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Household surveys remain the major source of official statistics for monitoring development policies particularly in developing countries. In the context of rapid developments in data needs, extensive methodological work, data processing and use at national and international levels and a remaining capacity gap despite efforts for statistical capacity building in last decade, it is critical for training centers to keep up to speed with international best practices. This paper show that the approach of the Centre for Development Data Training initiative (C4D2 Training Initiative) is highly effective and stand to have a long-term impact on household survey capacity in Africa region. It is made of several components all of which aim to bolster capacity development in the region. It harmonizes and improves the quality and sustainability of training on household surveys through increased local capacity and greater dissemination of best practices, creates a network among participants and trainers to facilitate knowledge exchange on best practices as well as survey harmonization across countries. Taking advantage of benefits, the initiative should endeavor other regions subject to their interest and embrace the use of virtual and web-based training.

BackgroundThe use of immune checkpoint inhibitor (ICI) therapy is becoming a standard of care for several cancers. Monoclonal antibodies targeting cytotoxic T-lymphocyte antigen-4 (CTLA-4) and programmed cell death protein 1 (PD-1) or its ligand (PD-L1) cause a broad spectrum of autoimmune adverse events. ICI-induced type 1 diabetes mellitus (T1DM) is extremely rare (Cases presentationWe report an acute onset T1DM with severe inaugural diabetic ketoacidosis (DKA) and remarkably elevated Glutamic Acid Decarboxylase antibody (GADA) titres following a single administration of combined ICI therapy with nivolumab (anti-PD-1) and ipilimumab (anti-CTLA-4) in two adult patients with advanced metastatic melanoma. In these cases, the time to diabetes onset was remarkably short (two and five weeks), and one presented with fulminous T1DM in a previous long-standing type 2 diabetes mellitus.ConclusionsOncological patients treated with combination therapy of anti-PD-1 and anti-CTLA-4 can develop a particular pattern of T1DM, with very rapid onset within a few weeks after starting ICI therapy, even in the presence of an existing type 2 diabetes. ICI-induced T1DM is a medical emergency in presence of severe inaugural DKA and requires a collaboration between specialists and primary care physicians, as well as patient education, for early diagnosis and supportive care.

Advances in agricultural data production provide ever-increasing opportunities for pushing the research frontier in agricultural economics and designing better agricultural policy. As new technologies present opportunities to create new and integrated data sources, researchers face tradeoffs in survey design that may reduce measurement error or increase coverage. In this chapter, we first review the econometric and survey methodology literatures that focus on the sources of measurement error and coverage bias in agricultural data collection. Second, we provide examples of how agricultural data structure affects testable empirical models. Finally, we review the challenges and opportunities offered by technological innovation to meet old and new data demands and address key empirical questions, focusing on the scalable data innovations of greatest potential impact for empirical methods and research.

Following the onset of the COVID-19 pandemic, face-to-face survey data collection efforts came to a halt due to lockdowns, limitations on mobility and social distancing requirements. What followed was a surge in phone surveys to fulfill rapidly evolving needs for timely and policy-relevant microdata for understanding the socioeconomic impacts of and responses to the pandemic. Even as the face-to-face survey data collection efforts are resuming in different parts of the world with COVID-19 safety protocols, the rapidly-acquired experience with phone surveys on the part of national statistical offices and survey practitioners in low- and middle-income countries appears to have formed the foundation for phone surveys to be more commonly implemented in the post-pandemic era, in response to other shocks and as complementary efforts to face-to-face surveys. Informed by the practical experience with the high-frequency phone surveys that have been implemented with support from the World Bank Living Standards Measurement Study (LSMS) to monitor the socioeconomic impacts of the COVID-19 pandemic, this paper provides an overview of options for the design and implementation of phone surveys to collect representative data from households and individuals. Further, the discussion identifies the requirements for phone surveys to be a mainstay in the toolkits of national statistical offices and the directions for future research on the design and implementation of phone surveys.

The organic food certification system in Italy, based on the EU legislation, relies on private control bodies (CBs) that are supervised by national authorities. The aim of this paper is to investigate whether it is possible to test for differences in controls outcome based on CBs’ behavior. To this extent, we use a multinomial logit model estimated on data corresponding to the results of the inspections in the year 2015 in Italy. The model controls for two fixed effects represented by the type of operator and a contextual variable, i.e., the region where a firm is located. Significant variability in CBs behavior could induce adverse selection in the choice of the CB by organic operators. In this vein, we discuss some implications in terms of policies and consequences for supervision in the conclusions.

Considering the importance of honey bees for pollination activity and biodiversity preservation different studies have dealt with the impact of pesticides on honeybee health. Within the hive, beeswax is a matrix of particular interest because most of the chemicals used in agricultural and beekeeping activities can easily accumulate and persist in this matrix long after treatment has ceased, affecting honeybees survival. However, chemical analyses of pesticide residues in beeswax are not mandatory, so there are no residue limits, for beeswax. The present study was carried out with the aim of investigating the beeswax residue pattern in the Italian hives. 178 beeswax samples collected from 2013 to 2015 were analyzed for 247 pesticides. 73.6% of the analyzed samples reported the presence of one or more pesticides. On average every single sample showed a mean of three different pesticides each with a maximum of fourteen compounds, some of which were banned in Europe or not authorized in Italy. The higher frequencies were associated with three acaricides: coumaphos (60.7% of samples), tau-fluvalinate (50%) and chlorphenvinphos (35.4%), but the higher concentrations were associated to pyrethrins and piperonil butoxide.

