Investment for food

Groenveld attempted to show the magnitude of investments in agriculture, which were necessary to meet the increasing world demand for food. The formula S = K/Y (ΔN +ΔH) was assumed as a description that for a community the proportion of national income saved and invested must equal the product of proportional increase in population plus increase in income per head, and of the capital coefficient. Thus ensued the problem of allocating investments in agriculture and other sectors of the economy. In private investment decisions involved many people. For public investment decisions were usually central. But public complemented private investment. The figures for future demand for food were based on population size and estimated population growth, income per head and expected increase of it and income elasticity of food costs. Changes in supply through rise in production from an increase in productivity were distinguished from changes through enlargement of agricultural area. Extrapolation of production from the period 1950-60 until the year 1980 showed that investments in Asia (other than China and the Soviet Union), Africa and Latin America should be about 10% higher to keep pace with demand for agricultural products. Groenveld believed the solution could be to raise public investment, which he then estimated to be about the same size as the private investments

Downgrade of cardiac defibrillator devices to pacemakers in elderly heart failure patients:clinical considerations and the importance of shared decision-making

Implantable cardioverter defibrillators are implanted on a large scale in patients with heart failure (HF) for the prevention of sudden cardiac death. There are different scenarios in which defibrillator therapy is no longer desired or indicated, and this is occurring increasingly in elderly patients. Usually device therapy is continued until the device has reached battery depletion. At that time, the decision needs to be made to either replace it or to downgrade to a pacing-only device. This decision is dependent on many factors, including the vitality of the patient and his/her preferences, but may also be influenced by changes in recommendations in guidelines. In the last few years, there has been an increased awareness that discussions around these decisions are important and useful. Advanced care planning and shared decision-making have become important and are increasingly recognised as such. In this short review we describe six elderly patients with HF, in whose cases we discussed these issues, and we aim to provide some scientific and ethical rationale for clinical decision-making in this context. Current guidelines advocate the discussion of end-of-life options at the time of device implantation, and physicians should realise that their choices influence patients' options in this critical phase of their illness

Successful recovery of infective endocarditis-induced rapidly progressive glomerulonephritis by steroid therapy combined with antibiotics: a case report

BACKGROUND: The mortality rate among patients with infective endocarditis, especially associated with the presence of complications or coexisting conditions such as renal failure and the use of combined medical and surgical therapy remains still high. Prolonged parenteral administration of a bactericidal antimicrobial agent or combination of agents is usually recommended, however, the optimal therapy for infective endocarditis associated with renal injury is not adequately defined. CASE PRESENTATION: Patient was a 24-years old man who presented to our hospital with fever, fatigue, and rapidly progressive glomerulonephritis. He had a history of ventricular septum defect (VSD). A renal biopsy specimen revealed crescentic glomerulonephritis and echocardiogram revealed VSD with vegetation on the tricuspid valve. Specimens of blood demonstrated Propionibacterium Acnes. The intensive antibiotic therapy with penicillin G was started without clinical improvement of renal function or resolution of fever over the next 7 days. After the short-term treatment of low dose of corticosteroid combined with continuous antibiotics, high fever and renal insufficiency were dramatically improved. CONCLUSION: Although renal function in our case worsened despite therapy with antibiotics, a short-term and low dose of corticosteroid therapy with antibiotics was able to recover renal function and the patient finally underwent tricuspid valve-plasty and VSD closure. We suggest that the patients with rapidly progressive glomerulonephritis associated with infective endocarditis might be treated with a short-term and low dose of corticosteroid successfully

A U-shaped relationship between haematocrit and mortality in a large prospective cohort study

