The Black AIDS Institute (The Institute), with support from Merck, announced the launch of the Black Treatment Advocates Network (BTAN). BTAN, the first collaborative Network of its kind, will train and mobilize a team of treatment advocates with a mission to link Black Americans with HIV into care and treatment; strengthen local and national leadership; raise HIV science and treatment literacy in Black communities; and advocate for policy change and research priorities.

Black Americans represent 13 percent of the U.S. population, and yet they are the largest group impacted by HIV/AIDS at 51 percent, according to the Centers for Disease Control and Prevention. They also remain those least in care. Studies show that among individuals with HIV/AIDS, Blacks are 59 percent less likely than Whites to be receiving HIV treatment.

“We are at an important juncture in the trajectory of the AIDS epidemic in Black communities. Improving HIV literacy, increasing the number of trained Black treatment educators, and expanding the level of treatment advocacy in Black communities is critical to our efforts to end the AIDS epidemic in Black communities,” said Phill Wilson, president and CEO of the Black AIDS Institute. “The Institute is pleased to partner with Merck, people living with HIV/AIDS, and community organizations to launch BTAN. Their support, leadership, and dedication will help to lay the foundation for a new era in Black HIV/AIDS treatment education and advocacy.”

The National Network will connect individuals from across the country and, for the first time, unify Black HIV/AIDS advocacy efforts under an umbrella initiative focused on reducing disparities and improving care for the Black American HIV community. The Network will allow advocates to learn together and from each other via regular, national web-based trainings, regional programs around the U.S., and the Network website, which will serve as a portal to connect members and house resources to inform, guide and support efforts in the field.

“We are proud to support BTAN and partner with the Black AIDS Institute, AIDS service organizations (ASOs) and advocates across the country to launch this important initiative,” said Patrick Bergstedt, senior vice president and general manager, Merck Infectious Disease Franchise. “Merck is committed to helping reduce healthcare disparities and improve access to HIV/AIDS care and treatment for Black Americans through collaborative efforts such as BTAN. This dynamic Network has the potential to positively impact the lives of thousands of Black Americans in the U.S. affected by HIV/AIDS.”

Across the board, treatment advances have helped to result in declines of more than 70 percent in the national rate of AIDS deaths, but Black Americans are not benefiting equally from the breakthroughs. Very few community-based treatment advocacy initiatives are rooted in agencies focused on Black communities. BTAN aims to mobilize existing community leaders with appropriate training to create the backbone of a new era in Black American HIV/AIDS advocacy.

As its first major initiative, BTAN will partner with Merck & Co., Inc. and local ASOs in a small number of high prevalence, resource-limited “pilot” communities across the country to hold intensive science and advocacy trainings to address local critical needs. The pilot launch cities for 2010 are Philadelphia, Pennsylvania; Houston, Texas; and Jackson, Mississippi. A core group of advocates from these cities will be key to growing the Network and sustaining its long-term impact.

The pilot partners will be introduced at a BTAN program at September’s U.S. Conference on AIDS (USCA) in Orlando, Florida.

Individuals interested in more information about the Black Treatment Advocates Network, including how to become involved, should contact the Black AIDS Institute at 213.353.3610 ext. 120.

Source: Black AIDS Institute Continue reading →

Responding to the Department of Health (England) announcement banning the
use of higher rate telephone numbers within the NHS, Dr Hamish Meldrum,
chairman of the BMA’s General Practitioners Committee said:

“The BMA is sympathetic to the view that patients should not be charged
over the odds for contacting their family doctor. A relatively small number
of GP practices use 0870 numbers, as do some other NHS bodies. Some of the
GP practices involved were encouraged to switch to 0870 systems by their
primary care organisation. By introducing 0870 telephone systems,
practices will have benefited from improved equipment installed with the
aim of ensuring patients were able to get through to the practice quickly,
deliver their message or request speedily, and in general spend less time
on the telephone than with previous systems. We welcome the Government’s
intention to fund the cost of the change back to lo-call rate systems and
this should apply to all affected practices, whatever their telephone
system supplier. We look forward to talks with the Department about
implementing the new policy in a workable time-frame.”

Ends

NB
The BMA understands that in the region of 300 GP practices use 0870
telephone numbers. This figure should be seen in the context of 11,000
practices in the UK, approx 8,000 of them in England.

