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Background: Concerns have been raised regarding proton pump inhibitor (PPI) use and risk of severe coronavirus disease 2019 (COVID‐19). Observational studies have yielded heterogeneous results and were subject to important methodological limitations. Aims: To examine the association between the receipt of PPIs and risk of COVID‐19 hospitalizations and severe in‐hospital outcomes or death. Methods: Case–control study among Medicare fee‐for‐service beneficiaries 66+ years old with gastroesophageal reflux disorder (GERD). Within this population, we identified cases by an incident hospital discharge diagnosis of COVID‐19 from April 1 to December 11, 2020, using the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD‐10‐CM) U07.1, and randomly selected up to 10 controls per case, matched on date and neighborhood. We defined PPI use as a prescription providing ≥15 days of supply in the 30 days before admission, with H2‐receptor antagonist (H2RA) use as the reference to account for indication. We analyzed uncomplicated hospitalizations and hospitalizations with severe outcomes (intensive/coronary care unit admission, invasive mechanical ventilation, or death), estimating odds ratios (ORs), and 95% confidence intervals (CIs) with multinomial conditional logistic regression adjusted for demographics, comorbidities, chronic medications, and health care utilization. Results: We matched 25,867 uncomplicated and 12,954 severe hospitalized COVID‐19 cases to 146,972 and 73,104 controls, respectively. Cases tended to be older and have more comorbidities. Relative to H2RA use, we found no association of PPI use with uncomplicated COVID‐19 hospitalization (OR 0.99, 95% CI 0.93–1.06) or severe COVID‐19 hospitalization (OR 1.00, 95% CI 0.91–1.10). Conclusions: Relative to H2RA use, PPI use was not associated with uncomplicated or severe COVID‐19 hospitalizations among Medicare beneficiaries with GERD. [ABSTRACT FROM AUTHOR]

Design patterns represent a means of communicating reusable solutions to common problems, provided they are implemented and maintained correctly. However, many design pattern instances erode as they age, sacrificing qualities they once provided. Identifying such instances of pattern decay is valuable because it allows for proactive attempts to extend the longevity and quality attributes of pattern components. Apart from structural decay, design patterns can exhibit symptoms of behavioral decay. We utilized a taxonomy that characterizes these negative behaviors and designed a case study wherein we measured structural and behavioral decay, hereafter referred to as pattern grime, as well as pattern quality and size, across pattern evolutions. We evaluated the relationships between structural and behavioral grime and found statistically significant cases of strong correlations between specific types of structural and behavioral grime. Furthermore, we extended the QATCH operational software quality model to incorporate design pattern evolution metrics and measured and correlated software quality to the presence of behavioral grime in software systems. Our results suggest a strong inverse relationship between software quality and behavioral grime. [ABSTRACT FROM AUTHOR]

In this case study, rubble masonry walls from the Sierra Nevada de Santa Marta in Northern Colombia were investigated. We applied a combined object‐based image analysis (OBIA), photogrammetry, and petrography method to characterize and determine the provenance of the materials used in three targeted terraces of the archaeological site of La Palma. In situ data acquisition included detailed photographic records and petrographic descriptions of a selected section of masonry walls, as well as mapping of local geological units. Photographs were processed using OBIA. The data obtained allowed characterization and systematization of the constructive elements, via parameters that include architectural function within the construction (headers, stretchers, and wedges), roundness, and lithotype. This methodology enabled us to identify the source of the lithotypes from local rock outcrops (metagranodiorite and schist) as well as rock boulders and cobbles from the nearby riverbeds. The results suggest that pre‐Hispanic communities had knowledge of the properties of the geological resources available in the region, which they used to build masonry that has endured more than five centuries. Vertical differences identified in segments of different terrace walls suggest changes in the constructive process and therefore may serve to determine a construction chronology. [ABSTRACT FROM AUTHOR]

