Given a 38% risk of rejection, per 100 recipients compared with no treatment, nine recipients would need treatment with IL2Ra to prevent one recipient having rejection, 42 to prevent one graft loss, and 38 to prevent one having CMV disease over the first year post-transplantation. Compared with ATG treatment, ATG may prevent some experiencing acute rejection, but 16 recipients would need IL2Ra to prevent one having CMV, but 58 would need IL2Ra to prevent one having malignancy. There are no apparent differences between basiliximab and daclizumab. IL2Ra are as effective as other antibody therapies and with significantly fewer side effects.
Inconsistent and incomplete outcome reporting may make estimates of treatment effects from published randomized trials unreliable. We aimed to determine outcome reporting practices and source of differences in reporting quality among randomized trials of primary immunosuppression in kidney transplantation. We searched the Cochrane Renal Group's Specialized Register, 2000–2012, specified four core outcomes we expected trials to report, and recorded if and how completely each was reported. We identified 179 trials. One hundred sixty‐eight (94%) reported death, 145 (81%) as number dead and 119 (66%) as time to death. One hundred sixty‐five (92%) reported graft loss, 158 (88%) as number with graft loss and 127 (71%) as time to graft loss. One hundred twenty‐one (68%) reported creatinine and 114 (64%) estimated GFR (eGFR). One hundred forty‐one (79%) provided complete reports of number dead, 95 (53%) censored and 99 (55%) uncensored number with graft loss. Seventy‐three (41%) provided complete reports of time to death, 67 (37%) censored and 31 (17%) uncensored time to graft loss. Complete reporting of graft function was infrequent: 62 (35%) eGFR and 50 (28%) creatinine. All four outcomes were reported in any form in 61 (34%) and completely in 28 (16%) trials. No single trial or journal characteristic was consistently associated with complete outcome reporting. Outcome reporting in kidney transplant trials is inconsistent and frequently incomplete, and published estimates of treatment effects may be unreliable.
A contractual mechanism to protect and amplify the interests of Indigenous community well-being in the development of Artificial Intelligence (AI) that affects them is investigated. Our proposal explores the need for a legal mechanism that recognizes the importance of cultural knowledge and ways of being and doing, acknowledging that these can be in tension with the (potentially myopic) goals of AI development. We outline the preconditions for such a legal mechanism to be possible, including some of the core components that could give rise to a termination for cultural misalignment, as well as the supporting types of governance structures and operating principles such a legal mechanism may engender. We discuss how the establishment of such a mechanism in contracts forces procurers of AI technology development services, and therefore developers of AI technology systems themselves, to adopt and enact principles by which they will work to protect and enable community wellbeing, thereby instigating important behavior change. Consideration is given to the types of knowledge, skills and training that would be required to implement such a mechanism successfully. This essay has a particular emphasis on working to ensure Indigenous community well-being in the development of AI, however there are also applications for other communities.
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