ObjectivesThis study was designed to assess patterns of objectively measured physical activity (PA) and sedentary behaviour in a sample of adults in a rural setting from a low-income Sub-Saharan African country (Malawi). The patterns of PA and sedentary behaviour in Malawi were compared with US data collected and analysed using the same methodology.MethodsThe Malawi PA data were collected as part of a survey experiment on the measurement of agricultural labor conducted under the World Bank Living Standards Measurement Study program. ActiGraph accelerometers (model GT3X) were worn on the right hip in a household-based sample of 414 working-age adults (15–85 years).ResultsMean total and 95% CIs for PA by category in min/day for Malawi adults were: sedentary 387.6 (377.4–397.8), low-light 222.1 (214.7–229.5), high-light 136.3 (132.7–139.9), moderate 71.6 (68.8–74.5), vigorous 1.1 (0.5–1.8) and moderate-to-vigorous physical activity (MVPA) 72.8 (69.7–75.9). Mean of PA and sedentary behavior (min/day) summed across age and sex groups are compared between Malawi and US samples: sedentary behaviour, 387.6 vs 525.8 (pConclusionOverall, levels of MVPA and high-light activity in adults in Malawi were substantially higher and sedentary time was substantially lower than those observed in US samples using near identical data collection, scoring and analysis.

Background MitraClip is a percutaneous way of treatment of mitral regurgitation. Recent trials demonstrate its value in modifying prognosis of patients with functional mitral regurgitation. During MitraClip implant imaging with 3D TEE is mandatory to guide the procedure and monitoring the results. Unfortunately, laceration of mitral leaflets is a well-described complication of Percutaneous Mitral valve repair by implantation of MitraClip. 3D TEE can be useful even to detect complication of the procedure and in particular leaflets lacerations. Here we describe a case where 3D TEE was capable to recognize and visualize a laceration in the anterior leaflet (AL) and we assume some mechanisms leading to this complication. Methods An 83 years old man with post-ischemic severe functional mitral regurgitation underwent to MitraClip implantation. The mitral valve shows a severe tenting and annulus was deformed and dilated. The procedure was performed under fluoroscopic and 3D TEE guidance (Philips iE33). Due to the large central regurgitation and large coaptation gap, we decide to implant MitraClip XTR, this is the larger device 5 mm longer. Results A single MitraClip XTR was implanted in the central scallop (A2-P2) in the region of the larger jet, after device positioning a further jet was detected in the region of implant and the original jet was unchanged. Using 3D color complete volume and X-plane reconstructions we recognize that the jet originates between the clip and the basal aspects of AL. Without color Doppler in 3D zoom and X plane reconstruction, a continuum solution was suspected in the body of AL but the shadow of the delivery system partially masked the region. After removal of the device, perforation of AL was clearly depicted also with 3D zoom without color Doppler. The patient was surgically treated and inspection confirmed the laceration and shows a worn thin AL. The laceration of AL can be caused by the tension on a thinned tissue carried out by the large device. The severe tethering and annular dilatation with a marked distance between anterior and posterior leaflet at the tip of the device may have been a determinant factor in the tear occurrence. Conclusion 3D TEE can clearly depict lacerations of leaflets during MitraClip implantation. Preoperative extensive analysis of valve geometry and inspection of leaflets searching for a thinned region can avoid intraoperative complications. The distance between leaflets at the expected tips of the MitraClip can be a predictive parameter of tension applied on the leaflets and of the risk of tearing. Abstract 1634 Figure. Image 1

Background: Different tools and devices are effective to reduce operator radiation exposure at thorax level during percutaneous coronary procedures, but the operator radiation dose received at pelvic region still remains high. Our aim was to evaluate the efficacy of under-the-table adjunctive shields to reduce operator radiation exposure during percutaneous coronary procedures Methods and Results: The EXTRA-RAD study (Extended Protective Shield Under Table to Reduce Operator Radiation Dose in Percutaneous Coronary Procedures) is a prospective, single-center, randomized study. Patients who underwent transradial coronary procedures were randomized into 2 groups: group 1 (standard arrangement) and group 2 (adjunctive anti-rx shield under the angiographic table). In group 2, a further randomization was performed to compare 2 different under-the-table shields (a small curtain and a drape). A total of 205 procedures (122 diagnostic coronary angiographies and 83 percutaneous coronary interventions) performed in 157 patients by 4 different operators were included without significant differences in clinical and procedural characteristics between groups. The use of adjunctive shields was associated with lower radiation dose compared with no shield at pelvic region (42 µSv [14–98] in group 1, 13 µSv [5–27] in group 2; P P =0.001). The reduction in dose was observed in all the operators. No significant differences were observed in pelvic dose using the 2 different shields ( P =0.183). Conclusions: The use of adjunctive anti-rx shields under the angiographic table during transradial coronary procedures is associated with a significant lower radiation dose to operators at pelvic and thorax level. Clinical Trial Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT03259126.

Aims: High-touch surfaces cleaning and disinfection require the adoption of effective and proper executed protocols, especially during carbapenem-resistant Acinetobacter baumannii (CRAB) endemo-epidemic situations. We evaluated the effectiveness and residual disinfectant activity of disposable pre-impregnated wipes (Modified Operative Protocol, MOP) in reducing environmental bioburden versus a two-step Standard Operative Protocol (SOP) in a 12-bed Intensive Care Unit. Methods: Five high-touch surfaces were cleaned and disinfected either according to the SOP (alcohol-based cleaning and chlorine-based disinfection) or using quaternary ammonium compounds-based disposable wipes (MOP). Sampling was performed before each procedure and at 0.5, 2.5, 4.5 and 6.5 h after (560 sites). Total viable count (TVC) was evaluated according to Italian hygiene standard (&lt, 50 CFU/24 cm2). Clinical and environmental CRAB strains isolated were genotyped. Results: On non-electromedical surfaces the difference between TVC before procedure and at each of the following times was significant only for the MOP (p &lt, 0.05, Wilcoxon test). Using the MOP, only 7.4% (10/135) of sites showed TVC &gt, 50 CFU/24 cm2 (hygiene failures) versus 18.9% (25/132) after SOP (p &lt, 0.05, Fisher&rsquo, s Exact test). On infusion pumps a higher number of hygiene failures was observed after the SOP (7/44, 15.9%) compared with the MOP (4/45, 8.9%). Genotyping highlighted a common source of infection. Conclusion: On high-touch surfaces, the use of disposable wipes by in-house auxiliary nurses may represent a more effective alternative to standard cleaning and disinfection procedure performed by outsourced cleaning services, showing effectiveness in reducing microbial contamination and residual disinfection activity up to 6.5 h.