Background: Despite the increase in Alzheimer's disease (AD) research among ethnic and racial minority populations, they are underrepresented in research and successful recruitment of diverse cohorts remains challenging. Culturally specific recruitment strategies and community engagement are needed to increase diverse participant enrollment in aging research. In 2020, we designed and implemented a strategy to recruit 1,000 African Americans (AA), 50 years and older into the Health & Aging Brain Study‐ Health Disparities (HABS‐HD) project. In this study, we examined the effectiveness of recruitment strategies among this group. Method: HABS‐HD is an epidemiological study of cognitive aging among diverse communities. The team recruited an initial cohort of 1,000 non‐Hispanic whites and 1,000 Mexican Americans using a community‐based approach. This foundation was expanded to reach the AA community through the engagement of key stakeholders and the use of an integrated marketing and outreach strategy. Recruitment methods included an integrated approach combining traditional marketing (print, radio); social media (influencers and online ads), and in person community recruitment and education events at local churches, barbershops, health fairs, etc. The reach and enrollment data were collected and analyzed. Result: Out of 4066 participants that were interested in HABS‐HD, 1362 (33.5%) identified as AA. While recruiting the AA cohort outreach team participated in over 140 community events, ranging from state fairs, barbershops, and church events. Enrollment data indicated participants heard of us through word of mouth (35%); community events (21.6%); news (12.7%); refer a friend program (6.8%); print media (6.4%) radio (4%); and social media (3.6%). In terms of traditional marketing and overall general study awareness, the social media approach reached 179,200 individuals. Of this number12.1% of people interacted with the landing site and then a further 747 clicked to sign up. The reach of our radio advertising was 2,200,000 listeners. Conclusion: Recruiting diverse communities into research involves targeting the recruitment techniques and materials to the target population. The creation of a culturally appropriate media campaign and utilizing community based methods such as outreach, engagement, and collaboration between the research team and key stakeholders in the community led to the successful recruitment of AA into our study. [ABSTRACT FROM AUTHOR]

Purpose Medicare claims can provide real‐world evidence (RWE) to support the Food and Drug Administration's ability to conduct postapproval studies to validate products' safety and effectiveness. However, Medicare claims do not contain comprehensive information on some important sources of bias. Thus, we piloted an approach using the Medicare Current Beneficiary Survey (MCBS), a nationally representative survey of the Medicare population, to (a) assess cohort balance with respect to unmeasured confounders in a herpes zoster vaccine (HZV) effectiveness claims‐based study and (b) augment Medicare claims with MCBS data to include unmeasured covariates. Methods: We reanalyzed data from our published HZV effectiveness Medicare analysis, using linkages to MCBS to obtain information on impaired mobility, education, and health‐seeking behavior. We assessed survey variable balance between the matched cohorts and selected imbalanced variables for model adjustment, applying multiple imputation by chained equations (MICE) to impute these potential unmeasured confounders. Results: The original HZV effectiveness study cohorts appeared well balanced with respect to variables we selected from the MCBS. Our imputed results showed slight shifts in HZV effectiveness point estimates with wider confidence intervals, but indicated no statistically significant differences from the original study estimates. Conclusions: Our innovative use of linked survey data to assess cohort balance and our imputation approach to augment Medicare claims with MCBS data to include unmeasured covariates provide potential solutions for addressing bias related to unmeasured confounding in large database studies, thus adding new tools for RWE studies. [ABSTRACT FROM AUTHOR]

ABSTRACT: Following United States withdrawal, the Trans‐Pacific Partnership agreement (TPP) is likely to be replaced or complemented by a series of bilateral deals between the US and TPP partners. In this case, TPP will shape trade, finance and public policy globally even without formal US participation. Proponents of TPP emphasize its prospective economic benefits, with economic growth increasing due to rising trade volumes and investment. Widely cited projections suggest modest GDP gains after 10 years, varying from less than half a percentage point in the USA to 13 per cent in Vietnam. However, these projections assume full employment and constant income distribution in all countries, excluding some of the major risks of trade liberalization. This article provides alternative projections of the TPP's economic effects using the United Nations Global Policy Model, which allows for changes in employment and income distribution. Using this model, the authors obtain very different results. They find that the benefits to economic growth are even smaller than those projected with full‐employment models, and are negative for Japan and the USA. More importantly, they find that the TPP will likely lead to losses in employment and increases in inequality. [ABSTRACT FROM AUTHOR]

Background: Over 34 million residents of the United States aged 65 years and older are also Medicare prescription drug beneficiaries. Medical claims records for this age group potentially provide a wealth of data for better understanding influenza epidemiology. Objective: The purpose of this study was to evaluate data on oseltamivir dispensing extracted from medical claims records as an indicator of influenza activity in the United States for the 2010‐11 through 2014‐15 influenza seasons. Methods: We used Centers for Medicare and Medicaid Services (CMS) medical claims data to evaluate the weekly number of therapeutic oseltamivir prescriptions dispensed following a rapid influenza diagnostic test among beneficiaries 65 years old and older as an indicator of influenza timing and intensity. We compared the temporal changes in this indicator to changes in the proportion of influenza‐like illnesses among outpatient visits in the US Outpatient Influenza‐like Illness Surveillance Network (ILINet) by administrative regions defined by the US Department of Health and Human Services. Using the moving epidemic method, we determined intensity thresholds and categorized the severity of seasons for both CMS and ILINet data. Results: Centers for Medicare and Medicaid Services oseltamivir data and ILINet data were strongly correlated by administrative region (median Spearman's ρ = 0.78; interquartile range = 0.73‐0.80). CMS oseltamivir data and ILINet data substantially agreed (Cohen's weighted κ = 0.62) as to the seasonal severity across administrative regions. Conclusions: Our results support the use of oseltamivir dispensing in medical claims data as an indicator of US influenza activity. [ABSTRACT FROM AUTHOR]

