The Economic Impact of Migration – Productivity Analysis for Spain and the UK

As a consequence of increased internationalization over the past 20 years labour has become increasingly mobile, and yet the implications for firm and industry performance have been largely ignored. This paper explores the direct economic consequences of immigration on host nations’ productivity performance at a sectoral level. We consider its impact in two very different European countries, Spain and the UK. Whilst the UK has traditionally had a substantial in-flow of migration, for Spain, the phenomenon is much more recent. The paper provides an overview of the role played by immigration on per capita income, highlighting the importance of demographic differences. We then go on to analyze the role of migration on productivity using two different approaches: i) growth accounting methodology and ii) econometric estimation of a production function. Our findings indicate that migration has had very different implications for Spain and the UK, migrants being more productive than natives in the UK but less productive than natives in Spain. This may in part be a function of different immigration policies, particularly related to the skill requirements on entry, but also in part a feature of the host nations’ ability to ‘absorb’ foreign labour.Migration, productivity

Developing a scale : adolescents' health choices related rights, duties and responsibilities

Background: Adolescents´ health choices have been widely researched, but the ethical basis of these choices, namely their rights, duties and responsibilities, have been disregarded and scale is required to measure these. Objective: To describe the development of a scale that measures adolescents´ rights, duties and responsibilities in relation to health choices and document the preliminary scale testing. Research design: A multi-phase development method was used to construct the Health Rights Duties and Responsibilities (HealthRDR) scale. The concepts and content were defined through document analysis, a systematic literature review and focus groups. The content validity and clarity of the items were evaluated by expert panel of 23 adolescents, school nurses and researchers. We then calculated the content validity index and the content validity ratio at on item and scale levels. Preliminary testing was conducted with 200 adolescents aged 15-16 years. Descriptive statistics, Cronbach´s alpha correlation and statistics for the item-analysis were calculated. Ethical considerations: Ethical approval and permission were obtained according to national legislation and responsible research practice was followed. Informed consent was obtained from the participants and the parents were informed about the study. Findings: The HealthRDR scale comprises of four sub-scales with 148 items: 15 on health choices, 36 on rights, 47 on duties and 50 on responsibilities. The items had a 0.93 content validity index and a 0.85 content validity ratio. The Cronbach alpha correlation coefficient was 0.99 for the total scale and the individual sub-scales scores were: health choices (0.93), rights (0.97), responsibilities (0.99) and duties (0.98). Discussion: The findings are discussed in light of the ethical concepts and validity and reliability of the developed scale. Conclusion: The HealthRDR scale defines and understands adolescents´ rights, duties and responsibilities in relation to health choices and has good content validity. Further testing and refinement of the concepts are needed

Environmental responsibility in hospital care : findings from a qualitative study

Objective: To identify the key elements of environmental responsibility in hospital care and the stakeholders involved. Background: Hospital care causes a significant global environmental burden, which threatens human health and wellbeing. Environmental responsibility has been identified as an essential part of patient care with regard to health promotion and wellbeing of humans, but it has often been regarded as a secondary issue in hospitals. In addition, the lack of organizational structures and administrative as well as managerial support inhibit the promotion of environmental responsibility in hospitals. Methods: We used a qualitative study with semi-structured interviews and document analysis. Our data was drawn from the environmental managers of five Finnish university hospitals and documents on their environmental programs. Results: We found that the aim of environmental responsibility in hospital care was to avoid unnecessary emissions, and that it was guided by the authorities and by ethical values. It included targets for sustainable use of material, electricity, water and transport. Environmental responsibility required the involvement of several stakeholders, including administrators, environmental manager, immediate leaders, environmental support people, staff and patients. Implementation of environmental responsibility was promoted by collaboration, education, diverse initiatives to motivate staff, and continuously developing practices. Conclusions: Environmental responsibility extended throughout a hospital organization. Staff was in a key position to implement it, but they needed versatile organizational support, including education, clear procedures, defined roles, and a motivational culture and facilities. Implications for hospital management: This study yields new knowledge that will provide information for the development of organisational structures with respect to environmental responsibility in hospital care. Keywords: Environmental manager, Environmental program, Environmental responsibility, Hospital, Key informan

Automatic detection of Crohn's disease using quantified motility in magnetic resonance enterography : initial experiences