Cannabis use is common among adolescents. Identification of the factors associated with continued heavy use into young adulthood and development of cannabis abuse and dependence is of considerable importance. The role of familial risk for addiction and an associated endophenotype, P300 amplitude, has not previously been related to cannabis use and dependence. A prospective longitudinal study spanning childhood and young adulthood provided the opportunity for exploring these factors, along with genetic variation, in the cannabis use behaviors of 338 young adult offspring from high and low familial risk for alcohol dependence families (ages 19-30). P300 data were collected multiple times in childhood. The association between young adult patterns of cannabis use or cannabis abuse/dependence was tested with genetic variation in the cannabinoid gene, CNR1, the ANKK1-DRD2 gene, and childhood developmental trajectories of P300. Young adult patterns of cannabis use was characterized by three patterns: (i) no use throughout; (ii) declining use from adolescence through young adulthood; and (iii) frequent use throughout. Following the low P300 trajectory in childhood predicted cannabis abuse and dependence by young adulthood. A four SNP ANKK1-DRD2 haplotype (G-G-G-C) was found to be significantly associated with the frequency of use patterns (P = 0.0008). Although CNR1 variation overall was not significantly associated with these patterns, among individuals with cannabis abuse/dependence the presence of one or both copies of the rs806368 A > G minor allele conferred a 5.4-fold increase (P = 0.003) in the likelihood that they would be in the frequent and persistent use group rather than the declining use group.

In many developing countries, consumption of animal source foods among the poor is still at a level where increasing its share in total caloric intake may have many positive nutritional benefits. This paper explores whether ownership of various livestock species increases consumption of animal source foods and helps improve child nutritional status. The paper finds some evidence that food consumption patterns and nutritional outcomes may be affected by livestock ownership in rural Uganda. The results are suggestive that promoting (small) livestock ownership has the potential to affect human nutrition in rural Uganda, but further research is needed to estimate more precisely the direction and size of these effects.

In October 2011, we discoursed about how conflicting messages and inadequate clarity in communications regarding the United States’ Affordable Care Act (ACA) caused major confusion among the American public and hindered progress on healthcare reform implementation. Five years since President Obama signed the ACA into law on March 23, 2010, it would still be premature to draw definitive conclusions about its overall impact as some provisions are still being phased in (e.g., payment reductions to Medicare providers) and others have yet to be implemented (e.g., the tax on the most generous health insurance plans). However, with multiple constitutional challenges of the ACA now in the rearview mirror and an impending presidential campaign that will undoubtedly influence its impact, this is an opportune time to reassess how the law is currently perceived and how healthcare communication experts can assist in improving both messaging and implementation. We have deliberately focused on a specific subset of stakeholders—i.e., the patients— seeing pivotal opportunities available for them to be drivers of change.

To determine whether magnetic resonance (MR) imaging examination rates for low back pain before conservative therapy in the Medicare and privately insured populations changed after introduction of a Centers for MedicareMedicaid Services public reporting initiative.Institutional review board approval was obtained, with waiver of informed consent. A retrospective study was performed by using fee-for-service claims data from Medicare and a commercial carrier (Blue Cross Blue Shield of Texas [BCBSTX]) for Texas enrollees. OP-8 was calculated, which is a publicly reported measure as of 2009 of the proportion of MR imaging examinations performed for low back pain without history of conservative therapy. For 330 463 MR imaging examinations, OP-8 rates, trends, and regional variation were analyzed for 2008-2011 within different outpatient settings-outpatient hospital department (OHD) and nonhospital outpatient department (NOD)-according to payer. Largest-volume hospitals were also evaluated within the Medicare population.No significant reduction was found in annual OP-8 values for Medicare or BCBSTX (Medicare OHD, 0.35 for 2008 vs 0.36 for 2009 [P = .01]; BCBSTX OHD, 0.42 for 2008 vs 0.44 for 2009 [P = .03]; Medicare NOD, 0.33 for 2008 vs 0.35 for 2009 [P.0001]; and BCBSTX NOD, 0.43 for 2008 vs 0.42 for 2009[P = .23]). These changes were not sustained during subsequent years in the BCBSTX population, and there were no further changes in Medicare rates. Among hospitals with highest Medicare volumes, those with the highest OP-8 rates in 2008 were associated with the highest decrease in their measure. (The annual change rate was negative for all years, with 2008 as the reference [P.0001 for 2009-2011].) Hospitals with the lowest OP-8 rates had increases in OP-8 rates, which persisted in following years (P = .006 for 2009, P = .037 for 2010, and P = .004 for 2011). Hospitals with baseline OP-8 rates in the 25th-75th percentile remained relatively steady over time.No evidence was found that public reporting (OP-8) reduced MR imaging rates for low back pain without conservative therapy in either Medicare or commercially insured populations in hospital or nonhospital settings.

The idea of this special issue emerged when Eckhard Hein visited my department in Cassino, Italy. I thought it would be interesting to invite for a workshop a small number of Italian scholars who w...

Background While the rise in opioid analgesic prescribing and overdose deaths was multifactorial, financial relationships between opioid drug manufacturers and physicians may be one important factor. Methods Using national data from 2013 to 2015, we conducted a retrospective cohort study linking the Open Payments database and Medicare Part D drug utilization data. We created two cohorts of physicians, those receiving opioid-related payments in 2014 and 2015, but not in 2013, and those receiving opioid-related payments in 2015 but not in 2013 and 2014. Our main outcome measures were expenditures on filled prescriptions, daily doses filled, and expenditures per daily dose. For each cohort, we created a comparison group that did not receive an opioid-related payment in any year and was matched on state, specialty, and baseline opioid expenditures. We used a difference-in-differences analysis with linear generalized estimating equations regression models. Results We identified 6,322 physicians who received opioid-related payments in 2014 and 2015, but not in 2013; they received a mean total of $251. Relative to comparison group physicians, they had a significantly larger increase in mean opioid expenditures ($6,171; 95% CI: 4,997 to 7,346), daily doses dispensed (1,574; 95%CI: 1,330 to 1,818) and mean expenditures per daily dose ($0.38; 95% CI: 0.29 to 0.47). We identified 8,669 physicians who received opioid-related payments in 2015, but not in 2013 or 2014; they received a mean total of $40. Relative to comparison physicians, they also had a larger increase in mean opioid expenditures ($1,031; 95% CI: 603 to 1,460), daily doses dispensed (557; 95% CI: 417 to 697), and expenditures per daily dose ($0.06; 95% CI: 0.002 to 0.13). Conclusions Our findings add to the growing public policy concern that payments from opioid drug manufacturers can influence physician prescribing. Interventions are needed to reduce such promotional activities or to mitigate their influence.