For more information please contact:
Linda Millington
Tel: 020 7383 6473
Fax: 020 7383 6403
Email: pressofficebma

Public Affairs Division
British Medical Association
BMA House
Tavistock Square
London
WC1H 9JP

After 6:00 pm and weekends:
+44 (0) 790 167 0068
+44 (0) 208 651 5130
+44 (0) 208 444 7992
+44 (0) 1525 379792
+44 (0) 7747 394450
+44 (0) 7810 523 722
+44 (0)115 845 1860 Continue reading →

In its response to the draft Pharmacy Order 2009 consultation the NPA’s major concerns relate to:

- regulation of pharmacy premises
- membership of the Council
- use of post-nominals
- temporary registration in emergencies
- proposals for differential fees.

Membership of the Council

The NPA considers that at least two places should be reserved on the General Pharmaceutical Council for community pharmacists, with one reserved for a hospital pharmacist.

Given the General Pharmaceutical Council’s role in setting standards for the education and training necessary for registration, it would also be appropriate for a reserved place for a pharmacist with expertise in this field.

We also note that the reserved places for England, Scotland and Wales may be held by lay members of the Council, and are concerned that the Council may therefore lack insight into the changing practices of pharmacy across the UK.

The Inspectorate

By effectively regulating the practitioners, the GPhC will be able to maintain high quality practice without the need to regulate the pharmacy premises. We believe that regulation of pharmacy practice, coupled with incentives within service level agreements between PCTs and contractors, and ultimately patient choice, engender an upwards dynamic of quality. Minimum standards, on the other hand, can have the effect of maintaining standards at a minimum level. Consequently we do not support the introduction of standards for premises, noting that many of the areas for standards outlined in the order are for issues already considered by PCTs as part of their contract monitoring.

The General Pharmaceutical Council’s role in relation to premises, therefore, can be restricted to the keeping of a register, detailing where persons may lawfully carry on a retail pharmacy business and sell or supply medicines not on the general sales list.

The NPA is also concerned that there should be clear separation between the roles of regulators and contracting bodies. The role of the contracting body (eg, PCT in England) is to secure services and monitor the delivery of contractual obligations. The role of the regulator is to verify that minimum standards of practice are met. These are clearly distinct roles, and there should not be duplication between the activities of the regulator and the local contracting body.

Post-nominals

The NPA proposes that, in the interests of public safety, registered pharmacists should be able to identify themselves to the public and other health care professionals by the use of a set of post-nominals. These post-nominals should be awarded by the General Pharmaceutical Council to its registrants.

Temporary registration with regard to emergencies

Whilst the NPA accepts that the registrar should be able to register very recently retired pharmacists, some non-practising pharmacists and some pre-registration trainees nearing the end of their training on the practising register, we do not agree that the registrar should have the power to register other groups as pharmacists.

Statutory committees

The NPA does express concern at the loss of the health committee. A caring profession should ensure that, whilst ensuring public protection, practitioners whose performance is impaired through ill health receive support and understanding, rather than being subject to the full weight of the disciplinary mechanisms. A non-statutory committee would be an acceptable alternative.

Improvement notices, fees and superintendents

The NPA believes that minimum periods for complying with an improvement notice should be increased. The proposal for differential fees for inspection needs careful consideration, it would be completely unacceptable if those who offer clinical services are penalised for their innovation. We do not believe that there is any justification for imposing additional requirements on superintendent pharmacists

The NPA has, in addition, signed up to a joint response with other community pharmacy bodies submitted separately, covering in greater detail concerns about GPhC powers in relation to pharmacy premises.

National Pharmacy Association Continue reading →

New guidance on best practice to support the pharmacist’s role in the fight against lung cancer
has been launched this week by the Royal Pharmaceutical Society of Great Britain’s (RPSGB)
Practice Division in conjunction with The Pharmaceutical Journal. ”Practice Guidance: Lung
Cancer” is available at pjonline to coincide with a special article in The
Pharmaceutical Journal on 03 November.

The practice guidance has been produced as part of Lung Cancer Awareness Month
(November), which includes activity organised by a multi-disciplinary working group based at
the Department of Health (DH), involving leading lung cancer experts, senior NHS and DH
professionals, charities and healthcare companies and organisations, including the RPSGB.