Background: Hemolytic reactions (HRs) are rare serious adverse events after immune globulin (IG) use. Our large claims-based study evaluated occurrence of same-day hemolysis after administration of different IG products and potential risk factors, during the 2008 to 2014 study period.Study Design and Methods: We conducted a retrospective cohort study using a large commercial administrative database. The study included individuals exposed to IG products as identified by procedure codes. HRs were ascertained using ICD-9-CM diagnosis codes. Unadjusted same-day hemolysis rates (per 1000 persons) were estimated overall, by age, sex, and IG products. Multivariable regression analyses were used to evaluate potential risk factors.Results: Of 20,440 persons exposed, 211 (10.3 per 1000) had same-day HRs. The median numbers of doses for IG users with versus without same-day hemolysis were one and six, respectively. The unadjusted product-specific HR rates ranged from 1.92 for subcutaneous product Hizentra to 17.99 for intravenous Octagam. The multivariable regression analyses showed significantly increased same-day HR risk in males and in IG users with histories of hemolysis, pneumonia, and hereditary hemolytic anemias. Compared to Gammagard Liquid, significantly elevated overall hemolysis risk was identified with Octagam (odds ratio, 2.36; 95% confidence interval, 1.04-5.35), using Firth's method to account for small sample size bias.Conclusion: The study showed variation in the same-day IG-related hemolysis by age, sex, and IG products administered. The results suggest importance of underlying health conditions, especially prior hemolysis, and first IG product dose. Differences in HR occurrence may also be explained by product manufacturing processes, indications, routes, and rates of administration, which warrant further investigation. [ABSTRACT FROM AUTHOR]

Background: Acute renal failure (ARF) is a rare serious adverse event after immune globulin (IG) use. Our large claims-based study evaluated occurrence of same-day ARF after administration of different IGs and ascertained potential risk factors, during the 2008 to 2014 study period.Study Design and Methods: A retrospective cohort study was conducted using a large commercial administrative database. The cohort included individuals exposed to IG products as identified by procedure codes. ARF was ascertained using ICD-9-CM diagnoses. Unadjusted same-day ARF rates (per 1000 persons exposed) were estimated overall and by age, sex, and IG products. Regression analyses were conducted to control for confounding and assess potential risk factors.Results: Of 20,440 persons exposed, 163 (7.97 per 1000) had a recorded same-day ARF. The unadjusted nonzero same-day ARF rates (per 1000) ranged from 1.92 (95% confidence interval [CI], 0.05-10.69) for Hizentra to 16.97 (95% CI, 11.36-24.37) for Privigen and differed by sex. In multivariate analyses, compared to Gammagard Liquid, no significantly elevated ARF risks were identified with any IGs. A significantly lower odds ratio was identified with Gamunex, 0.53 (95% CI, 0.30-0.93). Age 45 and over, prior renal impairment, hypertension, and other factors were associated with increased risk of same-day ARF.Conclusion: The study showed variation in the risk of IG-related ARF by age, sex, and IG products. The study results suggest the importance of recipient factors, such as older age and underlying health conditions. Variations in ARF occurrence may also be explained by product dosage, administration route and rate, and manufacturing processes, which warrant further evaluation. [ABSTRACT FROM AUTHOR]

Introduction Quantification of mitral regurgitation ( MR) by two-dimensional (2D) transthoracic echocardiography ( TTE) is based on the analysis of the proximal flow convergence ( PFC) and the 'vena contracta' ( VC). This method assumes geometries and can be misleading. In contrast, three-dimensional (3D) echocardiography directly measures flow volumes and does not assume geometries, which allows for more accurate MR evaluation. Aims To report the 3D transesophageal echocardiography (3 DTEE) feasibility for MR quantification and evaluate its concordance with 2D echo. Methods Twenty-seven consecutive patients undergoing 2D and 3 DTEE for presurgical MR evaluation were studied prospectively. MR quantification was performed by classical 2D methods based on PFC. Diameters of the VC in orthogonal planes by 3 DTEE were estimated, establishing the VC sphericity index as well as VC area ( VCA) by direct planimetry. In case of multiple jets, we calculated the sum of the VCA. Results MR assessment by 3 DTEE was feasible. An adequate concordance between VC measurements by 2D methods ( TTE and TEE) was observed; however, there was a poor correlation when compared with 3 DTEE. The sphericity index of the VC was: 2.08 (±0. 72), reflecting a noncircular VC. Conclusions 3 DTEE is a feasible method for the assessment of the MR true morphology, allowing a better quantification of MR without assuming any geometry. This method revealed the presence of multiple jets, potentially improving MR evaluation and leading to changes in medical decision when compared to 2D echo assessment. [ABSTRACT FROM AUTHOR]

