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Background: Secondary hyperparathyroidism (SHPT) is common in patients with chronic kidney disease (CKD). Many recommendations in the Kidney Disease Improving Global Outcomes (KDIGO) CKD-mineral and bone disorder guidelines are supported by modest evidence and predate the approval of newer agents. Therefore, an expert panel defined consensus SHPT practice patterns in the United States with real-world context from the nephrology community. Methods: Ten US healthcare providers and one patient participated in a modified Delphi method comprising three phases. Consensus was determined via iterative responses to a questionnaire based on the 2009 and 2017 KDIGO guidelines and published literature on the identification, evaluation, monitoring, and interventional strategies for patients with SHPT. The threshold for consensus was 66% agreement. Results: Panelists generally agreed with KDIGO recommendations, with some differences. Consensus was reached on 42/105 (40%), 95/105 (90.5%), and 105/105 (100%) questions after phases 1, 2, and 3, respectively. Panelists unanimously agreed that SHPT treatment is often started late. There was a preference for serum phosphate level <4.6 mg/dL, and consensus to maintain serum calcium levels <9.5 mg/dL. There was unanimous agreement for vitamin D analogues as first-line options in patients not on dialysis with severe, progressive SHPT and unanimous preference for intravenous calcimimetic, etelcalcetide, in appropriate in-center dialysis patients. Factors such as formularies, dialysis center protocols, and insurance were recognized to influence therapeutic strategies. Conclusions: Expert consensus was reached on SHPT management, further defining therapeutic strategies and medication use and emphasizing need for treatment early. Despite evidence-based treatment preferences supported by clinical experience, factors other than scientific evidence influence decision making, particularly with medications. [ABSTRACT FROM AUTHOR]

This study evaluates the impact of a College to University Pathway Program in the Faculty of Social Science and Humanities at The University of Ontario Institute of Technology. The findings support the assertion that Pathway students perform as well as or better than students who enter university directly from secondary school. This finding is encouraging for universities and colleges as they work toward developing additional Pathway Programs and improving the Pathway Programs they may already offer.

There is a general sense that most outcomes trials in patients receiving dialysis failed to yield statistically significant benefits, in contrast to many cardiovascular (CV) trials in the general population. It is unknown whether methodologic reasons caused this discrepancy. We performed a systematic MEDLINE search for randomized trials with mortality end points of the 42 compounds most commonly used for CV indications. In total, 115 trials were selected for review. We further reviewed 9 mortality end point trials in patients receiving dialysis. The CV trials in populations not receiving dialysis enrolled from 66 to 33,357 participants with an average of 4,910; 59% of the trials showed statistically significant results. The average hazard ratio (HR) was 0.77, ranging from 0.10 to 1.65; 10 drugs had ≥5 published trials each. In the population receiving dialysis, most drugs were studied in single trials; the average number of patients was 1,500 with a range of 127 to 3,883. The average HR was 0.77 and ranged from 0.06 to 1.30. Only 22% of the trials showed statistically significant results. The limitations listed in the general population and dialysis studies were similar. In conclusion, no apparent methodologic issues were detected (other than sample size) that could justify the lower frequency of randomized trials with statistically significant results in patients receiving dialysis. The most obvious difference was the paucity of trials with each drug in the dialysis cohorts; this lowers the chances of at least 1 trial being successful.

Background and objectivesStudies suggest an association between elevated serum alkaline phosphatase (AP) and increased mortality in hemodialysis patients, but the effect of existing therapies on AP is not fully understood. We assessed the effects of cinacalcet on AP in a secondary analysis of controlled trial data.Design, setting, participants, & measurementsThis was a post hoc analysis of data from three 26-wk randomized, double-blind, placebo-controlled, phase 3 trials and a 26-wk double-blind, placebo-controlled extension trial that investigated cinacalcet in secondary hyperparathyroidism treatment in dialysis patients. Hemodialysis patients (n = 890) with intact parathyroid hormone >or=300 pg/ml and serum calcium >or=8.4 mg/dl received cinacalcet plus standard therapy or standard therapy alone for up to 52 wk. Total, not bone-specific, AP was assessed (proportion of cinacalcet/control subjects achieving a >or=20% or any AP reduction from baseline; the proportion of subjects with AP >or=120 U/L) at baseline; the end of titration; and study weeks 26, 42, and 52.ResultsAt 52 wk, a greater proportion of cinacalcet-treated patients had either a >or=20% (39 versus 18%) or any (58 versus 36%) AP reduction compared with control subjects, respectively. The likelihood of achieving either a >or=20% or any AP reduction (determined by relative proportion) was 2.33 (95% confidence interval 1.50 to 3.61) and 1.74 (95% confidence interval 1.31 to 2.31), respectively, at week 52. Cinacalcet treatment tended toward a decreased percentage of patients with AP >or=120 U/L (baseline, 42.6%; week 52, 30.6%) compared with control (35.0 to 48.6%, respectively).ConclusionsIn this combined analysis of controlled trials of patients who were receiving hemodialysis, cinacalcet lowered total serum AP.

Purpose: This study aims to examine the experience of 31 university students who were issued tablet PCs for their use during an academic year. The primary research problem which drove this project revolved around the student perceptions of the benefits of technology to provide opportunities to restructure their learning experiences. Design/methodology/approach: The students were surveyed twice during the year and they were invited to participate in either individual interviews or a series of focus groups. A number of lectures were also visited and observed. The survey results provided quantitative data regarding student usage of the technology. The interviews, focus groups and observed classes provided data around the reasons why the students used the technology in the ways they did. Findings: Little evidence was found to support a contention that meaningful learning with technology had occurred and, in spite of their comfort and familiarity with the technology, there is no evidence of changing attitudes with respect to meaningful learning on the part of the students surveyed in this study. Research limitations/implications: A major application of this should be directed towards similar studies focused on combining the redefinition usage potential of new touch interface-driven devices, such as the iPad, with a new pedagogical approaches to support learners to use the technology as cognitive tools. Originality/value: It is important to note that the introduction of a new technology, even if it makes a wide variety of affordances available for use, cannot by itself, instigate redefinition of learning tasks to allow for meaningful learning to occur. (Contains 1 figure and 1 table.)

Educational statistics and worldwide media have reported a gender gap in academic achievement, with boys falling behind girls with regard to grades, high school graduation, and college enrollment and retention. This mixed methods study involved interviews with educators and the examination of quantitative data to investigate this issue in a school district. Local results mirrored national statistics regarding gender differences in achievement and school success factors. Themes are explored and recommendations are made to enhance school success skills for male students. (Contains 4 tables.)

In 1998, foreign economic crises lowered the demand for U.S. goods and reduced U.S. manufacturing jobs. Hiring increased in construction, finance, and government. Unemployment was low throughout the year. (Author)

Notes that during 1996, overall job gains were moderated by losses in nondurable goods manufacturing and federal employment, and that declining unemployment was tempered by persistent long-term joblessness. (Author)