A key message of the campaign is that early detection and diagnosis of lung cancer can save
lives and pharmacy has been positioned as a front-runner in early intervention. The new
practice guidance urges pharmacists to:

- Be alert to possible lung cancer symptoms, such as the worsening of a longstanding
cough, especially in high risk patients

- Increase public awareness of the signs and symptoms of lung cancer and the
importance of early detection

- Take all opportunities to offer advice on smoking cessation

Paul Gimson, Lead Pharmacist for Long Term Conditions at the RPSGB, comments: ”With
lung cancer, early detection leading to a swift diagnosis is vital to improve chances of patient
survival and save lives.

”Patients will often share worrying symptoms with a pharmacist and the role of community
pharmacists in raising awareness of particular health issues is becoming more widely
recognised.”

Mr Gimson says that the guidance aims to help pharmacists to be extra vigilant in detecting
early signs and symptoms of lung cancer, offer advice and refer people to a GP when
appropriate: ”This work further highlights the valuable role that community pharmacy has to
play in improving public health.”
Lung Cancer Awareness Month, now in its fifth year, was pioneered by Macmillan Cancer
Support and the Roy Castle Lung Cancer Foundation.

Although overall incidence rates of lung cancer in the UK fell by 16% between 1995 and 2004,
lung cancer remains the most common cause of death from cancer in the UK, with some
38,000 new cases diagnosed each year.

Royal Pharmaceutical Society of Great Britain Continue reading →

The citric acid cycle, one of the most important metabolic processes in our bodies, was formulated in 1937. Since then, all of the intermediates have been produced in multigram quantities – with one exception, (2R,3S)-isocitric acid. Athanassios Giannis and his team at the University of Leipzig have finally done it. As they report in the journal Angewandte Chemie, their process, a combination of one biotechnological and one chemical step, starts with sunflower oil, a renewable starting material. Isocitric acid and its derivatives thus become accessible on a kilogram scale.

In the citric acid cycle, acetyl CoA, formed in the breakdown of lipids, sugars, and amino acids, is used to produce energy that is biochemically available to an organism. Carbon dioxide and water are produced in this process. This reaction mechanism is named after one of the intermediate products, the anion of citric acid.

In nature, isocitric acid is always found with its isomer, citric acid. The difference between these two compounds is merely that the hydroxy group (-OH) is bound to a different carbon atom of each molecule. Large-scale separation of the two isomers has not been possible. A fermentative synthesis of the pure compound has also not worked.

Giannis team has now finally done it, thanks to a host of tiny helpers, the yeast Yarrowia lipolytica, which produces isocitrate from refined sunflower oil in previously unachievable yield and in a favorable isocitrate to citrate ratio. After the biomass is filtered out, electrodialysis is used to obtain the pure acids. The researchers use a trick to separate citric acid from isocitric acid: They use methanol to convert the compounds into the corresponding methyl esters. Why does this work” Whereas the citric acid ester crystallizes, the isocitric acid ester is a liquid. Separation then becomes child’s play.

Why was isocitric acid so important to these researchers” Isocitric acid is a compound with chiral centers – carbon atoms with four different groups bound to them. There are always two versions of a chiral center, one being the mirror image of the other. Smaller, easily accessible chiral compounds are useful building blocks for the synthesis of complex natural products and are interesting starting materials for the pharmaceutical industry. Isocitric acid makes available a new assortment of such chiral building blocks.

###

Author: Athanassios Giannis, Universit?¤t Leipzig (Germany)

Title: Syntheses with a Chiral Building Block from the Citric Acid Cycle: (2R,3S)-Isocitric Acid by Fermentation of Sunflower Oil

Angewandte Chemie International Edition, doi: 10.1002/anie.200705000

Source: Athanassios Giannis

Wiley-Blackwell Continue reading →

World Diabetes Day, November 14,
is observed every year by over 200 associations in more than 160 countries,
and by others with an interest in diabetes. This year’s theme, “prevention
of diabetes in children and adolescents,” provides an excellent opportunity
to focus on the significant increase in type 1 diabetes in children and the
research community’s response.

Funded by the National Institutes of Health (NIH), researchers at more
than 150 medical centers in the U.S., Canada, Europe and Australia have
joined forces through Type 1 Diabetes TrialNet, a global network dedicated
to study the prevention, early detection and early treatment of type 1
diabetes. These centers are offering free screenings for relatives of
people with type 1 diabetes to determine their risk of developing the
disease. Those at increased risk can join research studies that are testing
ways to prevent or delay type 1 diabetes.

