There is currently no evidence that phosphate-binder treatment reduces mortality compared to placebo in adults with CKD. It is not clear whether the higher mortality with calcium versus sevelamer reflects whether there is net harm associated with calcium, net benefit with sevelamer, both, or neither. Iron-based binders show evidence of greater phosphate lowering that warrants further examination in randomized trials.

Concerns about the need for assessing multidialectal listening skills for global contexts are becoming increasingly prevalent. However, the inclusion of multiple accents on listening assessments may threaten test fairness because it is not practical to include every accent that may be encountered in the language use domain on these tests. Given this dilemma, this study aimed to determine the extent to which accent strength and familiarity affect comprehension and to provide a defensible direction for assessing multidialectal listening comprehension. A strength of accent scale was developed, and one US, four Australian, and four British English speakers of English were selected based on a judgment of their strength of accent. Next, TOEFL test takers (N = 21,726) were randomly assigned to listen to a common lecture given by one of the nine selected speakers, and respond to six comprehension items and a survey designed to assess their familiarity with various accents. The results suggest that strength of accent and familiarity do affect listening comprehension, and these factors affect comprehension even with quite light accents. AbstractConcerns about the need for assessing multidialectal listening skills for global contexts are

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Lake Chapala, whose primary tributary is the Río Lerma, is the largest freshwater lake in Mexico and for the past 95 years has maintained an average storage capacity close to 6,700 Mm3. Starting hi the early 1970s, the Lerma‐Chapala basin rapidly industrialized. In response to these upstream anthropogenic activities, the fisheries, aesthetics, and water quality of Lake Chapala have decreased as a consequence of the increasing chemical and biologic pollutants mainly from the Río Lerma. Additionally, the growth of Guadalajara has resulted in increasing potable water demands on the lake to satisfy a population currently greater than 4.5 million. During the 1980s, the outflow and water losses from the lake substantially exceeded the inflow and other water contributions. In this paper, the recent behavior of the hydrologic and bathymetric parameters of Lake Chapala are summarized and some important physical stresses on the system are identified. The focus of this work is the 1934–1989 period, and it is shown that starting around 1980 some of the main contributors to the lake water balance were severely perturbed and the lake reached its second lowest recorded level. The disturbances of the system are so severe that the entire regional ecosystem could be irreversibly affected in the near future.