The development of the livestock sector can contribute to economic growth and poverty reduction, but there is inadequate understanding of livestock-livelihoods linkages. This article draws on household-level data from 12 developing countries to investigate the livestock-asset position of rural households and its contribution to their income. The majority keep livestock; the less well-off are more likely to keep livestock than the better-off, but the very poor often lack the resources to invest in small animals. The key policy conclusion is that, contrary to common belief, there are no universal messages about livestock: policy needs to be tailored to farming systems, species, uses of livestock and different wealth groups.

Aim: Familial loading for alcohol dependence (AD) and variation in genes reported to be associated with AD or BMI were tested in a longitudinal study. Materials & methods: Growth curve analyses of BMI data collected at approximately yearly intervals and obesity status (BMI > 30) were examined. Results: High-risk males were found to have higher BMI than low-risk males, beginning at age 15 years (2.0 kg/m2 difference; p = 0.046), persisting through age 19 years (3.3 kg/m2 difference; p = 0.005). CHRM2 genotypic variance predicted longitudinal BMI and obesity status. Interactions with risk status and sex were also observed for DRD2 and FTO gene variation. Conclusion: Variation at loci implicated in addiction may be influential in determining susceptibility to increased BMI in childhood and adolescence. Orginal submitted 4 February 2014; Revision submitted 16 May 2014

BackgroundOne approach considered for reducing health care spending is to narrow the gap in spending between high- and low-spending areas. The goal would be to reduce spending in the high areas to similar levels achieved in areas that use health care more efficiently. This paper examined the degree to which high-spending areas remain high-spending and which types of service lead to convergence or divergence in spending in New York State.MethodsThis analysis utilized publicly available data on county-level spending trends for the Medicare fee-for-service population from 2007 to 2016. The study applied methods previously used to evaluate changes in the regional variation of health care spending nationally to county-level data within New York.ResultsThe spread of health care spending converged slightly over the ten-year period analyzed. There was also evidence for regression to the mean-effects and changes in the relative rankings of spending across counties during this time. While there was strong evidence for convergence, many high-spending counties in 2007 remained high-spending in 2016. There were also differences in which services drove spending variation at the national level compared to within New York.ConclusionsThese findings point to counties with consistently high spending as a potential focus for health care cost-control efforts. Moreover, efforts to reduce unwarranted variation in spending may need to be tailored to the circumstances of particular regions as there are geographic differences in which services drive spending variation. Regression to the mean effects also have important implications for the specifications of alternative provider payment models, such as accountable care organizations, which promote convergence in spending by utilizing spending targets.

A variety of indicators are currently used for food security analysis, monitoring, and programming, and most agencies have their preferred variant on methods of data collection, aggregation, and analysis. This lack of consensus is reflected in an inefficient multiplicity of survey instruments collecting information on various dimensions of food and nutrition security, with tremendous variation in the content, quality, and quantity of the information collected. No single existing survey instrument will ever be able to collect all needed indicators at the desired periodicity, and no single institution has either the mandate or the ability to measure and monitor food security in its many dimensions on a global scale. However, with better coordination across institutions and survey efforts, the state of food security measurement worldwide can be greatly improved. This paper attempts to identify the elements of a strategy, built around a combination of short-term fixes and long-term methodological advancements, to reverse the existing trends of poor coordination and slow methodological innovation in food security measurement and monitoring. International focus on a small dashboard of indicators, collected on a regular basis by different stakeholders through a number of available data collection options, is feasible and can be partially achieved by repurposing existing surveys to better suit food security monitoring goals.

Objectives This study evaluated synovial and systemic plasma pharmacokinetic variables of marbofloxacin after a single intravenous regional limb perfusion (IVRLP) performed using two different tourniquets in clinically healthy, standing, non-sedated dairy cows. The authors hypothesised that the type of tourniquet used for IVRLP would influence the synovial fluid concentration of marbofloxacin in the perfused distal limb. Design The study had a randomised parallel-group design. Methods Ten adult dairy cows were included. Unilateral hindlimb IVRLP through the dorsal common digital III vein was performed in two groups of five cows (group 1: wide rubber tourniquet; group 2: manual pneumatic tourniquet) using 0.67 mg/kg of marbofloxacin. The tourniquet was applied proximal to the tarsus and maintained for 30 minutes. Samples of jugular blood and synovial fluid from the tibiotarsal joints of the perfused limb were obtained before and at intervals after IVRLP. All samples were analysed for drug concentrations using liquid chromatography tandem mass spectrometry. Pharmacokinetic parameters were determined to establish the influence of tourniquet types. Differences were considered significant at P≤0.05. Results No adverse effects from the procedure or marbofloxacin were observed in any animal. Significant differences in synovial concentrations and pharmacokinetic parameters were measured. The mean ± sd areas under the concentration versus time curve from time 0 to 24 hours were 178.98±58.08 µg hour/ml for group 2 and 21.11±9.93 µg hour/ml for group 1. The mean ± sd maximum marbofloxacin concentrations were 75.50±10.19 µg/ml for group 2 and 6.35±1.47 µg/ml for group 1. Conclusions Performing IVRLP using the dorsal common digital III vein and a manual pneumatic tourniquet set at 300 mmHg above the tarsus in standing cows resulted in significantly higher marbofloxacin concentrations in the tibiotarsal joint compared with those with the wide rubber tourniquet. Trial registration Local ethical committee (number 41/2012/CEISA).