Developing more often in children and young adults, type 1 diabetes is
currently unpreventable, and a diagnosis means a lifelong commitment to
insulin injections and monitoring for health complications. In contrast,
type 2 diabetes occurs more often in adults, can sometimes be prevented or
delayed through diet and exercise, and doesn’t always require insulin
injections.

“The number of people being diagnosed with type 1 diabetes is
increasing every year, reaching epidemic proportions in some countries,”
says Jay Skyler, M.D., Chairman of Type 1 Diabetes TrialNet and a Professor
at the University of Miami’s internationally renowned Diabetes Research
Institute. “The greatest change is an increased rate of diabetes in
children under age five,” he adds.

In response, diabetes researchers around the world have been working to
advance the study, prevention and treatment of type 1 diabetes. As a
result, the way the disease is detected and treated is dramatically
changing. A simple blood test can now reveal a person’s risk for type 1
diabetes up to 10 years before diagnosis.

If diabetes can be delayed, even for a few years, those at risk may be
able to postpone the difficult challenges of trying to control their
glucose levels and the potential development of serious complications. The
serious complications of diabetes include heart disease, stroke, blindness,
kidney damage and lower-limb amputations

In addition, Type 1 Diabetes TrialNet is preparing to launch several
new studies in early 2008 for people newly diagnosed with type 1 diabetes.
The group is also collaborating with the Immune Tolerance Network, also
funded by NIH, to perform studies aimed at the protection of beta cells in
people recently diagnosed with type 1 diabetes.

These researchers are working together to answer such critical
questions as:

— Can insulin taken by mouth once a day prevent or delay type 1 diabetes
in some people at risk for the disease?

— Is it possible to turn off the body’s immune attack that causes type 1
diabetes by administering certain antibodies that bind to and
temporarily destroy a specific class of immune cells?

— Can certain drugs or combinations of drugs slow or arrest the
autoimmune response in type 1 diabetes?

— Can an omega-3 fatty acid, naturally found in a mothers’ breast milk
and some foods, have anti-inflammatory benefits that can prevent or
delay development of the autoimmunity leading to type 1 diabetes?

Diabetes TrialNet
DiabetesTrialNet Continue reading →

The production of health economic evaluations of pharmaceuticals is a multibillion dollar industry globally. Nevertheless, little is known about uptake by medical decision makers.

Dr. Sandra Erntoft has investigated whether there are differences in use across decision makers and to what extent these patterns can be explained by contextual factors?

The review – “Pharmaceutical priority setting and the use of health economic evaluations – A systematic literature review”, published in Value In Health identifies differences in the use between decision makers and contexts. Health Economic evaluations are not only used in order to inform decisions, but also serves the purpose of rationalize decisions, structuring the priority setting process or requesting additional budgets. Factors that seem to support an increased use of health economic evaluations are a general awareness and acceptance of limited health care resources, demands for an explicit priority setting process, the lack of budgetary responsibilities and the presence of health economic skills.

Dr. Sandra Erntoft, Research Director of the Swedish Institute for Health Economics says “When these preconditions are not in place, it is difficult for a decision maker to use health economic evaluations directly in medical decision making. In order to increase the use these cultural and institutional barriers need to be removed.”

Source:

ISPOR Continue reading →

A molecular ‘battle of the sexes’ long considered the major driving force in a baby’s development is being challenged by a new genetic theory of parental teamwork.

Biologists at The University of Manchester say the prevailing view that maternal and paternal genes compete for supremacy in their unborn offspring fails to answer some important questions relating to child development.

In fact, rather than a parental power struggle, the researchers suggest that certain offspring characteristics can only be explained by their theory of genetic cooperation.

“When we are conceived we inherit two copies of every gene – one set from our mother and one from our father,- explained Dr Jason Wolf, who led the research in Manchester-s Faculty of Life Sciences.

“But some genes – through a process called genomic imprinting – only use one parent-s copy; the spare copy from the other parent is silenced by a chemical stamp.”

The concept of imprinting has long puzzled scientists as it appears to undermine the natural benefits organisms gain from inheriting two sets of genes.