Background and Objectives Febrile non-haemolytic transfusion reaction ( FNHTR) is an acute transfusion complication resulting in fever, chills and/or rigours. Study's objective was to assess FNHTR occurrence and potential risk factors among inpatient U. S. elderly Medicare beneficiaries, ages 65 and older, during 2011-2012. Materials and Methods Our retrospective claims-based study utilized large Medicare administrative databases. FNHTR was ascertained via ICD-9- CM diagnosis code, and transfusions were identified by recorded procedure and revenue centre codes. The study ascertained FNHTR rates among the inpatient elderly overall and by age, gender, race, blood components and units transfused. Multivariate logistic regression analyses were used to assess potential risk factors. Results Among 4 336 338 inpatient transfusion stays for elderly during 2011-2012, 2517 had FNHTR diagnosis recorded, an overall rate of 58·0 per 100 000 stays. FNHTR rates (per 100 000 stays) varied by age, gender, number of units and blood components transfused. FNHTR rates were substantially higher for RBCs- and platelets-containing transfusions as compared to plasma only. Significantly higher odds of FNHTR were identified with greater number of units transfused ( P < 0·01), for females vs. males ( OR = 1·15, 95% CI 1·04-1·27), and with 1-year histories of transfusion ( OR = 1·25, 95% CI 1·10-1·42), lymphoma ( OR = 1·22, 95% CI 1·02-1·46), leukaemia ( OR = 1·90, 95% CI 1·56-2·31) and other diseases. Conclusions Our study shows increased FNHTR occurrence among elderly with greater number of units and with RBCs- and platelets-containing transfusions, suggesting need to evaluate effectiveness of prestorage leucoreduction in elderly. The study also suggests importance of prior recipient alloimmunization and underlying health conditions in the development of FNHTR. [ABSTRACT FROM AUTHOR]

BACKGROUND: Posttransfusion purpura (PTP) is a serious transfusion complication resulting in sudden thrombocytopenia with bleeding. The study's objective was to assess PTP occurrence and potential risk factors among the inpatient US elderly, ages 65 and older, during 2011 through 2012. STUDY DESIGN AND METHODS: This retrospective claims-based study utilized large Medicare databases for calendar years 2011 and 2012. Transfusions of blood and blood components were identified by recorded ICD-9-CM procedure codes and revenue center codes, and PTP was ascertained via ICD-9-CM diagnosis code. Our study evaluated PTP rates (per 100,000 inpatient transfusion stays) among elderly Medicare beneficiaries, overall and by age, sex, race, number of units, and blood components transfused. Multivariate regression analyses were used to assess potential risk factors. RESULTS: Among 4,336,338 inpatient transfusion stays for elderly beneficiaries during the study period, 78 had a PTP diagnosis code recorded, an overall rate of 1.8 per 100,000 stays. PTP occurrence varied by the blood components, units transfused, and other characteristics. Significantly higher odds of PTP were found for platelet (PLT)-containing transfusions, with greater number of units transfused, as well as for elderly with histories of cardiac arrhythmias (odds ratio [OR], 2.65; 95% confidence interval [CI], 1.43-4.93), coagulopathy (OR, 1.79; 95% CI, 1.01-3.21), leukemia (OR, 2.37; 95% CI, 1.07-5.26), transplant (OR, 2.68; 95% CI, 1.41- 5.09), and other conditions. CONCLUSION: Our population-based study suggests a substantially higher PTP risk with PLT-containing transfusions. The study also suggests increased PTP risk with greater number of units transfused as well as the importance of underlying health conditions and prior recipient alloimmunization for PTP occurrence among the elderly. [ABSTRACT FROM AUTHOR]

