Spontaneous coronary artery dissection: Current state of the science: A scientific statement from the American Heart Association

© 2018 American Heart Association, Inc. Spontaneous coronary artery dissection (SCAD) has emerged as an important cause of acute coronary syndrome, myocardial infarction, and sudden death, particularly among young women and individuals with few conventional atherosclerotic risk factors. Patient-initiated research has spurred increased awareness of SCAD, and improved diagnostic capabilities and findings from large case series have led to changes in approaches to initial and long-term management and increasing evidence that SCAD not only is more common than previously believed but also must be evaluated and treated differently from atherosclerotic myocardial infarction. High rates of recurrent SCAD; its association with female sex, pregnancy, and physical and emotional stress triggers; and concurrent systemic arteriopathies, particularly fibromuscular dysplasia, highlight the differences in clinical characteristics of SCAD compared with atherosclerotic disease. Recent insights into the causes of, clinical course of, treatment options for, outcomes of, and associated conditions of SCAD and the many persistent knowledge gaps are presented

Tourism income and economic growth in Greece: Empirical evidence from their cyclical components

This paper examines the relationship between the cyclical components of Greek GDP and international tourism income for Greece for the period 1976–2004. Using spectral analysis the authors find that cyclical fluctuations of GDP have a length of about nine years and that international tourism income has a cycle of about seven years. The volatility of tourism income is more than eight times the volatility of the Greek GDP cycle. VAR analysis shows that the cyclical component of tourism income is significantly influencing the cyclical component of GDP in Greece. The findings support the tourism-led economic growth hypothesis and are of particular interest and importance to policy makers, financial analysts and investors dealing with the Greek tourism industry

China\u27s hegemonic intentions and trajectory: Will it opt for benevolent, coercive, or Dutch‐style hegemony?

China\u27s unprecedented economic growth led some scholars to conclude that it will replace the United States as the future global hegemon. However, China\u27s intentions in exercising future global leadership are yet unknown and difficult to extrapolate from its often contradictory behaviour. A preliminary overview of China\u27s island building in the South China Sea reveals its potentially coercive intentions. This inference is consistent with the analysis of those who prognosticate China\u27s violent rise. Conversely and simultaneously, China\u27s participation in peacekeeping operations and its global investments evince its benevolent hegemonic intentions, which are congruent with the argument of those who predict China\u27s peaceful hegemonic ascent. Confronted with these divergent tendencies in China\u27s recent international relations, and assuming its continued rise, it is, thus, essential to examine China\u27s strategic intentions and how these may ultimately project its violent or peaceful hegemonic rise. This article argues that the “Third Way” or “Dutch‐style” hegemony is highly instructive in this context and, thus, should be examined and added to the existing debate on China\u27s rise as either a benevolent or coercive hegemon. We argue that Dutch‐style hegemony may be the most viable way for China to proceed in its global hegemonic ascendancy

State Capacity and the Environmental Investment Gap in Authoritarian States

We construct an n-period, constrained optimization model where the authoritarian ruler maximizes expected rents subject to budget constraint of available surplus. We show that the larger state capacity is in the previous period, the worse environmental quality will be in the next period: while infrastructural investment and environmental protection increase with state capacity, the former increases at a faster rate which enlarges the gap between the two?the environmental investment gap. Given infrastructural public goods typically damage the environment, the larger this gap is the worse the environmental quality would be. This follows from rulers? optimizing logic of equating marginal returns once we assume the declining marginal productivity of factors of production of surplus. We model three types of air and water pollutants in autocracies as a function of state capacity and other relevant variables. State capacity is associated with higher levels of all three types of pollutants

Integral analysis of environmental and economic performance of combined agricultural intensification & bioenergy production in the Orinoquia region

Agricultural intensification is a key strategy to help meet increasing demand for food and bioenergy. It has the potential to reduce direct and indirect land use change (LUC) and associated environmental impacts while contributing to a favorable economic performance of the agriculture sector. We conduct an integral analysis of environmental and economic impacts of LUC from projected agricultural intensification and bioenergy production in the Orinoquia region in 2030. We compare three agricultural intensification scenarios (low, medium, high) and a reference scenario, which assumes a business-as-usual development of agricultural production. The results show that with current inefficient management or with only very little intensification between 26% and 93% of the existing natural vegetation areas will be converted to agricultural land to meet increasing food demand. This results in the loss of biodiversity by 53% and increased water consumption by 111%. In the medium and high scenarios, the intensification allows meeting increased food demand within current agricultural lands and even generating surplus land which can be used to produce bioenergy crops. This results in the reduction of biodiversity loss by 8-13% with medium and high levels of intensification compared to the situation in 2018. Also, a positive economic performance is observed, stemming primarily from intensification of cattle production and additional energy crop production. Despite increasing irrigation efficiency in more intensive production systems, the water demand for perennial crops and cattle production over the dry season increases significantly, thus sustainable management practices that target efficient water use are needed. Agricultural productivity improvements, particularly for cattle production, are crucial for reducing the pressure on natural areas from increasing demand for both food products and bioenergy. This implies targeted investments in the agricultural sector and integrated planning of land use. Our results showed that production intensification in the Orinoquia region is a mechanism that could reduce the pressure on natural land and its associated environmental and economic impacts