If one copy of a gene is damaged, for instance, then the second copy can compensate; imprinted genes lose this safeguard and so are more susceptible to disease. Errors in imprinting have also been linked to cancer and other genetic disorders.

Scientists have argued that the reason some genes only use or ‘express’ one copy is due to a conflict between paternal and maternal interests.

In the natural world, for example, males would hope to produce large offspring to give them the best chance of survival and carry on their gene line. But large offspring require greater maternal investment, so females will try to impose their genetic stamp so that smaller young are born.

“The idea that imprinting evolves because of conflict between males and females over maternal investment in their offspring has become a generally accepted truth that has remained largely unchallenged,” said Dr Wolf.

“But we have shown that selection for positive interactions between mothers and their offspring, rather than conflict, can produce the sorts of imprinting patterns we see for a lot of genes.

“For example, during placental development the maternal and offspring genomes have to work together to produce a functional placenta. By expressing the genes they get from their mothers, the offspring are more likely to show an adaptive fit with their mother’s genes; they complement each other and so work better together to produce the placenta.”

###

The findings – published in the world-s leading biology journal PLoS Biology – are important because the conflict hypothesis is cited by people working in a diverse range of areas. This new theory is therefore likely to have implications across the biological sciences.

Contact: Aeron Haworth

University of Manchester Continue reading →

Vicki L. Seltzer, M.D., vice president for Women’s Health Services at North Shore-Long Island Jewish Health System in Great Neck, N.Y. is the 2008 chair of the American Hospital Association’s (AHA) Section for Maternal and Child Health. As chair, Seltzer will lead the section’s governing council on public policy issues concerning women and children’s health, hospitals serving that patient population and AHA member service strategies.

Seltzer is currently chair of the Department of Obstetrics and Gynecology at both North Shore University Hospital and the Long Island Jewish Medical Center, two of the largest obstetrics programs in New York. North Shore-Long Island Jewish Health System provides obstetrical care for approximately 23,000 women at seven hospitals.

Seltzer previously served as president of the American College of Obstetricians and Gynecologists and was only the second woman ever to hold this elected position. She was also president of the New York Obstetrical Society. She has served important roles in national and international medical organizations including the International Federation of Gynecology and Obstetrics, American Medical Women’s Association, Obstetrics and Gynecology Residency Review Committee, Council on Graduate Medical Education and the Council on Resident Education in Obstetrics and Gynecology.

Seltzer was one of the first women in the U.S. to be board certified as a subspecialist in gynecologic oncology. She is the Edie and Marvin H. Schur Professor of Obstetrics & Gynecology and Women’s Health at the Albert Einstein College of Medicine in Bronx, N.Y.

John Duval, M.B.A., chief executive officer of Medical College of Virginia Hospitals of Virginia Commonwealth University Health System in Richmond, Va., an 822-bed teaching hospital that includes more than 600 faculty physicians, is chair-elect and will assume the role of chair in 2009. Duval received his bachelor of science in biological sciences and his masters of business administration in management from the University of California Irvine.

Herman B. Gray, M.D., president of Children’s Hospital of Michigan (CHM), a member of the Detroit Medical Center in Detroit, Mich., will join the council for a 3-year term, serving until 2010. CHM is the only free-standing children’s hospital in Michigan. Prior to becoming president Gray served as the chief operating officer at CHM.

Paula Broderick, R.N., director of Women & Children’s Health Nursing at New York Presbyterian Hospital/Weill Cornell Medical Center in New York, N.Y., is the immediate past-chair. New York Presbyterian Hospital is one of the largest and most comprehensive hospitals in New York, with over 13,000 employees and 2,200 patient beds.

Current AHA board member Raymond Grady, president of Hospitals & Clinics Evanston Northwestern Healthcare in Evanston, Ill., was reappointed as the 2008 Board Liaison to the Council.

About AHA

The American Hospital Association (AHA) is a not-for-profit association of health care provider organizations and individuals that are committed to health improvement in their communities. The AHA is the national advocate for its members, which include almost 5,000 hospitals, health care systems, networks, and other providers of care. Founded in 1898, the AHA provides education for health care leaders and is a source of information on health care issues and trends. aha.

About the Section for Maternal and Child Health

AHA’s Section for Maternal and Child Health supports women’s and children’s hospitals as they build systems of care to improve the health status of their communities.