Publisher Copyright: © 2021 The AuthorsAIM: To report initial experiences of automatic detection of Crohn's disease (CD) using quantified motility in magnetic resonance enterography (MRE). MATERIALS AND METHODS: From 302 patients, three datasets with roughly equal proportions of CD and non-CD cases with various illnesses were drawn for testing and neural network training and validation. All datasets had unique MRE parameter configurations and were performed in free breathing. Nine neural networks were devised for automatic generation of three different regions of interests (ROI): small bowel, all bowel, and non-bowel. Additionally, a full-image ROI was tested. The motility in an MRE series was quantified via a registration procedure, which, accompanied with given ROIs, resulted in three motility indices (MI). A subset of the indices was used as an input for a binary logistic regression classifier, which predicted whether the MRE series represented CD. RESULTS: The highest mean area under the curve (AUC) score, 0.78, was reached using the full-image ROI and with the dataset with the highest cine series length. The best AUC scores for the other two datasets were only 0.54 and 0.49. CONCLUSION: The automatic system was able to detect CD in the group of MRE studies with lower temporal resolution and longer cine series showing potential in primary bowel disorder diagnostics. Larger ROI selections and utilising all available cine series for motility registration yielded slight performance improvements. (c) 2021 The Authors. Published by Elsevier Ltd on behalf of The Royal College of Radiologists. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/ 4.0/).Peer reviewe

Evaluation of a CTA-based convolutional neural network for infarct volume prediction in anterior cerebral circulation ischaemic stroke

Background Computed tomography angiography (CTA) imaging is needed in current guideline-based stroke diagnosis, and infarct core size is one factor in guiding treatment decisions. We studied the efficacy of a convolutional neural network (CNN) in final infarct volume prediction from CTA and compared the results to a CT perfusion (CTP)-based commercially available software (RAPID, iSchemaView). Methods We retrospectively selected 83 consecutive stroke cases treated with thrombolytic therapy or receiving supportive care that presented to Helsinki University Hospital between January 2018 and July 2019. We compared CNN-derived ischaemic lesion volumes to final infarct volumes that were manually segmented from follow-up CT and to CTP-RAPID ischaemic core volumes. Results An overall correlation of r = 0.83 was found between CNN outputs and final infarct volumes. The strongest correlation was found in a subgroup of patients that presented more than 9 h of symptom onset (r = 0.90). A good correlation was found between the CNN outputs and CTP-RAPID ischaemic core volumes (r = 0.89) and the CNN was able to classify patients for thrombolytic therapy or supportive care with a 1.00 sensitivity and 0.94 specificity. Conclusions A CTA-based CNN software can provide good infarct core volume estimates as observed in follow-up imaging studies. CNN-derived infarct volumes had a good correlation to CTP-RAPID ischaemic core volumes.Peer reviewe

Automatic CT Angiography Lesion Segmentation Compared to CT Perfusion in Ischemic Stroke Detection: a Feasibility Study

In stroke imaging, CT angiography (CTA) is used for detecting arterial occlusions. These images could also provide information on the extent of ischemia. The study aim was to develop and evaluate a convolutional neural network (CNN)-based algorithm for detecting and segmenting acute ischemic lesions from CTA images of patients with suspected middle cerebral artery stroke. These results were compared to volumes reported by widely used CT perfusion-based RAPID software (IschemaView). A 42-layer-deep CNN was trained on 50 CTA volumes with manually delineated targets. The lower bound for predicted lesion size to reliably discern stroke from false positives was estimated. The severity of false positives and false negatives was reviewed visually to assess the clinical applicability and to further guide the method development. The CNN model corresponded to the manual segmentations with voxel-wise sensitivity 0.54 (95% confidence interval: 0.44-0.63), precision 0.69 (0.60-0.76), and Sorensen-Dice coefficient 0.61 (0.52-0.67). Stroke/nonstroke differentiation accuracy 0.88 (0.81-0.94) was achieved when only considering the predicted lesion size (i.e., regardless of location). By visual estimation, 46% of cases showed some false findings, such as CNN highlighting chronic periventricular white matter changes or beam hardening artifacts, but only in 9% the errors were severe, translating to 0.91 accuracy. The CNN model had a moderately strong correlation to RAPID-reported T-max > 10 s volumes (Pearson's r = 0.76 (0.58-0.86)). The results suggest that detecting anterior circulation ischemic strokes from CTA using a CNN-based algorithm can be feasible when accompanied with physiological knowledge to rule out false positives.Peer reviewe

Le competenze infermieristiche avanzate nel trattamento dello stroke in fase acuta in Italia. Strategia per l’identificazione (I parte)