Land area is a fundamental component of agricultural statistics, and of analyses undertaken by agricultural economists. While household surveys in developing countries have traditionally relied on farmers' own, potentially error-prone, land area assessments, the availability of affordable and reliable Global Positioning System (GPS) units has made GPS-based area measurement a practical alternative. Nonetheless, in an attempt to reduce costs, keep interview durations within reasonable limits, and avoid the difficulty of asking respondents to accompany interviewers to distant plots, survey implementing agencies typically require interviewers to record GPS-based area measurements only for plots within a given radius of dwelling locations. It is, therefore, common for as much as a third of the sample plots not to be measured, and research has not shed light on the possible selection bias in analyses relying on partial data due to gaps in GPS-based area measures. This paper explores the patterns of missingness in GPS-based plot areas, and investigates their implications for land productivity estimates and the inverse scale-land productivity relationship. Using Multiple Imputation (MI) to predict missing GPS-based plot areas in nationally-representative survey data from Uganda and Tanzania, the paper highlights the potential of MI in reliably simulating the missing data, and confirms the existence of an inverse scale-land productivity relationship, which is strengthened by using the complete, multiply-imputed dataset. The study demonstrates the usefulness of judiciously reconstructed GPS-based areas in alleviating concerns over potential measurement error in farmer-reported areas, and with regards to systematic bias in plot selection for GPS-based area measurement.

BACKGROUND As benefits of revascularization in non-ST elevation acute coronary syndromes (NSTEACSs) in the elderly are still unproven, we sought to assess the association between invasive or conservative management of NSTEACS and short-, mid- and long-term mortality or composite outcome of all-cause mortality and myocardial infarction in a cohort of consecutive elderly patients. METHODS AND RESULTS Consecutive NSTEACS patients older than 75 years discharged between 2006 and 2010 from a single intensive cardiac care unit, and managed with invasive or conservative strategy according to available guidelines were retrospectively surveyed. By multivariate regression and sensitivity analysis, crude and adjusted mortality and composite outcome were estimated at prespecified time points of short-term (in-hospital or 30 days mortality), mid-term (T1: 31 days to 6 months), and long-term (T2: 31 days to 12 months). A total of 453 patients (median age 80 years, 47% men) were evaluated; 301 (66.5%) underwent invasive treatment. Invasive was associated with significantly lower risk of short- [odds ratio (OR) 0.28, 95% confidence interval (CI) 0.12-0.67, P = 0.004], mid- (OR 0.33, 95% CI 0.16-0.67, P = 0.003) and long-term mortality (OR 0.34, 95% CI 0.20-0.58, P

Die idiopathische Erkrankung der unteren Harnwege der Katze (iLUTD) teilt viele Merkmale mit der interstitiellen Zystitis (IC) des Menschen. Bei einigen Menschen mit IC wurde nach der intravesikalen Applikation von alkalisiertem Lidocain eine anhaltende Symptomlinderung festgestellt. Das Ziel dieser Studie war, die Effekte der intravesikalen Instillation von alkalisiertem Lidocain in Bezug auf Rezidivrate und Symptomlinderung bei obstruktiver iLUTD zu evaluieren. Zwolf Katzen wurden in die Fallgruppe (2 oder 4mg/kg Lidocain und Natriumbikarbonat) und 14 in die Kontrollgruppe (Placebo (0.2mL/kg 0.9% NaCl und Natriumbikarbonat) oder Standardtherapie (nur Harnkatheter, ohne Instillation)) aufgenommen. Die Zuteilung zu den Gruppen erfolgte zufallig. Die Instillation wurde einmal taglich fur 3 Tage durchgefuhrt. Bei erfolgreicher Therapie wurde eine Nachkontrolle bis 2 Monate nach Entlassung mittels Fragebogen durchgefuhrt. Die Rezidivrate betrug 58% (7/12) bei der Fallgruppe und 57% (8/14) bei der Kontrollgruppe. Die Symptomlinderung war bei beiden Gruppen ahnlich. Bei Katzen mit obstruktiver iLUTD hatte die intravesikale Applikation von Lidocain wahrend drei Tagen keine Auswirkung auf die Rezidivrate oder den Schweregrad der Symptome. Idiopathic lower urinary tract disease (iLUTD) in cats shares many features in common with interstitial cystitis (IC) in humans. In human patients intravesical instillation of alkalinized lidocaine sometimes is associated with sustained amelioration of symptoms. The objective of this study was to evaluate whether the intravesical instillation of alkalinized lidocaine reduces recurrence of urethral obstructions and severity of clinical signs in cats with obstructive iLUTD. Twelve cats were included in the case group (2 or 4mg/kg lidocaine and sodium bicarbonate) and 14 cats served as controls (placebo (0.2mL/kg 0.9% NaCl and sodium bicarbonate) or standard therapy (urinary catheter only, without instillation)). Cats were randomly assigned to either group. The intravesical instillation was done once a day for 3 days. A follow-up of the cats with successful treatment was made up to 2 months after discharge using a questionnaire. Recurrence of urethral obstruction occurred in 58% (7/12) of the case group and 57% (8/14) of the control group. The amelioration scores were similar between the groups. The intravesical administration of alkalinized lidocaine for up to 3 days had no effects on recurrence and severity of clinical signs in cats with obstructive iLUTD.

It has been over a year since the United States committed to a landmark healthcare reform bill, now known as the Affordable Care Act (ACA). With a weakened economy and costs predicted to remain lar...