Political devolution and employment relations in Great Britain: the case of the Living Wage

This article examines the role of the devolved governments of Scotland and Wales in promoting the voluntary Living Wage. It shows that active promotion of the Living Wage standard has emerged in both countries from a broader commitment to an economic policy of ‘inclusive growth’. Employment law is not a devolved matter, and the article identifies a broad range of economic incentives and soft forms of regulation that have been used by the devolved governments to promote the Living Wage in the absence of hard power to legislate. Non‐legislative forms of state intervention are often regarded sceptically, but the article shows that the attempts of devolved governments to spread the Living Wage have been impactful, particularly in Scotland

The prospects for environmental accounting and accountability in China

Foucault’s ideas on episteme change are used to help understand change taking place in China from the “industrial civilization” to an “ecological civilization”. If episteme change is taking place this could be reflected in the philosophies and attitudes of Chinese accountants and their environmental accounting work will be developing. The conclusions are that: China is slowly moving towards an ecological civilisation; based around the thinking of Chinese accountants an epistemic change is in evidence in tandem with an emerging interest in ancient Chinese philosophy; Chinese accountants’ engagement with environmental accounting and accountability is evidence of reduced specialisation

Improvements in access to malaria treatment in Tanzania after switch to artemisinin combination therapy and the introduction of accredited drug dispensing outlets - a provider perspective

BACKGROUND\ud \ud To improve access to treatment in the private retail sector a new class of outlets known as accredited drug dispensing outlets (ADDO) was created in Tanzania. Tanzania changed its first-line treatment for malaria from sulphadoxine-pyrimethamine (SP) to artemether-lumefantrine (ALu) in 2007. Subsidized ALu was made available in both health facilities and ADDOs. The effect of these interventions on access to malaria treatment was studied in rural Tanzania.\ud \ud METHODS\ud \ud The study was carried out in the villages of Kilombero and Ulanga Demographic Surveillance System (DSS) and in Ifakara town. Data collection consisted of: 1) yearly censuses of shops selling drugs; 2) collection of monthly data on availability of anti-malarials in public health facilities; and 3) retail audits to measure anti-malarial sales volumes in all public, mission and private outlets. The data were complemented with DSS population data.\ud \ud RESULTS\ud \ud Between 2004 and 2008 access to malaria treatment greatly improved and the number of anti-malarial treatment doses dispensed increased by 78%. Particular improvements were observed in the availability (from 0.24 shops per 1,000 people in 2004 to 0.39 in 2008) and accessibility (from 71% of households within 5 km of a shop in 2004 to 87% in 2008) of drug shops. Despite no improvements in affordability this resulted in an increase of the market share from 49% of anti-malarial sales 2005 to 59% in 2008. The change of treatment policy from SP to ALu led to severe stock-outs of SP in health facilities in the months leading up to the introduction of ALu (only 40% months in stock), but these were compensated by the wide availability of SP in shops. After the introduction of ALu stock levels of the drug were relatively high in public health facilities (over 80% months in stock), but the drug could only be found in 30% of drug shops and in no general shops. This resulted in a low overall utilization of the drug (19% of all anti-malarial sales)\ud \ud CONCLUSIONS\ud \ud The public health and private retail sector are important complementary sources of treatment in rural Tanzania. Ensuring the availability of ALu in the private retail sector is important for its successful uptake

Distorted policy transfer? South Korea’s adaptation of UK social enterprise policy

This study draws upon communicative processes in policy transfer to consider the ways in which policy may be adapted to context or distorted. The theoretical framework is used to investigate exactly what the South Korean government borrowed from UK social enterprise policy. Despite claims that the UK was the source of both the general policy direction and the particular regulatory device, the Korean government did not learn about the specific contexts of the British policy, nor attempt two-way communication with domestic stakeholders. Rather, the UK policy was interpreted in accordance with the Korean government’s own ideas about how to utilize social enterprise. Historical legacies of top-down decision-making played an important role in this process, as did the state’s role as a regulator which mobilizes the private sector to achieve policy goals. The consequences have been negative for those organizations refused social enterprise status under the Ministry of Labor’s strict approval system, as well as for the original target population: the socially disadvantaged and vulnerable. It is suggested that the model advanced may help to illuminate the reasons why some borrowed policies differ considerably from the originals, and the use of policy transfer as a means of legitimizatio