Background Thrombotic events ( TEs) are rare and serious adverse events after administration of immune globulin ( IG) products. Our study evaluated the occurrence of same-day TEs for different IG products and ascertained potential risk factors. Study Design and Methods This retrospective cohort study utilized Health Core's Integrated Research Database ( HIRD) to assess individuals exposed to IGs during 2008 to 2012. IG products were identified using recorded procedure codes and TEs were ascertained using ICD-9- CM diagnosis codes. The unadjusted same-day TE rates (per 1000 persons exposed) were estimated overall and by IG products, age, and sex. Multivariable logistic regression analyses were used to estimate odds ratios ( ORs) and 95% confidence intervals ( CIs) for same-day TEs by IG products. Results Of 14,944 individuals exposed to IG products, 233 (15.6 per 1000 persons) had TE diagnosis code(s) recorded on the same-day as the IG exposure. Compared to Gammagard Liquid, Gammaplex ( OR, 20.96; 95% CI, 2.45-179.33) and Vivaglobin ( OR, 2.74; 95% CI, 1.19-6.32) users had a significantly increased same-day TE risk. Elevated, but nonsignificant TE risks were identified for Octagam, Gamunex, Privigen, and Lyophilized IG(s). An increased TE risk was also found with older age (≥45 years), prior TEs, and other health conditions. Conclusion Our claims-based cohort study suggests a potentially elevated TE risk with different IG products and shows importance of recipient factors such as older age, previous TE, hypercoagulable state(s), and other health conditions. The results of this study suggest the need for continuous evaluation of procoagulant activity and manufacturing processes for IG products to further assure their safety. [ABSTRACT FROM AUTHOR]

Background Transfusion-related acute lung injury ( TRALI) is a serious complication leading to pulmonary edema and respiratory failure. This study's objective was to assess TRALI occurrence and potential risk factors among inpatient US elderly Medicare beneficiaries, ages 65 and older, during 2007 through 2011. Study Design and Methods This retrospective claims-based study utilized large Medicare administrative databases. Transfusions were identified by recorded procedure and revenue center codes. TRALI was ascertained via ICD-9- CM diagnosis code. The study evaluated TRALI rates among the inpatient elderly overall and by calendar year, age, sex, race, blood components, and units transfused. Logistic regression analyses were used to assess potential risk factors. Results Of 11,378,264 inpatient transfusion stays for elderly Medicare beneficiaries, 2556 had a recorded TRALI diagnosis code, an overall rate of 22.46 per 100,000 stays. TRALI rates were higher for platelet (PLT)- and plasma-containing transfusions and increased by year and number of units transfused (p < 0.0001). Significantly higher odds of TRALI were also found for persons ages 65 to 79 years versus more than 79 years ( OR, 1.19; 95% confidence interval CI, 1.09-1.29), females versus males ( OR, 1.26; 95% CI, 1.16-1.38), white versus nonwhite ( OR, 1.43; 95% CI, 1.27-1.66), and with 6-month histories of postinflammatory pulmonary fibrosis ( OR, 1.89; 95% CI, 1.52-2.20), tobacco use ( OR, 1.16; 95% CI, 1.00-1.26), and other diseases. Conclusion Our study among the elderly suggests TRALI to be a severe event and identifies a substantially increased TRALI occurrence with greater number of units and with PLT- or plasma-containing transfusions. The study also suggests importance of underlying health conditions, prior recipient alloimmunization, and nonimmune mechanism in TRALI development among the elderly. [ABSTRACT FROM AUTHOR]

Background and Objectives Transfusion-associated circulatory overload ( TACO) is a serious transfusion complication resulting in respiratory distress. The study's objective was to assess TACO occurrence and potential risk factors among elderly Medicare beneficiaries (ages 65 and older) in the inpatient setting during 2011. Materials and Methods This retrospective claims-based study utilized Medicare administrative databases in coordination with Centers for Medicare & Medicaid Services. Transfusions were identified by recorded procedure and revenue centre codes, while TACO was ascertained via ICD-9- CM diagnosis code. We evaluated TACO diagnosis code rates overall and by age, gender, race, number of units and blood components transfused. Multivariate logistic regression analyses were used to estimate odds ratios ( ORs) and 95% confidence intervals ( CIs). Results Among 2 147 038 inpatient transfusion stays for elderly in 2011, 1340 had TACO diagnosis code, overall rate of 62·4 per 100 000 stays. TACO rates increased significantly with age and units transfused ( P < 0·0001). After adjustment for confounding, significantly higher odds of TACO were found for women vs. men ( OR = 1·40, 95% CI 1·26-1·60), White people vs. non-White people ( OR = 1·38, 95% CI 1·20-1·62) and persons with congestive heart failure ( OR = 1·61, 95% CI 1·44-1·88), chronic pulmonary disease ( OR = 1·19, 95% CI 1·08-1·32) and different anaemias. Conclusion Our study identified largest number of potential TACO cases to date and showed a substantial increase in TACO occurrence with age and number of units transfused. The study suggested increased TACO risk in elderly with congestive heart failure, chronic pulmonary disease and anaemias. Overall, study shows importance of large administrative databases as an additional epidemiological tool. [ABSTRACT FROM AUTHOR]