The sluggish supply response in most developing countries to the apparently favourable agricultural market situation of the past few years can be explained by the limited ability of price incentives to bring about an increase in production and marketed surplus in the presence of binding non-price constraints. This article characterises farm household heterogeneity in access to assets, markets and infrastructure drawing on household survey data from 15 developing countries. We relate this heterogeneity in access to household ability to engage successfully in agricultural output markets and find consistent supporting evidence for the hypothesis that this lack of access is significantly constraining their potential to engage successfully in agriculture.Dans la plupart des pays en développement, la réaction de l′offre à la situation des marchés agricoles – depuis quelques années favorable – est lente, et ce en raison de la capacité limitée des incitations en termes de prix à générer une augmentation de la production et des excédents commercialisés, en présence d′importantes contraintes non tarifaires. S′appuyant sur des données d′enquêtes sur les ménages recueillies dans 15 pays en développement, cet article décrit l′hétérogénéité des ménages agricoles en matière d′accès aux actifs, marchés et infrastructures. Nous montrons la relation qui existe entre cette hétérogénéité et la capacité des ménages à s′engager avec succès sur les marchés de produits agricoles, et trouvons des preuves solides soutenant l′hypothèse selon laquelle ce manque d′accès limite fortement leur potentiel à s′engager dans l′agriculture de manière profitable.

Urban agriculture may have a role to play in addressing urban food insecurity problems, which are bound to become increasingly important with the secular trend towards the urbanization of poverty and of pop- ulation in developing regions. Our understanding of the importance, nature and food security implica- tions of urban agriculture is however plagued by a lack of good quality, reliable data. While studies based on survey data do exist for several major cities, much of the evidence is still qualitative if not anec- dotal. Using a recently created dataset bringing together comparable, nationally representative house- hold survey data for 15 developing or transition countries, this paper analyzes in a comparative international perspective the importance of urban agriculture for the urban poor and food insecure. Some clear hints do come from our analysis. On the one hand, the potential for urban agriculture to play a sub- stantial role in urban poverty and food insecurity reduction should not be overemphasised, as its share in income and overall agricultural production is often quite limited. On the other hand, though, its role should also not be too easily dismissed, particularly in much of Africa and in all those countries in which agriculture provides a substantial share of income for the urban poor, and for those groups of households to which it constitutes an important source of livelihoods. We also find fairly consistent evidence of a positive statistical association between engagement in urban agriculture and dietary adequacy indicators.

In women with hypertrophic cardiomyopathy (HCM), pregnancy prompts major changes in hemodynamic and cardiac autonomic function that may precipitate heart failure (HF) or increase the risk of cardiac arrhythmia.We report the clinical follow-up of two patients with non-obstructive HCM implanted with a cardioverter defibrillator (ICD) allowing for continuous analysis of heart rate (HR), heart rate variability (HRV) and cardiac arrhythmia throughout the entire course of pregnancy.Both patients experienced increased HR and decreased HRV from the early stages of pregnancy, which persisted until delivery. Premature ventricular contractions (PVCs) and runs of non-sustained ventricular tachycardia (NSVT) reached a peak in the second and third trimesters, concurrent with sympathetic hyperactivity. In one patient with baseline NYHA class II HF symptoms, increased PVCs and NSVT were consistent with the deterioration of HF, supporting the decision to bring the delivery forward. While both patients experienced a persistent increase in sympathetic tone and ventricular ectopic activity, no life-threatening arrhythmias were documented.During pregnancy, patients with hypertrophic cardiomyopathy develop progressive neuroautonomic imbalance, prompting an increase in non-sustained ventricular arrhythmia. This enhanced arrhythmia burden warrants close follow-up and rhythm assessment during the third trimester, especially in women who have heart failure symptoms before pregnancy. Implantable cardioverter defibrillators provide a continuous analysis of heart rate variability and arrhythmia burden that supports therapeutic decision-making during follow-up. Resumo: Em mulheres com miocardiopatia hipertrófica, a gravidez aumenta as variações hemodinâmicas e as alterações da função autonómica cardíaca que podem provocar insuficiência cardíaca ou aumentar o risco de arritmia. Reportamos o acompanhamento clínico de duas pacientes com miocardiopatia hipertrófica não obstrutiva, ambas implantadas com cardioversor-desfibrilhador (CID). A monitoração com CID permite a análise contínua da frequência cardíaca, da variabilidade da frequência cardíaca (VFC) e da arritmia durante toda a gravidez. As duas pacientes manifestaram aumentos da FC e diminuições da VFC desde o início da gravidez até ao parto. Observou-se um pico de frequência de extrassístoles ventriculares (EV) e de taquicardias ventriculares não sustentadas (TVNS) no segundo e terceiro trimestres da gestação, em correspondência da hiperatividade simpática. Numa das pacientes com classe funcional NYHA II, antes da gravidez, o aumento de EV e de TVNS contemporaneamente ao agravamento da insuficiência cardíaca levou à decisão de antecipar o parto. As duas pacientes demonstraram um aumento persistente da atividade simpática e da atividade ectópica ventricular, não existiram casos de arritmias ventriculares malignas. Durante a gravidez as pacientes com miocardiopatia hipertrófica desenvolvem um progressivo desequilíbrio autonómico que causa um aumento das arritmias ventriculares não sustentadas. O aumento do risco arrítmico necessita de um constante e frequente controle clínico e do ritmo cardíaco durante o terceiro trimestre, especialmente em mulheres com sintomas de insuficiência cardíaca antes da gravidez. O cardioversor-desfibrilhador implantável fornece uma análise continua da variabilidade da frequência cardíaca e das arritmias que podem apoiar as decisões terapêuticas durante a gravidez. Keywords: Hypertrophic cardiomyopathy, Pregnancy, Implantable cardioverter defibrillator, Heart rate variability, Ventricular arrhythmia, Palavras-chave: Miocardiopatia hipertrófica, Gravidez, Cardioversor-desfibrilhador implantável, Variabilidade da frequência cardíaca, Arritmia ventricular

In view of its increasing importance, and the dearth of information on return migration and its impacts on source households, this study uses data from the 2005 Albania Living Standards Measurement Study survey and assesses the impact of past migration experience of Albanian households on non-farm business ownership through instrumental variables regression techniques. Moreover, considering the differences in earning potentials and opportunities for skill acquisition in different destination countries, the impact of household past migration experience is differentiated by main migrant destinations, namely Greece and Italy. The study also tests for the hypothesis of the existence of migration cycles, by differentiating the time spent abroad based on the year of return. The empirical results indicate that household past migration experience exerts a positive impact on the probability of owning a non-farm business. While one additional year in Greece increases the probability of household business ownership by roughly 7 percent, a similar experience in Italy or further destinations raises the probability by over 30 percent. Although past migration experience for the period 1990-2000 is positively associated with the likelihood of owning a household enterprise, a similar impact does not materialize for the period 2001-2004. The latter finding seems suggestive of the fact that more recent migrants are yet to attain a target level of required savings and skills in order to successfully establish a new business upon return.

