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Rationale & objectiveA low ankle-brachial index (ABI) is used to diagnose peripheral artery disease (PAD) but may be normal or elevated in patients with medial arterial calcification and stiff vessels, as is common in chronic kidney disease (CKD). The toe-brachial index (TBI) has been recommended because it is not influenced by medial arterial calcification, but alone the TBI does not capture risk associated with medial arterial calcification. We hypothesized that the difference between ABI and TBI (ABI - TBI) would capture both PAD and medial arterial calcification and thus better identify mortality risk from PAD, particularly in those with CKD.Study designProspective cohort study.Setting & participants471 patients with clinical suspicion for PAD referred for vascular testing.ExposuresABI, TBI, and ABI - TBI.OutcomeAll-cause mortality.Analytical approachCox proportional hazards models evaluating the association of ABI - TBI with mortality over 7 years.ResultsMean age was 68 years, 89% were men, 35% had diabetes, 64% had CKD, and mean estimated glomerular filtration rate was 55 mL/min/1.73 m2. Median ABI was 0.96 (interquartile range [IQR], 0.73-1.08), median TBI was 0.62 (IQR, 0.46-0.81), and median ABI - TBI was 0.23 (IQR, 0.14-0.39). Higher ABI - TBI values were associated with increased risk in mortality only among participants with ABI values ≥ 0.9 (P = 0.03). Among participants with CKD and ABI values ≥ 0.9, participants with ABI - TBI values higher than the median had greater (HR, 1.79; 95% CI, 1.18-2.72) risk for mortality (P = 0.005). This was attenuated after age adjustment (HR, 1.41; 95% CI, 0.91-2.20) but did not change after further adjustment for confounders.LimitationsMainly male cohort derived from a vascular laboratory; lack of limb outcomes and data for albuminuria.ConclusionsA high ABI - TBI value may be associated with higher risk for mortality in persons with CKD and a normal ABI. Age affects this association, and further studies evaluating ABI - TBI in larger populations are required.

IntroductionThe ankle-brachial index (ABI) is the most common test to diagnose peripheral artery disease (PAD). In dialysis patients, the ABI may under-diagnose PAD, due to a high prevalence of concomitant medial arterial calcification (MAC). The toe-brachial index (TBI) is not as susceptible to misclassification by MAC. Taking the ABI and TBI together in the form of their difference, the ABI-TBI, may provide a single measure for assessing both atherosclerosis and calcification. The relationship of these variables in dialysis patients has not been well studied.MethodsWe identified 37 dialysis patients referred for vascular studies between 2009 and 2017 in the San Diego Veterans Administration Medical Center (SDVAMC). The ABI and TBI were performed systematically for each patient, and TBI was performed regardless of ABI or waveform. We examined associations between ABI, TBI, and the difference between them (ABI-TBI) with all-cause mortality and major adverse limb events (MALE), which includes revascularizations and amputations.FindingsThe mean age was 65 years and 30% were African American. All patients were men, reflecting the Veterans Administration population. There were 26 deaths during follow-up and mortality was highest in patients who had low ABI and low TBI and least in those with high ABI and high TBI. Persons with TBI < 0.7 had an increased risk of all-cause mortality. The ABI-TBI, and the ABI itself, were not significantly associated with all-cause mortality although the patterns were similar.DiscussionAlthough ABI may be an important initial risk stratification tool, the TBI may be a more informative predictor of mortality in dialysis patients. Strengths of this study include a high rate of MALE and deaths. The TBI, and the difference between ABI and TBI, should be studied further in a larger cohort of persons with advanced kidney disease.

What was colonial about colonial print culture? By analyzing the social and material dimensions of print—its practices, communities, networks, and technologies—our special issue probes whether and how colonialism shaped the specific print cultures that took shape across varied and geographic and temporal contexts. In so doing, we contribute to a wide-ranging intervention on print that has, in recent decades, dismantled teleological narratives linking global modernity with the diffusion of European printing. Contributors make the case for situating histories of print and the public sphere within the world of comparative social analysis, rather than singularly within book, cultural, or intellectual history. By attending to the materiality of printing and the ground-level practices and "tactics" of production and circulation, contributors not only reveal the wide range of social actors who helped to shape the uses and meanings of print—including colonial and postcolonial officials and journalists as well as manufacturers, artisans, merchants, and collectors—but also identify overlooked connections within and between regions that linked practitioners and readers rooted in diverse colonial and postcolonial contexts. Rather than charting a linear march towards mass printing or a homogenous global printing industry, the essays highlight the temporal asymmetries of colonial printing and the political and economic forces and human actors that shaped the specific regional and local trajectories of print. [ABSTRACT FROM AUTHOR]

Examining a series of legal challenges by newspaper companies in the first half-century after Indian Independence (1947), this essay examines the legal boundaries and practical content of press freedom in postcolonial India. The cases, which were concerned with official regulation of page length, newsprint allocation, and customs duties, were far from obvious attempts at censorship. And yet the petitioners claimed that such regulation of form, price, and material did, in fact, violate their constitutionally guaranteed right to freedom of speech and expression. Meanwhile, the newly democratic Indian state contended that its prescriptive directives were affirmative measures intended to protect fledgling newspapers from competition with larger conglomerates—and, thus, necessary to ensure such diversity of news and opinion as fostered genuine freedom of the press. In drawing attention to more prosaic and oblique ways in which the press can be controlled, this essay highlights the complexity of defining press freedom in practice , especially in functioning democracies that not only hope to maintain that status but also retain international credibility. The legal battles point to the tension between abstract ideas of freedom and affirmative commitments to equity as it materialized in a newly independent country with tremendous diversity. Given that these cases stretch across the Emergency (1975–77)—which remains a defining event in terms of formal state censorship in postcolonial India—they also demonstrate how routine strategies of control often have a more subterranean timeline that traverses formal disruptions in state–press relations, including, in this case, the transition from colonialism to independence. [ABSTRACT FROM AUTHOR]

Examining cases of libel between 1780 and 1823, this article analyses how the theory and practice of press regulation and governmentality was initially articulated in colonial India, embodied in everyday transactions between the newly invented East India Company state and an emerging newspaper press. While Company officials recognized that scrutiny by a free press was central to establishing their fairly new claims to just governance and public legitimacy, they feared that public critique would destabilize the very sovereign authority that they sought to establish. Concerned with appearing arbitrary, officials developed strategies through which they could demand obedience without necessarily predicating it on censorship. Journalists derived much of their negotiating power from the early colonial state's vulnerability to public scrutiny, but they also knew that the state possessed extensive control over their livelihood. Cognizant of the power and constraints of colonial governmentality at this juncture, they produced their own mechanisms of permissible intransigence. This uneasy equilibrium generated the questions explored in this article: What rights of comment and critique practically accrued to newspapers? What was the legal authority of executive regulations censoring newspapers and how far were these enforceable? Why, in practice, did punishments remain strikingly similar across periods with and without formal censorship? The cases between 1780 and 1823 not only reveal the historical negotiations that structured this foundational—though somewhat marginalized—period of India's press history, but also explain the strategic shifts that followed as, in 1823, the fulcrum of crime and punishment turned away from press censorship and towards press licensing. [ABSTRACT FROM AUTHOR]