research limitations/implications--The main implication of this research is that current dividend/ earnings news is not a good guide to future company performance. Indeed, it is these firms which cut their dividends along with reporting a reduction of earnings which achieve excellent results over a subsequent five-year period. Of course, there are a number of limitations with the research; it draws on data from two previous studies, looks only at the UK and does not consider sophisticated models of investors' expectations with regard to dividend and earnings information. Originality/value--The main contribution of this paper is the long-run analysis of UK company performance following joint dividend-earnings announcements. The analysis is comprehensive in that it considers both stock market performance as well as financial ratio performance for a period of up to five years following the dividend-earnings news. Thus, it should be of interest to most UK investors as well as to financial managers with large quoted firms. Academics will also be interested in the results since they shed some light on an existing debate in the literature. Keywords Dividends, Returns, Financial performance Paper type Research paper

Practice recommendations * Avoiding obstetrical injury to the anal sphincter is the single biggest factor in preventing anal incontinence among women (A). Any form of instrument delivery has consistently been [...]

The Ludwig Report is reviewed and the possible implications of inadequate risk management and control systems within certain corporations are assessed. The Ludwig Report is about the investigations centered on the alleged fraudulent activities of one trader at the Allfirst Financial, causing losses estimated in millions of dollars.

OBJECTIVE -- Anemia is common in diabetes, potentially contributing to the pathogenesis of diabetes complications. This study aims to establish the prevalence and independent predictors of anemia in a cross-sectional [...]

Twenty-two currency forecasters are examined on their ability to predict movements in three major exchange rates. The profitability of portfolios of forward market positions based on the predictions of each forecaster is analyzed. Results of the study show that it is profitable to follow just one panel member. It is concluded that most of the currency analysts are not fully capable in predicting the future.

The article informs about how racial differences in healthcare primarily reflect dose exposure to racism and other social determinants of health linked to racism. It also mentions how the impetus to examine the use of race in renal function started when a small group of physicians learned that leading institutions, such as Massachusetts General Hospital, removed race from their Estimated Glomerular Filtration Rate (eGFR) in an effort to reduce the harms of race based medicine.

This case looks at the initial public offering (IPO) of 180 m shares in Uber Technologies Inc. on May 9th 2019. It considers why the company was seeking to list its shares on the New York Stock Exchange (NYSE) at this time and the possible issue price for these shares using valuation multiples from a competitor (Lyft Inc.) that was already listed. The difficulties associated with valuing Uber's IPO are examined by considering the legal, regulatory, staffing and other problems which affected the company at this time. This case considers whether Uber had the characteristics of an unsuccessful IPO. The main purpose of this case is to highlight how the first-day returns for the IPO performed poorly relative to findings from the literature about past IPOs. Finally, the case considers possible explanations for the poor first-day returns.

Purpose: The purpose of this paper is to provide a theoretically informed analysis of a struggle for power over the regulation of corporate social responsibility (CSR) and social and environmental accounting and reporting (SEAR) within the European Union. Design/methodology/approach: The paper combines insights from institutional theory (Lawrence and Buchanan, 2017) with Vaara et al.’s (2006) and Vaara and Tienar’s (2008) discursive strategies approach in order to interrogate the dynamics of the institutional “arena” that emerged in 2001, following the European Commission’s publication of a Green Paper (GP) on CSR policy and reporting. Drawing on multiple sources of data (including newspaper coverage, semi-structured interviews and written submissions by companies and NGOs), the authors analyse the institutional political strategies employed by companies and NGOs – two of the key stakeholder groupings who sought to influence the dynamics and outcome of the European initiative. Findings: The results show that the 2001 GP was a “triggering event” (Hoffman, 1999) that led to the formation of the institutional arena that centred on whether CSR policy and reporting should be voluntary or mandatory. The findings highlight how two separate, but related forms of power (systemic and episodic power) were exercised much more effectively by companies compared to NGOs. The analysis of the power initiatives and discursive strategies deployed in the arena provides a theoretically informed understanding of the ways in which companies acted in concert to reach their objective of maintaining CSR and SEAR as a voluntary activity. Originality/value: The theoretical framework outlined in the paper highlights how the analysis of CSR and SEAR regulation can be enriched by examining the deployment of episodic and systemic power by relevant actors.

Transcatheter aortic valve replacement (TAVR) is a validated treatment option for severe aortic stenosis. Ischemic and thrombotic complications remain important and strongly correlate with mortality. The optimal postprocedural antithrombotic strategy for prevention of thrombotic events remains unclear. The international guidelines for medical management following TAVR are discordant, allowing for significant variance in prescribing habits. The optimal treatment strategy has yet to be delineated. Clinical trials are ongoing to assess the risks and benefits of various strategies. We discuss the pathobiology and rationale for antithrombotic therapy after TAVR, review current evidence and guidelines, and offer a concise evidence-based approach to this subject.