ABSTRACT Purpose The assumption that the occurrence of outcome event must not alter subsequent exposure probability is critical for preserving the validity of the self-controlled case series (SCCS) method. This assumption is violated in scenarios in which the event constitutes a contraindication for exposure. In this simulation study, we compared the performance of the standard SCCS approach and two alternative approaches when the event-independent exposure assumption was violated. Methods Using the 2009 H1N1 and seasonal influenza vaccines and Guillain-Barré syndrome as a model, we simulated a scenario in which an individual may encounter multiple unordered exposures and each exposure may be contraindicated by the occurrence of outcome event. The degree of contraindication was varied at 0%, 50%, and 100%. The first alternative approach used only cases occurring after exposure with follow-up time starting from exposure. The second used a pseudo-likelihood method. Results When the event-independent exposure assumption was satisfied, the standard SCCS approach produced nearly unbiased relative incidence estimates. When this assumption was partially or completely violated, two alternative SCCS approaches could be used. While the post-exposure cases only approach could handle only one exposure, the pseudo-likelihood approach was able to correct bias for both exposures. Conclusions Violation of the event-independent exposure assumption leads to an overestimation of relative incidence which could be corrected by alternative SCCS approaches. In multiple exposure situations, the pseudo-likelihood approach is optimal; the post-exposure cases only approach is limited in handling a second exposure and may introduce additional bias, thus should be used with caution. Copyright © 2013 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Los autores analizan los efectos de combinar la austeridad fiscal con políticas de flexibilización laboral enriqueciendo así el debate actual al respecto. Mediante un macromodelo analítico simplificado con una dinámica de distribución explícita y una perspectiva mundial plantean el problema de agregación y demuestran que las políticas de flexibilización que merman el componente salarial provocan retroacciones mundiales que se traducen en una espiral descendente y en una contracción, aun en las economías impulsadas por las exportaciones. En conclusión, los beneficios iniciales de las economías competitivas resultan efímeros; a largo plazo, la economía mundial está impulsada por los salarios y responde positivamente a estímulos keynesianos coordinados. [ABSTRACT FROM AUTHOR]

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. This article assesses the effects of combining fiscal austerity with policies aimed at reducing labour costs and, in doing so, sheds new light on current policy debates. Taking a global perspective, the authors explore the aggregation problem by proposing a stylized analytical macro-model with explicit distribution dynamics. In this framework, flexibilization policies that suppress the labour share trigger global feedbacks that result in a downward spiral, with contraction even in export-led economies. The initial gains of more competitive economies are shown to be ephemeral. In the long term, the world economy is essentially wage-led and responds positively to coordinated Keynesian stimuli. [ABSTRACT FROM AUTHOR]

BACKGROUND: Transfusion-related acute lung injury (TRALI) and hemolytic transfusion reactions account for significant transfusion-related morbidity and mortality in the United States. Our study evaluated types and quantities of transfused components as well as occurrence of TRALI, ABO, and Rh incompatibilities among the US elderly in the institutional outpatient setting during 2007 to 2008. STUDY DESIGN AND METHODS: This retrospective claims-based study utilized the Centers for Medicare & Medicaid Services' large administrative databases. Transfusions were identified by recorded procedure and revenue center codes, while complications were ascertained via ICD-9-CM diagnosis codes. The study quantified blood use based on revenue center units. RESULTS: Among 26,054,242 and 25,662,864 Medicare elderly in 2007 and 2008, a total of 241,055 (0.9%) and 251,284 (1.0%) had outpatient transfusions. Leukoreduced red blood cells (LR-RBCs) was the most frequently transfused single blood component (60.1 and 61.3%, respectively) each year. Likewise, LR-RBCs and LR pheresis platelets (LR-PLTs) was the most frequent component combination (2.4 and 2.6%, respectively). TRALI rate comparison for RBCs and PLTs versus RBCs only showed higher rate for RBCs and PLTs (p = 0.033). In 2007 and 2008, ABO incompatibility rate comparison for irradiated (IR) LR-RBCs versus LR-RBCs showed higher rates for IR LR-RBCs (rate ratio [RR] 37.4, 95% confidence interval [CI] 10.6-132.6; and RR 31.3, 95% CI 11.6-84.4, respectively). CONCLUSION: This study shows potential usefulness of Medicare databases in assessment of blood utilization, transfusion-related complications, and risk factors among US elderly in the outpatient setting. It suggests limitations (e.g., need for several years of data to better assess rare complications) and importance of databases as hypothesis-generating tool to supplement blood safety research. [ABSTRACT FROM AUTHOR]

