Impacts of prenatal ultrasound on morbidity and mortality of cardiac pathologies in pediatrics

Introduction Background The literature describes numerous advantages associated with prenatal diagnosis of congenital heart disease (CHD). The main findings indicate that prenatal diagnosis of CHD is associated with lower morbidity and mortality among newborns, as well as other benefits. For example, it allows the parents to consider termination of pregnancy (TOP), in case of severe disease with poor prognosis, especially when there are associated extracardiac malformations or chromosomal defects(3). Similar cases are handled by a multidisciplinary counseling team when a diagnosis of CHD is found(38). Furthermore, if the parents decide to continue the pregnancy, it allows them to be better prepared to the postnatal life(51). Thus, the stress induced by a perinatal discovery of a cardiac disease can be reduced. Parents can be reassured by the recommendations of the medical staff and the preparation of the early care after birth. The malformations that most likely benefit from a prenatal diagnosis are those threatening the children's life soon after birth, and thus necessitating early treatments. Examples of these defects are ductus arteriosus dependent CHD, cyanotic CHD, severe obstructive CHD (valvular stenosis) and arrhythmia(51). In those instances, it is important to manage perinatal care by determining the time and place of delivery, usually in a tertiary care center. Early treatments should be initiated soon after birth, for example prostaglandins use and mechanical ventilation. Surgery or catheterization can be planned during the same period(3). Moreover, for some defects, it seems that prenatal diagnosis leads to better preoperative conditions, in terms of haemodynamic stability for example(32), and that this could contribute to reduce morbidity and improve neurodevelopmental outcome(62). In few cases, fetus may benefit from a prenatal intervention. For example, we can proceed to a balloon valvuloplasty in case of aortic or pulmonary valve stenosis, but there are limited indications(62)

Valuing life over the life cycle.

Adjusting the valuation of life along the (i) person-specific (age, health, wealth) and (ii) mortality risk-specific (beneficial or detrimental, temporary or permanent changes) dimensions is relevant in prioritizing healthcare interventions. These adjustments are provided by solving a life cycle model of consumption, leisure and health choices and the associated Hicksian variations for mortality changes. The calibrated model yields plausible Values of Life Year between 154K$and 200K$ and Values of Statistical Life close to 6.0M$. The willingness to pay (WTP) and to accept (WTA) compensation are equal and symmetric for one-shot beneficial and detrimental changes in mortality risk. However, permanent, and expected longevity changes are both associated with larger willingness for gains, relative to losses, and larger WTA than WTP. Ageing lowers both variations via falling resources and health, lower marginal continuation utility of living and decreasing longevity returns of changes in mortality

Health and (other) Asset Holdings

The empirical literature on the asset allocation and medical expenditures of U.S. households consistently shows that risky portfolio shares are increasing in both wealth and health whereas health investment shares are decreasing in these same variables. Despite this evidence, most of the existing models treat financial and health-related choices separately. This paper bridges this gap by proposing a tractable framework for the joint determination of optimal consumption, portfolio and health investments. We solve for the optimal rules in closed form and show that the model can theoretically reproduce the empirical facts. Capitalizing on this closed-form solution, we perform a structural estimation of the model on HRS data. Our parameter estimates are reasonable and confirm the relevance of all the main characteristics of the model

A Structural Analysis of the Health Expenditures and Portfolio Choices of Retired Agents

Richer and healthier agents tend to hold riskier portfolios and spend proportionally less on health expenditures. Potential explanations include health and wealth effects on preferences, expected longevity or disposable total wealth. Using HRS data, we perform a structural estimation of a dynamic model of consumption, portfolio and health expenditure choices with recursive utility, as well as health-dependent income and mortality risk. Our estimates of the deep parameters highlight the importance of health capital, mortality risk control, convex health and mortality adjustment costs and binding liquidity constraints to rationalize the stylized facts. They also provide new perspectives on expected longevity and on the values of life and health

Information Asymmetry in Mauritius Slave Auctions

Evidence on adverse selection in slave markets remains inconclusive. A necessary prerequisite is that buyers and sellers have different information. We study informational asymmetry on the slave markets through notarial acts on public slave auctions in Mauritius between 1825 and 1835, involving 4,286 slaves. In addition to slave characteristics, the acts document the identities of buyers and sellers. We use this information to determine whether the buyer of a slave was related (e.g. a relative or a spouse) to the original slave owner, and thus most likely better--informed than other bidders. Auction--theoretic models predict that bidding should be more aggressive when informed bidders are present in open-bid, ascending auctions, such as slave auctions. By proxying informed bidders by related bidders, our results consistently indicate that this is the case, pointing toward the presence of information asymmetry in the market for slaves in Mauritius

