Impending U.S. Spending Bust? The Role of Housing Wealth as Borrowing Collateral

Using data from the Panel Study of Income Dynamics, this paper considers the mechanism by which changing house values impact U.S. household spending. The results suggest that house values affect consumption by serving as collateral for households to borrow against to smooth their spending. The results show that the consumption of households who need to borrow against their home equity increases by roughly 11 cents per $1.00 increase in their housing wealth. Changing house values, however, have little effect on the expenditures of households who do not need to borrow to finance their consumption. Based on these results, the paper further finds that declining housing wealth has a relatively small implied negative impact on aggregate consumption expenditures

Anti-tumour necrosis factor discontinuation in inflammatory bowel disease patients in remission: study protocol of a prospective, multicentre, randomized clinical trial

Background: Patients with inflammatory bowel disease who achieve remission with anti-tumour necrosis factor (anti-TNF) drugs may have treatment withdrawn due to safety concerns and cost considerations, but there is a lack of prospective, controlled data investigating this strategy. The primary study aim is to compare the rates of clinical remission at 1?year in patients who discontinue anti-TNF treatment versus those who continue treatment. Methods: This is an ongoing, prospective, double-blind, multicentre, randomized, placebo-controlled study in patients with Crohn?s disease or ulcerative colitis who have achieved clinical remission for ?6?months with an anti-TNF treatment and an immunosuppressant. Patients are being randomized 1:1 to discontinue anti-TNF therapy or continue therapy. Randomization stratifies patients by the type of inflammatory bowel disease and drug (infliximab versus adalimumab) at study inclusion. The primary endpoint of the study is sustained clinical remission at 1?year. Other endpoints include endoscopic and radiological activity, patient-reported outcomes (quality of life, work productivity), safety and predictive factors for relapse. The required sample size is 194 patients. In addition to the main analysis (discontinuation versus continuation), subanalyses will include stratification by type of inflammatory bowel disease, phenotype and previous treatment. Biological samples will be obtained to identify factors predictive of relapse after treatment withdrawal. Results: Enrolment began in 2016, and the study is expected to end in 2020. Conclusions: This study will contribute prospective, controlled data on outcomes and predictors of relapse in patients with inflammatory bowel disease after withdrawal of anti-TNF agents following achievement of clinical remission. Clinical trial reference number: EudraCT 2015-001410-1

Postoperative outcomes in oesophagectomy with trainee involvement

BACKGROUND: The complexity of oesophageal surgery and the significant risk of morbidity necessitates that oesophagectomy is predominantly performed by a consultant surgeon, or a senior trainee under their supervision. The aim of this study was to determine the impact of trainee involvement in oesophagectomy on postoperative outcomes in an international multicentre setting. METHODS: Data from the multicentre Oesophago-Gastric Anastomosis Study Group (OGAA) cohort study were analysed, which comprised prospectively collected data from patients undergoing oesophagectomy for oesophageal cancer between April 2018 and December 2018. Procedures were grouped by the level of trainee involvement, and univariable and multivariable analyses were performed to compare patient outcomes across groups. RESULTS: Of 2232 oesophagectomies from 137 centres in 41 countries, trainees were involved in 29.1 per cent of them (n = 650), performing only the abdominal phase in 230, only the chest and/or neck phases in 130, and all phases in 315 procedures. For procedures with a chest anastomosis, those with trainee involvement had similar 90-day mortality, complication and reoperation rates to consultant-performed oesophagectomies (P = 0.451, P = 0.318, and P = 0.382, respectively), while anastomotic leak rates were significantly lower in the trainee groups (P = 0.030). Procedures with a neck anastomosis had equivalent complication, anastomotic leak, and reoperation rates (P = 0.150, P = 0.430, and P = 0.632, respectively) in trainee-involved versus consultant-performed oesophagectomies, with significantly lower 90-day mortality in the trainee groups (P = 0.005). CONCLUSION: Trainee involvement was not found to be associated with significantly inferior postoperative outcomes for selected patients undergoing oesophagectomy. The results support continued supervised trainee involvement in oesophageal cancer surgery

Implementaci?n de estrategias para incentivar el cuidado y preservaci?n del recurso del agua, con estudiantes de 12 a 14 a?os en la instituci?n educativa departamental rural ?Cerezos Grandes? del municipio de Chipaque

134 p. Recurso Electr?nicoEl presente proyecto de investigaci?n muestra la experiencia de la implementaci?n de algunas estrategias pedag?gicas para incentivar el cuidado y preservaci?n del recurso del agua, con estudiantes de 12 a 14 a?os de grado sexto de la Instituci?n Educativa Departamental Cerezos Grandes del Municipio de Chipaque, el tipo de investigaci?n desarrollado es investigaci?n y acci?n (IA) con un enfoque cualitativo. Se describen dichas estrategias desarrolladas con los estudiantes como encuestas, talleres, video foros, salidas de campo, murales y tr?pticos, es importante mencionar que para la delimitaci?n de la investigaci?n se reconoci? el contexto es por ello que se tuvieron en cuenta las percepciones de maestros y padres de familia adem?s del de los estudiantes. Palabras claves: Recurso h?drico, preservaci?n de agua, estrategias pedag?gicas, ciclo del agua, recursos h?dricos y fuentes h?dricas.The present research project shows the experience of the implementation of some pedagogical strategies to encourage the care and preservation of the water resource, with students from 12 to 14 years of sixth grade of the Departmental Educational Institution Cerezos Grandes of the Municipality of Chipaque, the of research developed is research and action (IA) with a qualitative approach. We describe these strategies developed with students as surveys, workshops, video forums, field trips, murals, and triptychs, it is important to mention that for the delimitation of the research, the context was recognized, which is why the perceptions of teachers and parents as well as students. Keywords: Water resource, water preservation, pedagogical strategies, water cycle, water resources and water sources