Objective To assess reproducibility of constituent time intervals measured by pulsed Doppler echocardiography for calculation of the right and left fetal myocardial performance indices (MPIs). Methods This was a prospective study of 30 normal singleton pregnancies (19-36 weeks). In each, five different time intervals were measured from the Doppler waveform and four repeated measures were taken for each time interval. Three were from the left heart: isovolumetric contraction time (ICT), isovolumetric relaxation time (IRT) and ejection time (ET); two were from the right heart: 'a-interval' and 'b-interval'. The left and right modified MPIs (Mod-MPIs) generated by these constituent time intervals were also evaluated. Two operators evaluated the reproducibility of all measures. Results There was generally good intra- and interobserver reproducibility for all time intervals and resultant Mod-MPIs: ICT, range, 19-43 ms with intraclass correlation coefficient (ICC), 0.91 (95% CI, 0.85-0.95); ET, range, 160-184.8 ms with ICC, 0.90 (95% CI, 0.84-0.95); IRT, range, 35.8-48.5 ms with ICC, 0.67 (95% CI, 0.52-0.81); a-interval, range 208-265 ms with ICC, 0.89 (95% CI, 0.82-0.94); b-interval, range, 163.1-188.3 ms with ICC, 0.82 (95% CI, 0.71-0.90); left Mod-MPI, range, 0.33-0.48 with ICC, 0.84 (95% CI, 0.74-0.91); right Mod-MPI, range, 0.21-0.49 with ICC, 0.82 (95% CI, 0.71-0.90). The 95% limits of agreement showed no statistically significant difference in measurements between the two examiners for all time intervals. Conclusion This is the first study to evaluate the reproducibility of the component time intervals of both right and left fetal Mod-MPIs in the second and third trimesters and supports the reproducibility of fetal functional cardiac assessment. The IRT is the main source of variation for the left Mod-MPI so should be the focus of further investigation. Even using two separate pulsed-wave Doppler gates and therefore separate cardiac cycles, the right Mod-MPI is reproducible. Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objective To assess the influence of machine settings (wall motion filter (WMF), angle of insonation, Doppler aliasing) and phase of valve clicks on repeatability of measurement of the fetal left modified myocardial performance index (Mod-MPI). Methods Fetal left Mod-MPI was evaluated prospectively in 157 morphologically normal fetuses at 19-36 weeks' gestation. In a baseline cohort, a previously published technique and settings were used for measurement of Mod-MPI. In a second cohort, the influence of WMF, angle of insonation, Doppler aliasing and selection of the phase of the valve clicks on repeatability of measurement of Mod-MPI was assessed. Results The intraclass correlation coefficient (ICC) for measurement repeatability in the baseline cohort was 0.22. Increase in WMF to 300 Hz or 500 Hz was associated with an increase in ICC to 0.60 and 0.55, respectively. An angle of insonation of < 15° was associated with an increase in ICC to 0.79 and 0.78 at a WMF of 300 and 500 Hz, respectively. A WMF of 300 Hz, angle of insonation of < 15° and absence of aliasing was associated with an increase in ICC to 0.85 and 0.87 at the beginning and peak of the valve click, respectively. Mod-MPI ranged from 0.35 to 0.48. An increase in calculated MPI was associated with increasing WMF, selection of the beginning vs. peak of the valve clicks and increase in angle of insonation. The presence or absence of aliasing had no effect. Conclusions Refinement of machine settings improves repeatability of Mod-MPI, as does selection of the peak of the valve click. We suggest a consensus be reached as to the precise measurement of MPI, but for the moment would suggest: WMF, 300 Hz; angle of insonation, < 15°; avoiding Doppler aliasing; and selection of valve click peak. Systematic variation in measurement of time intervals may be responsible for the widely varying published normal ranges for Mod-MPI. Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented on the benefits of nonnucleoside reverse transcriptase inhibitor (NNRTI) etravirines in pregnant women infected with HIV-1.

This contribution addresses the question of whether growth convergence can be sustained in the global economy without compromising welfare and without causing major crises. It employs a simplified stock-flow analytical framework to examine the proposition that the pace and pattern of global growth is conditioned by 'under-consumption' in some regions of the world and 'over-borrowing' in other regions. A baseline projection using the Cambridge-Alphametrics model (CAM) illustrates consequences of resumed global imbalances after the 2008-2009 crisis. An alternative scenario exemplifies the case in which China and India shift towards internal income redistribution and domestic demand-orientated policies and suggests that this will not be sufficient to correct global imbalances or induce improved growth rates in other developing regions. Finally a more ambitious development perspective is simulated. Such a scenario requires internationally-coordinated policy efforts, with a greater role for governments in the management of demand, income distribution and environmental sustainability, as well as measures to reduce instability of exchange rate and commodity markets. [ABSTRACT FROM AUTHOR]

An interview is presented with Robert Wade, professor of Political Economy at the London School of Economics in England. Wade explains how he entered and moved through the study of economic development. He talks about his book "Governing the Market" and its general lessons for development. Wade also discusses the factors tying together the global financial crisis.