Introduction: the goal of this study was to describe advanced nursing competences indicators for identification strategy in the stroke care in Italy and develop a survey tool. Problem: the new structure of the NHS and the needs expressed by patients increasingly require an advancement of the skills of health professionals. To this end the authors have identified and described a method for the detection of advanced nursing skills. Starting from the theoretical structure of AB Hamric have been identified analyzed and compared documents of a professionalizing and clinical from which have identified some categories. For each indicator have been identified one or more items and has been developed ad hoc questionnaire. At the end this was validated. Discussion: the methodology for the identification of the indicators has been efficacy in achieving the objectives. The strategy used in the study is reproducible, since traced to a theoretical model, and contextualized to any clinical setting, where there are secondary sources of evidencebased. It can also be adapted to post basic training course of a single reality. Conclusions: advanced clinical knowledge and skills, frequently without a formal recognition because of the complexity and instability of the patient, are used in the stroke care. Itís hoped to use the tool to verify the effectiveness and then play back the path in other clinical setting

Ethinylestradiol in combined hormonal contraceptive has a broader effect on serum proteome compared with estradiol valerate : a randomized controlled trial

STUDY QUESTION: Does an estradiol-based combined oral contraceptive (COC) have a milder effect on the serum proteome than an ethinylestradiol (EE)-based COC or dienogest (DNG) only?SUMMARY ANSWER: The changes in serum proteome were multifold after the use of a synthetic EE-based COC compared to natural estrogen COC or progestin-only preparation.WHAT IS KNOWN ALREADY: EE-based COCs widely affect metabolism, inflammation, hepatic protein synthesis and blood coagulation. Studies comparing serum proteomes after the use of COCs containing EE and natural estrogens are lacking.STUDY DESIGN, SIZE, DURATION: This was a spin-off from a randomized, controlled, two-center clinical trial. Women (n = 59) were randomized to use either EE thorn DNG, estradiol valerate (EV) thorn DNG or DNG only continuously for 9 weeks.PARTICIPANTS/MATERIALS, SETTING, METHODS: Participants were healthy, young, white volunteer women. Serum samples were collected before and after 9 weeks of hormonal exposure. Samples from 44 women were available for analysis (EE thorn DNG n = 14, EV thorn DNG n = 16 and DNG only n = 14). Serum proteins were analyzed by quantitative, discovery-type label-free proteomics.MAIN RESULTS AND THE ROLE OF CHANCE: Altogether, 446 proteins/protein families with two or more unique peptides were detected and quantified. The number of proteins/families that altered over the 9-week period within the study groups was 121 for EE thorn DNG and 5 for EV thorn DNG, while no changes were detected for DNG only. When alterations were compared between the groups, significant differences were detected for 63 proteins/protein families, of which 58 were between the EE thorn DNG and EV thorn DNG groups. The most affected functions during the use of EE thorn DNG were the complement system, acute phase response signaling, metabolism and the coagulation system. The results were validated by fetuin-B and cortisol-binding globulin ELISA and sex hormone-binding globulin immunoassay.LARGE SCALE DATA: Data are available via ProteomeXchange with identifiers PXD033617 (low abundance fraction) and PXD033618 (high abundance fraction).LIMITATIONS, REASONS FOR CAUTION: The power analysis of the trial was not based on the proteomic analysis of this spin-off study. In the future, targeted proteomic analysis with samples from another trial should be carried out in order to confirm the results.WIDER IMPLICATIONS OF THE FINDINGS: The EE-based COC exerted a broader effect on the serum proteome than the EV-based COC or the DNG-only preparation. These results demonstrate that the effects of EE in COCs go far beyond the established endpoint markers of estrogen action, while the EV combination is closer to the progestin-only preparation. The study indicates that EV could provide a preferable option to EE in COCs in the future and signals a need for further studies comparing the clinical health outcomes of COCs containing EE and natural estrogens.Peer reviewe

Combined oral contraceptives containing estradiol valerate vs ethinylestradiol on coagulation : A randomized clinical trial