The Section is guided by a governing council composed of leaders representing some of the country’s leading hospitals and maternal and health providers.

Governing council members serve as elected representatives of their member peers. They advise the AHA on member service strategies, public policy issues, advocacy positions, and emerging issues, as well as serve as a channel back to the maternal and child health field.

American Hospital Association Continue reading →

Most kidney donors and recipients are in favor of exchanging personal health information that may influence success before scheduling a living organ donor transplant, while healthcare professionals are more reluctant, according to a study appearing in an upcoming issue of the Clinical Journal of the American Society Nephrology (CJASN). The results suggest that clinicians should consider supporting and facilitating more information sharing before transplantation.

Living kidney donation is a complex decision, with multiple medical, legal, and ethical aspects. In many situations it can be difficult to know what personal health information is important to share and what information should be kept confidential. For example, knowing that a donor has high blood pressure may affect a recipient’s willingness to accept the gift, or a potential recipient who is HIV positive may worry that this information could change a donor’s willingness to donate. The situation becomes even more complex during incompatible kidney exchanges when multiple incompatible donor-recipient pairs are matched with each other to produce compatible matches. In these cases, donors and recipients are usually strangers to each other and may be more reluctant to share personal health information.

Because there is currently no consensus on what information should be disclosed between potential transplant donors and recipients, Patricia Hizo-Abes (medical student), Ann Young (doctoral student) and Amit Garg, MD, PhD, FRCPC (all from The University of Western Ontario and Lawson Health Research Institute, London, Canada), and colleagues, conducted a survey on the preferences of 43 potential kidney donors, 73 potential recipients, and 41 health professionals towards sharing personal health information. When considering traditional live donor transplantation, 86% of donors and 80% of recipients said that a recipient’s health information that could influence the success of transplant should be shared with the donor; 97% of donors and 89% of recipients said that a donor’s information should be shared with the recipient. When considering incompatible kidney exchange, 85% of donors and 85% of recipients said that a recipient’s information should be shared with all donors and recipients involved in the transplantation; 95% of donor and 90% of recipients said that a donor’s information should also be shared with all involved individuals.

While the majority of kidney donors and recipients were in favor of exchanging information, transplant professionals’ opinions varied greatly and tended to be more conservative. (For example, for incompatible kidney exchanges, only 61% of health professionals were in favor of sharing donors’ information and only 47% were in favor of sharing recipients’ information.) These findings indicate that not only do transplant professionals lack a consensus related to information sharing, but their preferences are also markedly different from those of their patients.

The authors noted that the rights of any donor or recipient opposed to information sharing must be respected, but clinicians should not assume to know how much patients value their confidentiality. In addition, transplant professionals should better facilitate the sharing of information within legal limitations. “Our results do not advocate for complete information sharing, but rather consideration for greater information sharing,” said Dr. Garg.

In an accompanying podcast, William Harmon, MD of the Children’s Hospital Boston (Boston, MA) explains, “This is a very important study, because it’s the first of its kind, in which we’re actually asking the attitudes of both the donors and the recipients. This study should lead to additional studies to clarify this.”

Study co-authors include Meaghan Cuerden (University of Western Ontario, in London, Canada), Peter Reese, MD (University of Pennsylvania), Phil McFarlane, MD, PhD, FRCPC, and Linda Wright (University of Toronto, Canada) for the Donor Nephrectomy Outcomes Research (DONOR) Network.

Disclosures: The authors reported no financial disclosures.

The American Society of Nephrology (ASN) does not offer medical advice. All content in ASN publications is for informational purposes only, and is not intended to cover all possible uses, directions, precautions, drug interactions, or adverse effects. This content should not be used during a medical emergency or for the diagnosis or treatment of any medical condition. Please consult your doctor or other qualified health care provider if you have any questions about a medical condition, or before taking any drug, changing your diet or commencing or discontinuing any course of treatment.

Founded in 1966, the American Society of Nephrology (ASN) is the world’s largest professional society devoted to the study of kidney disease. Comprised of 11,000 physicians and scientists, ASN continues to promote expert patient care, to advance medical research, and to educate the renal community. ASN also informs policymakers about issues of importance to kidney doctors and their patients. ASN funds research, and through its world-renowned meetings and first-class publications, disseminates information and educational tools that empower physicians.

Source: American Society of Nephrology (ASN) Continue reading →