A study examines the extent of implementation of Six Sigma management concept in firms operating in Ireland, and the role of multinationals in its diffusion. Findings reveal that several firms in Ireland implement Six Sigma, and that multinational firms play a major role in its intra-organizational diffusion by adopting it in their headquarters, and then in their Irish subsidiaries and eventually in their suppliers.

A study was conducted to measure membership of the FTSE4Good 'socially responsible investment' indices in U.K. to increase accountability and change. Findings reveal that indices had a significant impact on firms' reputation.

A study aims to determine whether eating yogurt improves clearance of vancomycin-resistant enterococci (VRE). The results confirmed the hypothesis on probiotic treatment.

Graft-derived cell-free DNA (donor-derived cell-free DNA) is an emerging marker of kidney allograft injury. Studies examining the clinical validity of this biomarker have previously used the graft fraction, or proportion of total cell-free DNA that is graft-derived. The present study evaluated the diagnostic validity of absolute measurements of graft-derived cell-free DNA, as well as calculated graft fraction, for the diagnosis of graft dysfunction. Plasma graft-derived cell-free DNA, total cell-free DNA, and graft fraction were correlated with biopsy diagnosis as well as individual Banff scores. Sixty-one samples were included in the analysis. For the diagnosis of antibody mediated rejection, the receiver-operator characteristic area under the curves of graft-derived cell-free DNA and graft fraction were 0.91 (95% CI 0.82-0.98) and 0.89 (95% CI 0.79-0.98), respectively. Both measures did not diagnose borderline or type 1A cellular mediated rejection. Graft fraction was associated with a broader range of Banff lesions, including lesions associated with cellular mediated rejection, while graft-derived cell-free DNA appeared more specific for antibody mediated rejection. Limitations of this study include a small sample size and lack of a validation cohort. The capacity for absolute quantification, and lower barriers to implementation of this methodology recommend it for further study.

Graft‐derived cell‐free DNA(donor‐derived cell‐free DNA) is an emerging marker of kidney allograft injury. Studies examining the clinical validity of this biomarker have previously used the graft fraction, or proportion of total cell‐free DNAthat is graft‐derived. The present study evaluated the diagnostic validity of absolute measurements of graft‐derived cell‐free DNA, as well as calculated graft fraction, for the diagnosis of graft dysfunction. Plasma graft‐derived cell‐free DNA, total cell‐free DNA, and graft fraction were correlated with biopsy diagnosis as well as individual Banff scores. Sixty‐one samples were included in the analysis. For the diagnosis of antibody mediated rejection, the receiver‐operator characteristic area under the curves of graft‐derived cell‐free DNAand graft fraction were 0.91 (95% CI0.82‐0.98) and 0.89 (95% CI0.79‐0.98), respectively. Both measures did not diagnose borderline or type 1A cellular mediated rejection. Graft fraction was associated with a broader range of Banff lesions, including lesions associated with cellular mediated rejection, while graft‐derived cell‐free DNAappeared more specific for antibody mediated rejection. Limitations of this study include a small sample size and lack of a validation cohort. The capacity for absolute quantification, and lower barriers to implementation of this methodology recommend it for further study. The absolute measurements of plasma graft‐derived and total cell‐derived DNA, with the relative measure of calculated graft fraction, have good diagnostic performance for antibody‐mediated rejection in kidney transplant recipients undergoing for‐cause biopsy.

Purpose: The purpose of this paper is to examine the extent of segmental reporting disclosure and its value relevance to a sample of Qatari and Jordanian listed companies following the implementation review of the International Financial Reporting Standard (IFRS) 8. This was the first standard to be subjected to a post-implementation review. Annual reports are initially analyzed to investigate the level of segmental information that was published by companies in these two countries. Design/methodology/approach: Using the Ohlson (1995) model, the study employs regression analysis to test the hypotheses relating to the value relevance of the segmental disclosures uncovered. In addition, one-way ANOVA and Kruskal-Wallis tests are used to investigate any variation in segmental reporting among sectors. Findings: The findings indicate that the amount of segmental information disclosed by the sample firms differs across sectors. Moreover, the segmental information provided (including the number of segments and the amounts of disclosure) is value relevant and can explain the variations in firms’ share prices. Practical implications: The results of the current investigation have implications for policy makers, including the International Accounting Standards Board, as well as for accounting regulators in Jordan and Qatar. They suggest that the segmental disclosures supplied under IFRS 8 are value relevant for equity prices in a developing country context. Compliance with IFRS 8 should thus be monitored to ensure that all firms provide the segmental disclosures that they are meant to supply under the terms of the standard. Originality/value: This paper is one of the few to provide empirical evidence on the role of segmental reporting following the post-implementation review that was conducted for IFRS 8.