Background: Recruitment of older adults into aging research is a challenge. Several research studies and clinical trials have failed due to low participant enrollment. Older adults face many barriers to study participation (mistrust of research, lack of transportation, health status, etc.), so special efforts must be made to recruit them into research. We created a recruitment questionnaire with the goal of understanding how to better promote the study and to obtain participant suggestions of groups and locations where the study team could recruit new participants. Method: The Health and Aging Brain Study: Health Disparities (HABS‐HD) is a community based research study of cognitive aging in diverse communities. We designed a voluntary exit questionnaire for current study participants regarding their recruitment preferences. The questionnaire included the following questions: 1) How did you find out about the study? 2) How can we promote the study to someone similar to you? 3)Which of the following advertising methods do you prefer? 4) Do you know any organization/group that would benefit from the study information? Questionnaire data was compiled and analyzed to assess recruitment preferences and suggestions. Result: The total number of participants who responded to the questionnaire was 413. 26.9% of respondents stated that they would prefer TV as their main advertising method, followed by the internet (23%) and postal service (mail) (22.7%). Word of mouth was listed as the best way to promote the study (26.9%) followed by community engagement (16.2%) and church (8.2%). When asked for names of organizations, participants recommended tradition groups such as churches, senior centers, and retirement homes. Participants also recommended groups such as rotary clubs, veterans associations, libraries, and the community college senior education program. Conclusion: Participants can assist in recruitment efforts through suggesting organizations that study personnel may not have reached out to. The input allows for assessment of recruitment and the suggestions can broaden the study's reach. [ABSTRACT FROM AUTHOR]

We read with interest the article by Higano et al, which reported the results of the PROVENGE Registry for the Observation, Collection, and Evaluation of Experience Data (PROCEED).[1] The authors reported a cerebrovascular event (CVE) rate of 2.8%; a prior pooled analysis of phase 3 trials[[2], [4]] reported a CVE rate of 3.5% among patients treated with sipuleucel-T.[6] We would like to request clarification of the PROCEED methodology and analysis to help the reader interpret the results. The adjudication process may have used more stringent diagnostic criteria for CVE than the PROCEED study protocol, thereby resulting in fewer outcomes being identified and a potential underestimation of CVE rates. Third, comparison of CVE rates in PROCEED with those in the preceding phase 3 clinical trials was limited by potential differences in the CVE case definition. [Extracted from the article]

Objective To identify demographic, behavioural and environmental determinants of intestinal parasitic infection, evaluate the impact of a variety of dry sanitation systems on intestinal parasitic infection, and evaluate the safety of using stored biosolids in agriculture in order to guide future sanitation interventions in rural areas of El Salvador. Methods Interviews were conducted with 109 households in eight communities where double-vaulted and solar urine-diverting desiccating latrines, pit latrines or no latrines were used. Faecal samples from 499 individuals were tested for enteric helminths and protozoa. Results Users of solar desiccating latrines had the lowest prevalence of enteric parasite infection. Double-vault, urine-diverting desiccating latrines effectively reduced the transmission of some pathogens, but may not achieve the conditions sufficient for the complete destruction of the more environmentally persistent pathogens, Ascaris lumbricoides and Trichuris trichiura. Contact with inadequately treated latrine biosolids was associated with an increased risk of Ascaris infection. Conclusions Solar latrines were associated with the overall lowest prevalence of enteric parasitic infections. Members of households where latrine biosolids were used in agriculture had a higher prevalence of infection than those where biosolids were buried. We therefore recommend the promotion of solar latrines in rural areas of El Salvador over other dry sanitation systems, and recommend that stored biosolids not be used in agriculture. [ABSTRACT FROM AUTHOR]

Viet Nam's external deficit has risen to 10 per cent of GDP, a level which although still funded by capital inflows is causing alarm to donors, particularly in light of East Asia's financial crisis. The paper argues that the problem may be self-correcting where capital inflows are directed mainly to investment, where public and private investment are complementary and investment efficiency increases. Using cointegration analysis and a ‘general to specific' approach, a non-conventional econometric model is estimated using disaggregated data for imports, exports and investment from recent time series data. Finally, macroeconomic simulations are run up to 1999. The results show the trade gap narrowing significantly. If these results are borne out in practice, current obstacles to trade reform and to fomenting faster private sector growth may prove easier to overcome. Copyright © 2000 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

An abstract of the conference paper "Reproducibility of component time intervals measured by fetal pulse Doppler echocardiography for the fetal modified myocardial performance index (Mod-MPI)," by N. Meriki and colleagues, is presented.

An abstract of the conference paper "Fetal left myocardial performance (Tei) index: Improving reproducibility using wall motion filter setting and peak of valve clicks," by N. Meriki and colleagues is presented.