Tomorrow's silk road: Assessing an EU-China Free Trade Agreement.

Foreword. The Foreign Trade Association, which represents the European and international distribution and retail sector, commissioned this study in light of the importance of China as a sourcing country and its attractiveness as a rapidly growing consumer market. We believe that open borders and free trade can contribute to a broader choice and lower costs for consumers and create growth and employment in both Europe and China. This independent study aims to provide an in-depth contribution on the status of bilateral economic exchanges and persistent trade barriers that exist between the European Union and China. The second objective of the report is to encourage a frank and open dialogue, based on a scientific evaluation and without prejudice, on the possibility of a preferential trade agreement between the two sides. This study should be read by anyone who is interested in economic relations between the EU and China and in trade policy in general. The report provides many interesting findings and raises a number of surprising points. Overall, this study is one of the most significant contributions to the discourse on EU-China relations in recent years. We hope that this study will stimulate fresh thoughts on the benefits of closer future cooperation between two regions that have been interlinked since the times of antiquity and the first Silk Road

The Effect of Preoperative Opioid Education on Patient’s Postoperative Opioid Usage Following Hip Arthroscopy: A Randomized, Prospective Trial

Introduction: Over the past twenty years, opioid usage has continued to rise significantly, resulting in what many have termed an “opioid epidemic”. Several studies have noted that patients are routinely over-prescribed opioids following common surgical procedures, resulting in a large number of unused and therefore readily available opioid pills. Additionally, the highest reported age population for illicit drug usage is in individuals ages 20-39 years old, which is the same group that commonly undergoes hip arthroscopy. A previous study in patients undergoing arthroscopic rotator cuff repair demonstrated that patients who received pre-operative opioid education consumed significantly less opioids 3 months after surgery than those patients who did not receive the pre-operative education. As a result, further investigation is necessary in patients undergoing hip arthroscopy to determine the potential effects opioid education materials have on this patient population. The primary objective of this study was to investigate the effect that a pre-operative opioid educational video has on patient’s opioid consumption following hip arthroscopy procedures. Methods: This is a prospective, randomized trial enrolling patients undergoing arthroscopic hip surgery for either isolated or concomitant labrum repair, acetabuloplasty, or femoral osteoplasty. Exclusion criteria included a history of drug use, workman’s compensation, open surgery, patients \u3c18 years of age, and non-English speaking patients. Patients were randomly assigned a 1:1 ratio to either be shown an educational video detailing the risks of opioid utilization and dependence versus standard protocol. All patients received the current standard protocol for managing post-operative discomfort (local anesthetic injection at the time of surgery [20cc of ropivacaine intra-articularly], with 40 tablets of oxycodone 5mg/acetaminophen 325mg given for post-operative pain. All prescriptions were monitored through the state prescription monitors database and correlated with patient reporting. Physicians who performed the surgical procedure were blinded to which patients received patient education. Patients pain levels and opioid usage were determined through a custom narcotics use survey. Patients recorded their pain levels and opioid usage levels pre-operatively and then 2 weeks, 6 week, and 3 months after surgery. Included in each survey was the custom narcotic use survey, along with the Modified Harris Hip Score and Single Assessment Numeric Evaluation (SANE) rating. Number of opioid pills consumed was converted to morphine milligram equivalents for statistical analysis. Results: Ninety-eight patients were included in the analysis (48 controls, 49 who received the opioid education). There were no significant differences between the two groups in mean age at surgery (31.5 in control and 32.0 in education group P=0.445), MI (24.6 and 24.7, P=0.790), or sex ratio (26M/23F in control and 22M/27F in education group (P=0.544). There were also no significant preoperative differences between the two groups in patient reported function, as measured by SANE (48.0 in control and 47.9 in education group, P=0.976) or patient reported pain and function as measured by Modified Harris Hip score (67.5 in control and 70.2 in education group, P=0.409). Patients in the education group had a significantly higher median morphine milligram equivalents (MME) consumed at 2 weeks (65.0 education vs. 30.0 control, P=0.013). However, there was no significant difference in the median MME consumed at 6 weeks (75.0 education vs 35.0 control, P=0.077), or 12 weeks (75.0 education vs 41.2 control, P=0.504). When the two groups were compared, there were no significant differences in duration of opioid consumption, as measured by the question” are you still taking narcotic medication to control your hip pain”, or patient reported pain and function as reported by the SANE scale an MHHS at 2 weeks, 6 weeks, and 12 weeks postoperatively. Power analysis revealed an effect size of 0.416 and power of 0.53 for mean MME consumed at 2 weeks. Discussion and Conclusion: While those who received the preoperative education module on opioid medications actually demonstrated a higher mean amount of opioid pills consumed in the short term post-operative period at 2 weeks compared to the control group, they did not significantly differ from the control group at 6 and 12 weeks. Overall, the preoperative education module has no parent effect on patient-reported pain or function in the post-operative period

KardiaTool: An Integrated POC Solution for Non-invasive Diagnosis and Therapy Monitoring of Heart Failure Patients