Introduction Contraceptives containing ethinylestradiol (EE) induce changes in the coagulation system and are associated with a risk of venous thromboembolism. However, studies comparing the effects of combined oral contraceptives containing EE and low-potency estrogens (ie, estradiol [E-2] and estradiol valerate [EV]) on coagulation biomarkers are limited. This study represents secondary outcomes of a randomized trial comparing combined oral contraceptives containing EV + dienogest (DNG), EE + DNG, and DNG alone on selected coagulation biomarkers. We could compare the specific effects of the different estrogen components owing to the inclusion of preparations containing the same progestin. Material and methods We enrolled 59 healthy, 18- to 35-year-old, non-smoking women, of whom three discontinued. The participants were randomly allocated to 9 weeks of continuous treatment with EV 2 mg + DNG 2-3 mg (n = 20), EE 0.03 mg + DNG 2 mg (n = 20), or DNG 2 mg (n = 19). Blood samples were collected at baseline and after 9 weeks. We assessed coagulation in vitro by thrombin generation using the Calibrated Automated Thrombogram. Thrombin generation was evaluated by lag time, time to thrombin peak, thrombin peak, and endogenous thrombin potential in response to tissue factor (1 pm). In vivo coagulation assessment was based on levels of prothrombin fragment 1 + 2 (F1 + 2) (thrombin generation) and D-dimer (fibrin turnover). Clinical trial registration: NCT02352090. Results Lag time and time to thrombin peak remained unaltered after exposure to EV + DNG, whereas EE + DNG shortened both lag time (mean percentage change -24%, 95% confidence interval [CI] -32% to -15%; p < 0.01) and time to thrombin peak (-26%, 95% CI -37% to -16%; p < 0.01). EV + DNG induced lower thrombin peak and endogenous thrombin potential than EE + DNG (peak; +45%, 95% CI 22%-67% vs +147%,95% CI 96%-198%; p < 0.01, and endogenous thrombin potential; +26%, 95% CI 15%-38% vs +64%, 95% CI 51%-76%; p < 0.01). Median F1 + 2 levels remained unchanged with EV + DNG (p = 0.22) but increased within normal ranges with EE + DNG (from 152 pmol/L, 95% CI 127-206] pmol/L to 194 pmol/L, 95% CI 149-250 pmol/L, p = 0.04). The within-group change in D-dimer levels was not significant in any of the groups. DNG alone did not affect these biomarkers. Conclusions Both in vitro and in vivo thrombin generation was lower after exposure to EV + DNG compared with EE + DNG. The lower thrombin generation measures after treatment with EV + DNG indicate less enhancement of coagulation potential and suggest that EV may be favorable to EE as a component of combined oral contraceptives.Peer reviewe

Combined oral contraceptives containing estradiol valerate vs ethinylestradiol on coagulation : A randomized clinical trial

Introduction Contraceptives containing ethinylestradiol (EE) induce changes in the coagulation system and are associated with a risk of venous thromboembolism. However, studies comparing the effects of combined oral contraceptives containing EE and low-potency estrogens (ie, estradiol [E-2] and estradiol valerate [EV]) on coagulation biomarkers are limited. This study represents secondary outcomes of a randomized trial comparing combined oral contraceptives containing EV + dienogest (DNG), EE + DNG, and DNG alone on selected coagulation biomarkers. We could compare the specific effects of the different estrogen components owing to the inclusion of preparations containing the same progestin. Material and methods We enrolled 59 healthy, 18- to 35-year-old, non-smoking women, of whom three discontinued. The participants were randomly allocated to 9 weeks of continuous treatment with EV 2 mg + DNG 2-3 mg (n = 20), EE 0.03 mg + DNG 2 mg (n = 20), or DNG 2 mg (n = 19). Blood samples were collected at baseline and after 9 weeks. We assessed coagulation in vitro by thrombin generation using the Calibrated Automated Thrombogram. Thrombin generation was evaluated by lag time, time to thrombin peak, thrombin peak, and endogenous thrombin potential in response to tissue factor (1 pm). In vivo coagulation assessment was based on levels of prothrombin fragment 1 + 2 (F1 + 2) (thrombin generation) and D-dimer (fibrin turnover). Clinical trial registration: NCT02352090. Results Lag time and time to thrombin peak remained unaltered after exposure to EV + DNG, whereas EE + DNG shortened both lag time (mean percentage change -24%, 95% confidence interval [CI] -32% to -15%; p < 0.01) and time to thrombin peak (-26%, 95% CI -37% to -16%; p < 0.01). EV + DNG induced lower thrombin peak and endogenous thrombin potential than EE + DNG (peak; +45%, 95% CI 22%-67% vs +147%,95% CI 96%-198%; p < 0.01, and endogenous thrombin potential; +26%, 95% CI 15%-38% vs +64%, 95% CI 51%-76%; p < 0.01). Median F1 + 2 levels remained unchanged with EV + DNG (p = 0.22) but increased within normal ranges with EE + DNG (from 152 pmol/L, 95% CI 127-206] pmol/L to 194 pmol/L, 95% CI 149-250 pmol/L, p = 0.04). The within-group change in D-dimer levels was not significant in any of the groups. DNG alone did not affect these biomarkers. Conclusions Both in vitro and in vivo thrombin generation was lower after exposure to EV + DNG compared with EE + DNG. The lower thrombin generation measures after treatment with EV + DNG indicate less enhancement of coagulation potential and suggest that EV may be favorable to EE as a component of combined oral contraceptives.Peer reviewe