This paper presents the main features of the macroeconomic model being used at The Levy Economics Institute of Bard College, which has proven to be a useful tool in tracking the current financial and economic crisis. We investigate the connections of the model to the ›New Cambridge‹ approach, and discuss other recent approaches to the evolution of financial balances for all sectors of the economy. We will show the effects of fiscal policy in the model, and its implications for the proposed fiscal stimulus on the US economy. We show that the New Cambridge hypothesis, which claimed that the private sector financial balance would be stable relative to income in the short run, does not hold for the short term in our model, but it does hold for the medium/long term. This implies that the major impact of the fiscal stimulus in the long run will be on the external imbalance, unless other measures are taken.

The process of development, manufacturing, registration, distribution, and postmarketing support of drug and biologic products includes the need for clear, active, and ongoing communication between the sponsor/applicant and the Food and Drug Administration (FDA). Such communication occurs in written and spoken form, involving multiple media (including letters, secure e-mail, fax, face-to-face meetings, and teleconferences). Personnel in PhRMA member companies and FDA recognize the importance and challenges of communication. FDA’s attention to a number of key principles of communication is illustrated in the guidance document Good Review Management Principles and Practices for PDUFA Products. In this white paper, members of PhRMA’s Best Practices Working Group have summarized key information on communication from the guidance document, proposed expectations for communications to facilitate a shared understanding between FDA and applicant about a communication strategy during review of a New Drug Application (NDA) or Biologics License Application (BLA), and drafted some basic principles for companies to adopt to help foster constructive, professional, and efficient communication with FDA on Prescription Drug User Fee Act (PDUFA) products. Dialogue with FDA and other stakeholders about these principles and proposals is suggested as the logical next step in discussion of best practices for communication.

The genes encoding the gamma-aminobutyric acid(A) (GABA(A)) receptor have been the focus of several recent studies investigating the genetic etiology of alcohol dependence. Analyses of multiplex families found a particular gene, GABRA2, to be highly associated with alcohol dependence, using within-family association tests and other methods. Results were confirmed in three case-control studies. The objective of this study was to investigate the GABRA2 gene in another collection of multiplex families.Analyses were based on phenotypic and genotypic data available for 330 individuals from 65 bigenerational pedigrees with a total of 232 alcohol-dependent subjects. A proband pair of same-sex siblings meeting Diagnostic and Statistical Manual of Mental Disorders, Third Edition, criteria for alcohol dependence was required for entry of a family into the study. One member of the proband pair was identified while in treatment for alcohol dependence. Linkage and association of GABRA2 and alcohol dependence were evaluated using SIBPAL (a nonparametric linkage package) and both the Pedigree Disequilibrium Test and the Family-Based Association Test, respectively.We find no evidence of a relationship between GABRA2 and alcohol dependence. Linkage analyses exhibited no linkage using affected/affected, affected/unaffected, and unaffected/unaffected sib pairs (all p's.13). There was no evidence of a within-family association (all p's.39).Comorbidity may explain why our results differ from those in the literature. The presence of primary drug dependence and/or other psychiatric disorders is minimal in our pedigrees, although several of the other previously published multiplex family analyses exhibit a greater degree of comorbidity.

The October 2015 FDA/PQRI Conference on Advancing Product Quality provided a forum for the exchange of ideas focused on drug product quality between regulatory agencies, the pharmaceutical industry, and academia. Key topics of the 2015 conference were (i) emerging regulatory initiatives; (ii) regulatory submission, assessment, and inspection; (iii) product and process development; and (iv) manufacturing, risk management, and quality assurance. Key discussion points and recommendations for each track and session have been captured. With powerful advancements in product quality encompassing regulatory, industrial, and technological elements, an era of rapidly improving pharmaceutical quality is underway. At the conference, one theme prevailed through all sessions: regulators, industry, and academia are aligned in their desire for drug product quality on behalf of the ultimate stakeholder–the patient. 3D three dimensional, ANDA abbreviated new drug application, API active pharmaceutical ingredient, ASTM American society for testing and materials, BCS biopharmaceutics classification system, BLA biological license application, CGMP current good manufacturing practice, CMA critical material attribute, CMC chemistry manufacturing and controls, CPP critical process parameters, CQA critical quality attribute, CU content uniformity, DLS dynamic light scattering, DOE design of experiment, EMA European Medicines Agency, EWG Expert Working Group, FDA Food and Drug Administration, GDUFA generic drug user fee amendments, HCl Hydrogen Chloride, ICH International Conference on Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use, IND investigational new drug, IQA integrated quality assessment, IR immediate release, IR information request, ISPE International Society for Pharmaceutical Engineering, MIT Massachusetts Institute of Technology, NDA new drug application, NIPP new inspection protocols project, NIR near-infrared spectroscopy, OPQ office of pharmaceutical quality, PAI pre-approval inspection, PAT process analytical technology, PDUFA prescription drug user fee act, PHS public health service, PQRI Product Quality Research Institute, PQS pharmaceutical quality system, QbD quality by design, QMS quality management system, QRM quality risk management, QTPP quality target product profile, RPM revolutions per minute, RTRT real time release testing, SUPAC scale-up and post-approval changes, UDU uniformity of dosage units, USP U.S. Pharmacopeial Convention.

In addition to its expansion and reform of health insurance coverage, the Affordable Care Act (ACA) contains numerous provisions intended to resolve underlying problems in how health care is delivered and paid for in the United States. These provisions focus on three broad areas: testing new delivery models and spreading successful ones, encouraging the shift toward payment based on the value of care provided, and developing resources for systemwide improvement. This brief describes these reforms and, where possible, documents their initial impact at the ACA's five-year mark. While it is still far too early to offer any kind of definitive assessment of the law's transformation-seeking reforms, it is clear that the ACA has spurred activity in both the public and private sectors, and is contributing to momentum in states and localities across the U.S. to improve the value obtained for our health care dollars.