As I read your editorial 'Israel's Choice' (10/11), it seemed to me there is one person truly suitable to bring peace to this troubled land: a man who can understand [...]

The Institute of Chartered Accountants of Scotland (ICAS) has conducted study on the International Financial Reporting Standard (IFRS) disclosures on issued financial statements of UK companies. The preliminary investigations were focused on changes in the number of business segments and geographic segments. Details of the ICAS IFRS8 report are also discussed.

ACCORDING TO 'DISORDER IN THE Courts' (May 21), 63 per cent of 1,000 respondents in a national poll support the idea of electing judges. According to a report I read, [...]

Susceptibility and protection against human autoimmune diseases, including type I diabetes, multiple sclerosis, and Goodpasture disease, is associated with particular human leukocyte antigen (HLA) alleles. However, the mechanisms underpinning such HLA-mediated effects on self-tolerance remain unclear. Here we investigate the molecular mechanism of Goodpasture disease, an HLA-linked autoimmune renal disorder characterized by an immunodominant CD4+T-cell self-epitope derived from the α3 chain of type IV collagen (α3135–145). While HLA-DR15 confers a markedly increased disease risk, the protective HLA-DR1 allele is dominantly protective in trans with HLA-DR15 (ref. 2). We show that autoreactive α3135–145-specific T cells expand in patients with Goodpasture disease and, in α3135–145-immunized HLA-DR15 transgenic mice, α3135–145-specific T cells infiltrate the kidney and mice develop Goodpasture disease. HLA-DR15 and HLA-DR1 exhibit distinct peptide repertoires and binding preferences and present the α3135–145epitope in different binding registers. HLA-DR15-α3135–145tetramer+T cells in HLA-DR15 transgenic mice exhibit a conventional T-cell phenotype (Tconv) that secretes pro-inflammatory cytokines. In contrast, HLA-DR1-α3135–145tetramer+T cells in HLA-DR1 and HLA-DR15/DR1 transgenic mice are predominantly CD4+Foxp3+regulatory T cells (Tregcells) expressing tolerogenic cytokines. HLA-DR1-induced Tregcells confer resistance to disease in HLA-DR15/DR1 transgenic mice. HLA-DR15+and HLA-DR1+healthy human donors display altered α3135–145-specific T-cell antigen receptor usage, HLA-DR15-α3135–145tetramer+Foxp3−Tconvand HLA-DR1-α3135–145tetramer+Foxp3+CD25hiCD127loTregdominant phenotypes. Moreover, patients with Goodpasture disease display a clonally expanded α3135–145-specific CD4+T-cell repertoire. Accordingly, we provide a mechanistic basis for the dominantly protective effect of HLA in autoimmune disease, whereby HLA polymorphism shapes the relative abundance of self-epitope specific Tregcells that leads to protection or causation of autoimmunity.

Background Increased demand for treatment of end-stage kidney disease has largely been accommodated by a costly increase in satellite hemodialysis (SHD) in most jurisdictions. In the Australian State of Victoria, a marked regional variation in the uptake of home-based dialysis suggests that use of home therapies could be increased as an alternative to SHD. An earlier strategy based solely on increased remuneration had failed to increase uptake of home therapies. Therefore, the public dialysis funder adopted the incidence and prevalence of home-based dialysis therapies as a key performance indicator (KPI) for its health services to encourage greater uptake of home therapies.Methods A KPI data collection and bench-marking program was established in 2012 by the Victorian Department of Health and Human Services, with data provided monthly by all renal units in Victoria using a purpose-designed website portal. A KPI Working Group was responsible for analyzing data each quarter and ensuring indicators remained accurate and relevant and each KPI had clear definitions and targets. We present a prospective, observational study of all dialysis patients in Victoria over a 4-year period following the introduction of the renal KPI program, with descriptive analyses to evaluate the proportion of patients using home therapies as well as home dialysis modality survival.Results Following the introduction of the KPI program, the net growth of dialysis patient numbers in Victoria remained stable over 4 years, at 75 – 80 per year (approximately 4%). However, unlike the previous decade, about 40% of this growth was through an increase in home dialysis, which was almost exclusively peritoneal dialysis (PD). The increase was identified particularly in the young (20 – 49) and the elderly (> 80). Disappointingly, however, 67% of these incident patients ceased PD within 2 years of commencement, 46% of whom transferred to SHD.Conclusions Introduction of a KPI program was associated with an increased uptake of PD but not home HD. This change in clinical practice restricted growth of SHD and reduced pressure on satellite services. The effect was offset by a modest PD technique survival. Many patients in whom PD was unsuccessful were subsequently transferred to SHD rather than home HD.

