Decomposing the change in labour force indicators over time

In this paper we study changes in the size and the composition of the labour force in five OECD countries from 1983 through 2000. We apply a recent decomposition method to quantify the components of the change over time in the crude labour force rate and the mean age of the labour force. Our results show that the change in the crude labour force rate was dominated by the change in age-specific labour force participation rates. For the mean age of the labour force we find that for males the change in the age composition of the population predominately explains the overall change while the results for females are less clear-cut

Clinical predictors of all‐cause mortality in patients presenting to specialist heart failure clinic with raised NT‐proBNP and no heart failure

Aims Clinical outcomes for patients suspected of having heart failure (HF) who do not meet the diagnostic criteria of any type of HF by echocardiography remain unknown. The aim of this study was to investigate the clinical predictors of all‐cause mortality in patients with suspected HF, a raised N‐terminal pro‐b‐type natriuretic peptide (NTproBNP) and who do not meet the diagnostic criteria of any type of HF by echocardiography. Methods and results Relevant data were taken from the S heffield HEA rt F ailure (SHEAF) registry (222349P4). The inclusion criteria were presence of symptoms raising suspicion of HF, NTproBNP > 400 pg/mL, and preserved left ventricular function. Exclusion criteria were any type of HF by echocardiography. The outcome was defined as all‐cause mortality. Cox proportional‐hazards regression model was used to investigate the association between the survival time of patients and clinical variables; 1031 patients were identified with NTproBNP > 400 pg/mL but who did not have echocardiographic evidence of HF. All‐cause mortality was 21.5% (222 deaths) over the mean follow‐up (FU) period of 6 ± 2 years. NTproBNP was similar in patients who were alive or dead (P = 0.96). However, age (HR 1, P 627 pg/mL, NYHA class predicted death (II, 19.6%; III, 27.4%; IV, 66.7%; P < 0.01). Conclusions Patients with no HF on echocardiography but raised NTproBNP suffer excess mortality particularly in the presence of certain clinical variables. Age, male gender, worsening CKD stage, presence of COPD, and dementia are independently associated with all‐cause mortality in these patients. An NTproBNP > 627 pg/mL coupled with NYHA class could identify patients at greatest risk of death

The cardiac complications of COVID-19; many publications, multiple uncertainties

Since the first description of COVID-19 in December 2019, more than 63,000 publications have described its virology, clinical course, management, treatment and prevention. Most physicians are now encountering, or will soon encounter, patients with COVID-19 and must attempt to simultaneously assimilate this avalanche of information while managing an entirely novel disease with few guiding precedents. It is increasingly clear that, although primarily a respiratory illness, COVID-19 is associated with cardiovascular complications. However, the true incidence of direct cardiac complications remains unclear, as all complications thus far reported can also occur in patients without COVID19. In this review, we briefly summarise and critically appraise the data on cardiac complications associated with COVID-19 and describe some cases from our own experience. We identify unresolved questions and highlight the many uncertainties in this developing field

To grow or to fluctuate: Optimal paths to demographic equilibria

The principal goal of this paper is to establish a firm fundament of population policy. It is shown how intertemporal optimisation theory can be used to fulfill this important task. In particular, this will be illustrated by calculating the optimal trade-off between the further growth (or shrinking) of a population and the fluctuations of its age-structure generated by the decline (or the increase) of the fertility. While the system dynamics of the age-structured optimal control model considered in this paper is described by the McKendrick-von Foerster partial differential equation, its objective functional is given by the discounted stream of the adaptation costs of the net reproduction rate (NRR) and the aforementioned trade-off. For the sake of obtaining analytic results the model is reduced to concentrated vitality rates. Its essential results for growing and declining populations are that under-/over shooting of the NRR is optimal for a short time horizon, whereas a fluctuating NRR takes over if the time horizon is extended. Numerical simulations for a stylized population structure show how the change in the NRR carries over to the total population and age-groups along time

Fertility decline and age-structure in China and India

China and India, two Asian countries that experienced a rapid decline in fertility since the middle of the twentieth century, are the focus of this paper. Although there is no doubt that lower fertility levels have many positive effects on the economy, development and sustainability, little is known about the optimal transition from high to medium or even low levels of fertility. Firstly, implementing policies that have the potential to reduce fertility is costly. Secondly, additional costs arise from adapting the infrastructure to a population that fluctuates quickly not only in terms of size but also with respect to the age structure. We apply an intertemporal optimisation model that takes the costs and benefits of fertility decline into account. The optimal time path depends on the cost structure, the planning horizon and the initial conditions. In the case of a long planning horizon and high initial fertility, it may even be optimal to reduce fertility temporarily below replacement level in order to slow down population growth at an early stage. A key finding of our formal investigation is that, under the same plausible parameter settings, the optimal paths for China and India differ substantially. Moreover, our analysis shows that India, where the fertility decline emerged as a consequence of societal and economic developments, followed a path closer to the optimal fertility transition than China, where the fertility decline was state-imposed. The mathematical approach deployed for this analysis provides insights into the optimal long-term development of fertility and allows for policy conclusions to be drawn for other countries that are still in the fertility transition process

On the Common Support of Workflow Type and Instance Changes under Correctness Constraints