Asymmetric information and adverse selection in mauritian slave auctions

Information asymmetry is a necessary prerequisite for testing adverse selection. This paper applies this sequence of tests to Mauritian slave auctions. The theory of dynamic auctions with private and common values suggests that when an informed participant is known to be active, uninformed bidders will be more aggressive and the selling price will be higher. We conjecture that observable family links between buyer and seller entailed superior information and find a strong price premium when a related buyer purchased a slave, indicative of information asymmetry. We then test for adverse selection using sale motivation. Our results indicate large discounts on voluntary as compared to involuntary sales. Consistent with adverse selection, the market anticipated that predominantly low-productivity slaves would be brought to the market in voluntary sales

Benchmarks in Aggregate Household Portfolios

Reference-dependent preference models assume that agents derive utility from deviations of consumption from benchmark levels, rather than from consumption levels. These references can be either backward-looking (as explicit in the Habit literature) or forward-looking (as implicitly suggested by Prospect Theory). For both cases, we specify and estimate a fully structural multi-variate Brownian system in optimal consumption, portfolio and wealth using aggregate household financial and real estate wealth data. Our results reveal that references are (i) strongly relevant, (ii) state-dependent, and (iii) that the data is more consistent with the backward- than the forward-looking reference model

An Empirical Analysis of U.S. Aggregate Portfolio Allocations

This paper analyzes the important time variation in U.S. aggregate portfolio allocations. To do so, we first use flexible descriptions of preferences and investment opportunities to derive optimal decision rules that nest tactical, myopic, and strategic portfolio allocations. We then compare these rules to the data through formal statistical analysis. Our main results reveal that i) purely tactical and myopic investment behaviors are unambiguously rejected, ii) strategic portfolio allocations are strongly supported, and iii) the Fama-French factors best explain empirical portfolio shares

Manyara Regional and District Projections

This report presents population projections for the period 2003 to 2025 for the Manyara Region and its districts. The projections were made using the Cohort Component Method (Spectrum System), whereby three components responsible for population change, namely: mortality, fertility and migration are projected separately as well as HIV/AIDS prevalence. The projected components are then applied to 2002 midyear base population in order to come up with the desired projections from 2003 to 2025. The report gives mortality, fertility, migration and HIV/AIDS assumptions, which depicts Manyara’s demographic and socio-economic future trends. The results include estimated population by sex in single years and five-year age groups as well as some demographic indicators. Population growth for the period 2003 to 2025 shows an increase in growth rates. The projections show that population growth rate will increase from 3.9 percent in 2003 (with a population of 1,075,022) to 4.2 percent in 2025 (with a population of 2,483,873). Sex Ratio at birth is projected to decrease from 105 male births per 100 females in 2003 to 103 male births per 100 females in 2025. Mortality estimates show that Infant Mortality Rate (IMR) is expected to decline for both sexes from 62 deaths per 1,000 live births in 2003 to 31 deaths per 1,000 live births in 2025. Under Five Mortality Rate (U5MR) for both sexes will also decline from 96 deaths per 1,000 live births in 2003 to 42 deaths per 1,000 live births in the year 2025. The mortality projected estimates further show that the life expectancy at birth for females is higher compared to that of males, which is expected. Life expectancy at birth for Manyara will increase from 61 years in 2003 to 68 years in 2025 for both sexes. For male population, life expectancy at birth will increase from 60 years in year 2003 to 66 years in 2025, while for female population the life expectancy at birth will increase from 62 years in 2003 to 69 years in 2025. On fertility, TFR will increase from 6.4 children per woman in 2003 to 6.8 children per woman in 2025

Delivering new technologies to the Tanzanian sweetpotato crop through its informal seed system

The concept of integrated seed sector development (ISSD) for sweetpotato was tested in Shinyanga and Meatu districts of the Lake Zone of Tanzania. Agricultural Research Institute (ARI)–Ukiriguru documented the informal system. It comprised male and female vine multipliers with land close to water sources growing sweetpotato during the dry season. They sold vines during the rainy season, with male multipliers and those with larger crops selling more. The average multiplier supplied approximately 50 farmers who commonly travelled 20 km, each buying approximately 1–2 bundles of vine and provided an entry point for disseminating technologies. ARI–Ukiriguru organized demonstrations of rapid multiplication, inorganic and organic fertilizers and new cultivars on multipliers’ land. Fertilizer could economically more than double vine yields with huge potential benefits for an area where production is constrained by planting material; some multipliers immediately began using it. Multipliers took rapid multiplication and new cultivars to their home gardens for further experimentation, seeming likely to adopt especially the cultivar NASPOT 1. A strategy of growing large quantities of irrigated sweetpotato in Misungwi and selling the vines long-distance in Shinyanga, a marketing strategy derived from Uganda, was also adopted. These successes confirm the value of formal-informal seed sector interactions in ISSD