The aim of this work is to present KardiaTool platform, an integrated Point of Care (POC) solution for noninvasive diagnosis and therapy monitoring of Heart Failure (HF) patients. The KardiaTool platform consists of two components, KardiaPOC and KardiaSoft. KardiaPOC is an easy to use portable device with a disposable Lab-on-Chip (LOC) for the rapid, accurate, non-invasive and simultaneous quantitative assessment of four HF related biomarkers, from saliva samples. KardiaSoft is a decision support software based on predictive modeling techniques that analyzes the POC data and other patient's data, and delivers information related to HF diagnosis and therapy monitoring. It is expected that identifying a source comparable to blood, for biomarker information extraction, such as saliva, that is cost-effective, less invasive, more convenient and acceptable for both patients and healthcare professionals would be beneficial for the healthcare community. In this work the architecture and the functionalities of the KardiaTool platform are presented

Trials

Background The risk/benefit ratio of using statins for primary prevention of cardiovascular (CV) events in elderly people has not been established. The main objectives of the present study are to assess the cost-effectiveness of statin cessation and to examine the non-inferiority of statin cessation in terms of mortality in patients aged 75 years and over, treated with statins for primary prevention of CV events. Methods The “Statins in the elderly” (SITE) study is an ongoing 3-year follow-up, open-label comparative multi-centre, randomized clinical trial that is being conducted in two parallel groups in outpatient primary care offices. Participants meeting the following criteria are included: people aged 75 years and older being treated with statins as primary prevention for CV events, who provide informed consent. After randomization, patients in the statin-cessation strategy are instructed to withdraw their treatment. In the comparison strategy, patients continue their statin treatment at the usual dosage. The cost-effectiveness of the statin-cessation strategy compared to continuing statins will be estimated through the incremental cost per quality-adjusted life years (QALYs) gained at 36 months, from the perspective of the French healthcare system. Overall mortality will be the primary clinical endpoint. We assumed that the mortality rate at 3 years will be 15%. The sample size was computed to achieve 90% power in showing the non-inferiority of statin cessation, assuming a non-inferiority margin of 5% of the between-group difference in overall mortality. In total, the SITE study will include 2430 individuals. Discussion There is some debate on the value of statins in people over 75 years old, especially for primary prevention of CV events, due to a lack of evidence of their efficacy in this population, potential compliance-related events, drug-drug interactions and side effects that could impair quality of life. Data from clinical trials guide the initiation of medication therapy for primary or secondary prevention of CV disease but do not define the timing, safety, or risks of discontinuing the agents. The SITE study is one of the first to examine whether treatment cessation is a cost-effective and a safe strategy in people of 75 years and over, formerly treated with statins

Canary in a Coal Mine: Impact of Mid-20th Century Air Pollution on Infant Mortality and Property Values *

Abstract This paper uses the mid-20th century expansion in U.S. coal-fired electricity generation to study the local impact of air pollution on infant mortality and housing prices. The empirical analysis exploits the timing of coal-fired power plant openings and annual variation in plantlevel coal consumption in the U.S. from 1938 to 1962. The estimates suggest that the rise in power plant coal consumption was responsible for an additional 3,500 infant deaths per year by the end of the sample period. We examine whether individuals perceived these health costs. Although hedonic estimates of the average marginal willingness to pay for clean air are close to zero, there is substantial heterogeneity in the housing market response. At low levels of electricity access, expansions in coal-fired electricity generation have positive effects on housing prices. At high levels of electricity access, this relationship is negative. These results suggest that households traded off the pollution costs of coal-fired power against the benefits of low-cost electricity. * We than

Jet energy measurement with the ATLAS detector in proton-proton collisions at root s=7 TeV

The jet energy scale and its systematic uncertainty are determined for jets measured with the ATLAS detector at the LHC in proton-proton collision data at a centre-of-mass energy of √s = 7TeV corresponding to an integrated luminosity of 38 pb-1. Jets are reconstructed with the anti-kt algorithm with distance parameters R=0. 4 or R=0. 6. Jet energy and angle corrections are determined from Monte Carlo simulations to calibrate jets with transverse momenta pT≥20 GeV and pseudorapidities {pipe}η{pipe}<4. 5. The jet energy systematic uncertainty is estimated using the single isolated hadron response measured in situ and in test-beams, exploiting the transverse momentum balance between central and forward jets in events with dijet topologies and studying systematic variations in Monte Carlo simulations. The jet energy uncertainty is less than 2. 5 % in the central calorimeter region ({pipe}η{pipe}<0. 8) for jets with 60≤pT<800 GeV, and is maximally 14 % for pT<30 GeV in the most forward region 3. 2≤{pipe}η{pipe}<4. 5. The jet energy is validated for jet transverse momenta up to 1 TeV to the level of a few percent using several in situ techniques by comparing a well-known reference such as the recoiling photon pT, the sum of the transverse momenta of tracks associated to the jet, or a system of low-pT jets recoiling against a high-pT jet. More sophisticated jet calibration schemes are presented based on calorimeter cell energy density weighting or hadronic properties of jets, aiming for an improved jet energy resolution and a reduced flavour dependence of the jet response. The systematic uncertainty of the jet energy determined from a combination of in situ techniques is consistent with the one derived from single hadron response measurements over a wide kinematic range. The nominal corrections and uncertainties are derived for isolated jets in an inclusive sample of high-pT jets. Special cases such as event topologies with close-by jets, or selections of samples with an enhanced content of jets originating from light quarks, heavy quarks or gluons are also discussed and the corresponding uncertainties are determined. © 2013 CERN for the benefit of the ATLAS collaboration