Background: Only a limited number of studies have investigated the correlation between haematocrit (HCT) and mortality in the general population, and few of those studies have had data on a wide range of low and high levels of HCT. We investigated the association between baseline HCT and mortality in a prospective cohort study of 49 983 adult subjects in Iran with a broad spectrum of HCT values. Methods: Data on socio-demographic and life-style factors, past medical history, and levels of HCT were collected at enrollment. During a mean follow-up of 5 years (follow-up success rate ±99%), 2262 deaths were reported. Cox proportional hazards regression models were used to estimate hazard ratios and corresponding 95% confidence intervals. Results: There was a U-shaped relationship between categories of HCT and mortality in both sexes: both low and high levels of HCT were associated with increased overall mortality and mortality from cardiovascular disease. The U-shaped relationship persisted after several sensitivity analyses were done, including analyses restricted to non-smokers and non-users of opium; analyses excluding deaths from accidents and other external causes as well as deaths of persons with self-reported ischemic heart disease at the baseline interview for the study; and analyses excluding the first 2 years of follow-up. Self-reported past medical history and lack of data about lipids and other cellular blood components were the major limitations of the study. Conclusions: Low and high levels of HCT are associated with increased mortality in the general population. The findings in the present study can be of particular importance for low- and middle-income countries in which a substantial proportion of the population lives with suboptimal levels of HCT. © Published by Oxford University Press on behalf of the International Epidemiological Association 2013

Investment for food

Groenveld attempted to show the magnitude of investments in agriculture, which were necessary to meet the increasing world demand for food. The formula S = K/Y (ΔN +ΔH) was assumed as a description that for a community the proportion of national income saved and invested must equal the product of proportional increase in population plus increase in income per head, and of the capital coefficient. Thus ensued the problem of allocating investments in agriculture and other sectors of the economy. In private investment decisions involved many people. For public investment decisions were usually central. But public complemented private investment. The figures for future demand for food were based on population size and estimated population growth, income per head and expected increase of it and income elasticity of food costs. Changes in supply through rise in production from an increase in productivity were distinguished from changes through enlargement of agricultural area. Extrapolation of production from the period 1950-60 until the year 1980 showed that investments in Asia (other than China and the Soviet Union), Africa and Latin America should be about 10% higher to keep pace with demand for agricultural products. Groenveld believed the solution could be to raise public investment, which he then estimated to be about the same size as the private investments

Proportional reasoning in the laboratory : an intervention study in vocational education

Based on insights into the nature of vocational mathematical knowledge, we designed a computer tool with which students in laboratory schools at senior secondary vocational school level could develop a better proficiency in the proportional reasoning involved in dilution. We did so because we had identified computations of concentrations of chemical substances after dilution as a problematic area in the vocational education of laboratory technicians. Pre- and post-test results indeed show that 47 students aged 16–23 significantly improved their proportional reasoning in this domain with brief instruction time (50–90 min). Effect sizes were mostly large. The approach of using a visual tool that foregrounds mathematical aspects of laboratory work thus illustrates how vocational mathematical knowledge can be developed effectively and efficientl

Erythropoietin treatment in patients with chronic heart failure: a meta-analysis

Background: Anaemia is common in patients with chronic heart failure (HF), and erythropoiesis stimulating proteins (ESPs) are frequently used for its treatment. However, recent studies in patients with malignancies and renal failure have raised concerns about the safety of these agents. Objective: To determine whether treatment of anaemic patients with chronic HF with ESPs is associated with an effect on morbidity and mortality. Data sources: A systematic literature search in Medline, the Cochrane Controlled Trials Register Database and ClinicalTrials.gov through July 2008 was performed. Study selection: Randomised clinical trials comparing the effect of ESP treatment with placebo or usual care in anaemic patients with HF were included. Results: Seven randomised controlled trials were identified that enrolled 650 patients, of whom 363 were treated with ESPs and 287 with placebo. ESP treatment had a significantly lower risk of HF hospitalisation (risk ratio (RR)= 0.59; 95% CI 0.41 to 0.86; p = 0.006). There was no significant difference in the mortality risk between the two groups (RR = 0.69; 95% CI 0.39 to 1.23; p = 0.21). No significant differences were observed in the occurrence of hypertension or venous thrombosis. Conclusions: In chronic HF, treatment with ESPs is not associated with a higher mortality rate or more adverse events, whereas a beneficial effect on HF hospitalisation is seen. These outcomes are in contrast with studies in cancer and kidney disease, and support a large phase III morbidity and mortality trial of anaemia correction in patients with chronic HF