The capability to rapidly adapt in-progress workflows (WF) is an essential requirement for any workflow system. Adaptations may concern single WF instances or a WF type as a whole. Especially for long-running business processes it is indispensable to propagate WF type changes to in-progress WF instances as well. Very challenging in this context is to correctly adapt a (potentially large) collection of WF instances, which may be in different states and to which various ad-hoc changes may have been previously applied. This paper presents a generic framework for the common support of both WF type and WF instance changes. We establish fundamental correctness principles, position formal theorems, and show how WF instances can be automatically and efficiently migrated to a modified WF schema. The adequate treatment of conflicting WF type and WF instance changes adds to the overall completeness of our approach. By offering more flexibility and adaptability the so promising WF technology will finally deliver

Cardiovascular MRI evidence of reduced systolic function and reduced LV mass in rheumatoid arthritis: impact of disease phenotype

The accelerated risk of cardiovascular disease (CVD) in Rheumatoid Arthritis (RA) requires further study of the underlying pathophysiology and determination of the at-risk RA phenotype. Our objectives were to describe the cardiac structure and function and arterial stiffness, and association with disease phenotype in patients with established) RA, in comparison to healthy controls, as measured by cardiovascular magnetic resonance imaging (CMR). 76 patients with established RA and no history of CVD/diabetes mellitus were assessed for RA and cardiovascular profile and underwent a non-contrast 3T-CMR, and compared to 26 healthy controls. A univariable analysis and multivariable linear regression model determined associations between baseline variables and CMR-measures. Ten-year cardiovascular risk scores were increased in RA compared with controls. Adjusting for age, sex and traditional cardiovascular risk factors, patients with RA had reduced left ventricular ejection fraction (mean difference − 2.86% (− 5.17, − 0.55) p = 0.016), reduced absolute values of mid systolic strain rate (p < 0.001) and lower late/active diastolic strain rate (p < 0.001) compared to controls. There was evidence of reduced LV mass index (LVMI) (− 4.56 g/m2 (− 8.92, − 0.20), p = 0.041). CMR-measures predominantly associated with traditional cardiovascular risk factors; male sex and systolic blood pressure independently with increasing LVMI. Patients with established RA and no history of CVD have evidence of reduced LV systolic function and LVMI after adjustment for traditional cardiovascular risk factors; the latter suggesting cardiac pathology other than atherosclerosis in RA. Traditional cardiovascular risk factors, rather than RA disease phenotype, appear to be key determinants of subclinical CVD in RA potentially warranting more effective cardiovascular risk reduction programs

Removal processes for tributyltin during municipal wastewater treatment

This is the author's accepted manuscript. The final published article is available from the link below. Copyright @ 2013 Springer.The fate and behaviour of tributyltin (TBT) at two wastewater treatment works was examined. Both sites had two inlet streams, and each utilised high rate biological filters (biofilters) on one the streams, before treatment of the combined flows on trickling filters, with one having additional tertiary processes, installed to remove ammonia and solids. The study was designed to determine if these processes enhanced the removal of TBT. Degradation of TBT was observed in one of the biofilters, possibly as a result of temperature and hydraulic loading. At the treatment works with tertiary processes, the mass flux showed the overall removal of TBT was 68 %, predominantly due to removal with solids in the primary settlement processes. However, overall removal of 95 % was observed in the conventional trickling filter works with 94 % of this due to biodegradation in the trickling filter. The two works both removed TBT, but at different treatment stages and by different processes. Differences in the form (solubility) of TBT in the influent may have attributed to this, although further understanding of factors controlling degradation would allow for a more complete assessment of the potential of biological processes to remove hazardous compounds from wastewaters.United Utilities PL

Acute Reverse Remodelling After Transcatheter Aortic Valve Implantation: A Link Between Myocardial Fibrosis and Left Ventricular Mass Regression

Background: Despite the wealth of data showing the positive effects on cardiac reverse remodelling in the long-term, the immediate effects of transcatheter aortic valve implantation (TAVI) on the left ventricle are yet to be comprehensively described using cardiovascular magnetic resonance imaging. Also, the link between myocardial fibrosis and acute left ventricular (LV) mass regression is unknown. Methods: Fifty-seven patients with severe aortic stenosis awaiting TAVI underwent paired cardiovascular magnetic resonance scans before and early after the procedure (4 [interquartile range, 3-5] days). LV mass, volume, and function were measured. Late gadolinium enhancement (LGE) imaging was performed to assess for the presence of and pattern of myocardial fibrosis. Results: After the procedure, 53 (95%) patients experienced an immediate (10.1 ± 7.1%) reduction in indexed LV mass (LVMi) from 76 ± 15.5 to 68.4 ± 14.7 g/m2 (P < 0.001). Those with no LGE experienced the greatest LVMi regression (13.9 ± 7.1%) compared with those with a midwall/focal fibrosis pattern LGE (7.4 ± 5.8%) and infarct pattern LGE (7.2 ± 7.0%; P = 0.005). There was no overall change in LV ejection fraction (LVEF; 55.1 ± 12.1% to 55.5 ± 10.9%; P = 0.867), however a significant improvement in LVEF was seen in those with abnormal (< 55%; n = 24; 42%) baseline LVEF (43.2 ± 8.9 to 46.7 ± 10.5%; P = 0.027). Baseline LVMi (P = 0.005) and myocardial fibrosis (P < 0.001) were strong independent predictors of early LVMi regression. Conclusions: LV reverse remodelling occurs immediately after TAVI, with significant LV mass regression in the total population and an improvement in LVEF in those with preexisting LV impairment. Those without myocardial fibrosis at baseline experience greater LV mass regression than those with fibrosis