Albania is a country on the move. This mobility plays a key role in household-level strategies to cope with the economic hardship of transition. With the relaxing of controls on emigration at the beginning of the 1990s, international migration has exploded, becoming the single most important political, social, and economic phenomenon in post-communist Albania. Based on the 1989 and 2001 population censuses we estimate that over 600,000 Albanians live abroad, mostly in nearby Greece and Italy, with the vast majority coming from a limited number of districts located at the coastal and transport gateways to these destination countries, as well as Tirana. The available data also suggest that a similar number have considered migrating, and of these, half have tried and failed. Almost one-half of the children who since 1990 no longer live with their parents are now living abroad, a number of almost exodus proportions. This article also identifies clear patterns of temporary migration, with Greece being by far the most important destination and rural areas from the Center and NorthEast of the country being the primary origins of these flows. Although migration, with the resulting remittances, has become an indispensable part of Albanian economic development, there is increasing consensus on the necessity to devise more appropriate, sustainable strategies to lift households out of poverty and promote the country's growth.

In this paper we investigate how combining objective and subjective measures of welfare can enrich traditional poverty profiles by exploring the relationship between these welfare measures, and examining what explains the differences between the two. One important finding of our analysis (using data for Albania) is that reconciling subjective and objective poverty profiles suggests the presence of sizable economies of scale. This result calls for increased attention to the proper estimation of a scale parameter for poverty analysis, as changes in assumptions on economies of size and adult equivalence scales are likely to produce significant changes in the analysis of poverty and its distribution across households and individuals.

This paper analyses recent patterns of migration and poverty in Albania, a country that following the collapse of the communist regime in 1990 ‐ has been experiencing high migration rates. Using a combination of survey and census data, the paper characterises spatial patterns in the distribution of poverty and migration at a high level of geographic disaggregation. The results emphasise the importance of analysing internal and international migration as different phenomena, as the two appear to be associated in opposite ways to observed poverty and welfare levels. While poverty acts as a push factor for internal migration, it seems to be a constraining factor for the more costly international migration. The results also suggest that rural migration to urban areas contributes to the relocation of poverty in urban areas.

The paper clarifies the “meso-economy” concept by defining it as comprising both the market mechanisms and administrative procedures through which policy decisions and market signals trickle down to the household level. Three main bodies of literature are reviewed: the policy-oriented literature in which the meso-economy was initially considered; the transaction cost approach analyzing market and policy failures, and the “micro-economy” level of agricultural household models. The paper develops a synthesis of macro-, meso- and micro-economic perspectives, which focuses on the roles played by three levels of filters intervening along the policy chain. Implications for policy and research are drawn.

Milk is an important source of cash and nutrients for many households in developing countries. Yet, the understanding of the role of dairy production in livelihoods and nutritional outcomes is hindered by the lack of decent quality household survey data. Data on milk off-take for human consumption are difficult to collect in household surveys for several reasons that make accurate recall challenging for the respondent (continuous production and seasonality, among others). As a result, the quantification and valuation of milk off-take is particularly difficult in household surveys, introducing possibly severe biases in the computation of full household incomes and farm sales, as well as in the estimation of the contribution of livestock (specifically dairy) production in agricultural value added and the livelihoods of rural households. This paper presents results from a validation exercise implemented in Niger, where alternative survey instruments based on recall methods were administered to randomly selected households and compared with a 12-month system of physical monitoring and recording of milk production. The results of the exercise show that reasonably accurate estimates via recall methods are possible and provide a clear ranking of questionnaire design options that can inform future survey operations.

Is Africa's rural economy transforming as its economies grow? This paper uses comparable income aggregates from 41 national household surveys from 22 countries to explore the extent of income diversification among rural households in Sub-Saharan Africa, and to look at how income diversification in Sub-Saharan Africa compares with other regions, taking into account differences in levels of development. The paper also seeks to understand how geography drives income diversification, focusing on the role of agricultural potential and distance to urban areas. The countries in the African sample have higher shares of on-farm income (63 versus 33 percent) and lower shares on nonagricultural wage income (8 and 21 percent) compared with countries of other regions. Specialization in on-farm activities continues to be the norm in rural Africa (52 percent of households, 21 percent in other regions). In terms of welfare, specialization in nonagricultural income-generating activities stochastically dominates farm-based strategies in all of the countries in our African sample. Crop income is still important for welfare, however, and even at higher levels of household income, crop activities continue to play an important complementary role. Regardless of distance and integration in the urban context, when agro-climatic conditions are favorable, farming remains the occupation of choice for most households in the African countries for which the study has geographically explicit information. When urban integration is low and agricultural conditions more difficult, the picture is mixed, with households more likely to engage more fully in nonfarm activities in Niger and Malawi, but less likely to do so in Uganda and Tanzania.

This review provides a concise and complete overview of diagnostic work-up and treatment of venous thromboembolism in pregnancy, with attention to recent research developments and recent applicable guidelines. This may be useful for all the players of the multidisciplinary interaction needed in this disease management, namely cardiologists and gynecological/obstetric teams.Venous thromboembolism is, in the developed world, a major cause of maternal morbidity and mortality during pregnancy or early after delivery, with a reported incidence ranging from 0.49 to 2.0 events per 1000 deliveries. It is a particularly challenging issue and there is no common consensus on the major themes of this condition. Diagnostic options, prophylaxis and management, in the antenatal, childbirth and postnatal periods, are carefully analyzed in the light of the most recent published data. Besides, old and recent knowledge must be seen through the clinician's skilled and watchful eyes, deciding on a case-to-case and actively contributing in reducing pregnancy-related morbidity.Although there is an ongoing debate on various aspects of this condition and there is a paucity of high-quality studies, this review attempts to simplify the complex aspects of joining safety and efficacy in diagnosing and treating a possible two-people life-threatening disease.