The current study investigates factors affecting financial instruments (FI) disclosure for a sample of Jordanian listed companies (82 firms) over two consecutive years (2013 and 2014). An un-weighted disclosure index is used to examine the extent of FI disclosure. In addition, the study employs a number of multiple regression models to examine the determinants of FI disclosure. The findings indicate that the level of FI disclosure provided by the sample firms is relatively low with only 52% of FI-related items being supplied. In addition, the results illustrate that the level of FI-related disclosure has a statistically positive association with firm size, the audit firm employed and corporate governance attributes. However, the current study fails to document significant associations between FI disclosure and firm industry or ownership structure variables. This research provides a number of insights for policy makers. First, the results of the current study could help the IASB when revisiting FI-related accounting standards to consider an emerging country's perspective. In addition, it provides some insights to accounting regulators in Jordan about how Jordanian listed firms respond to IFRS 7 requirements.

Interatrial block (IAB) is associated with thromboembolism and atrial arrhythmias. However, prior studies included small patient cohorts so it remains unclear whether IAB predicts adverse outcomes particularly in context of atrial fibrillation (AF).

Introduction:High-bleeding risk (HBR) patients undergoing percutaneous coronary intervention (PCI) are often at high risk for thrombotic complications following coronary stenting. We sought to evaluate the frequency and predictors of myocardial infarction (MI) or stent thrombosis (ST) events in HBR patients at 1 year after PCI.Methods:We included HBR patients undergoing PCI with drug-eluting stent implantation at a tertiary-care center, between 2012 and 2019. HBR status was defined as the presence of ≥1 major or ≥2 minor Academic Research Consortium-HBR criteria. Clinical and angiographic baseline characteristics were analyzed after stratifying patients by the occurrence of MI/ST. Independent predictors of MI/ST at 1-year follow-up were assessed using Cox multivariate regression analysis.Results:Among 7,806 HBR patients undergoing PCI, 245 (3.1%) experienced MI/ST within one year of the index procedure. These patients were more frequently female (42.6% vs. 35.7%, p=0.03), had a higher prevalence of insulin-dependent diabetes mellitus (62.3% vs. 40.5%, p<0.001), peripheral artery disease (18.4% vs. 13.4%, p=0.03), chronic kidney disease (57.1% vs. 52.1%, p=0.006), and a history of prior PCI (57.1% vs. 45.7%, p<0.001). Furthermore, they were more likely to undergo complex PCI (43.3% vs. 32.3%, p<0.001) and had a higher mean syntax score (20.6±12.5 vs. 14.2±10.8, p<0.001). Multivessel disease was the most prevalent and strongest predictor of MI/ST at 1-year follow-up, followed by acute coronary syndrome and diabetes mellitus (Figure).Conclusions:MI/ST events frequently occur in HBR patients undergoing PCI. Predictors of MI/ST must be accounted for while deciding on the optimal antithrombotic therapy strategy in these patients.

This paper investigates the information content (signalling) of dividend announcements by firms listed on the Karachi Stock Exchange (KSE) over the period 2005 to 2009. This sample period was selected in order to avoid contamination of the dividend signal with a capital gains tax effect since a capital gains tax was introduced in Pakistan from 2010 onward. The paper contributes significantly to literature about the Pakistani market which has a unique institutional background. The findings show that no significant unexpected returns can be earned on the announcement date by trading on dividend news in Pakistan. It supports the semi-strong form of the efficient market hypothesis. The results also show that earnings are the dominant signal rather than the dividend announced. Moreover, there is some evidence of information leakage as significant unexpected returns were uncovered two days before the dividend announcements.

In response to Mo Guernon's 'The Forgotten Pope' (10/24): I have read Pope John Paul I's book, in which he writes letters to dead people. It was pastoral but plodding. [...]

In 'The Irish Question' (Current Comment, 4/4), it appears that America's editors agree with Fintan O'Toole in calling the Irish stupid. Nice that. But the facts are different from the [...]

I just wanted to say a big thank you for selecting the Rockcastle Shooting Center for the 2011 Shooting Industry Masters. The choice is well deserved. I know the Masters [...]

I write in reference to the recently updated and circulated 'Standards of Medical Care in Diabetes,' in particular part II, 'Screening for Diabetes,' which were recently updated and published in [...]