The clinical use of longitudinal bio-electrical impedance vector analysis in assessing stabilization of children with severe acute malnutrition

Background & aims: Severe Acute Malnutrition (SAM) in children is determined using anthropometry. However, bio-electrical impedance (BI) analysis could improve the estimation of altered body composition linked to edema and/or loss of lean body mass in children with SAM. We aimed to assess: 1) the changes in BI parameters during clinical stabilization and 2) whether BI parameters add prognostic value for clinical outcome beyond the use of anthropometry. Methods: This prospective observational study enrolled children, aged 6–60 months, that were admitted at Queen Elizabeth Central Hospital in Blantyre, Malawi, for complicated SAM (i.e., having either severe wasting or edematous SAM with a complicating illness). Height, weight, mid-upper arm circumference (MUAC), and BI were measured on admission and after clinical stabilization. BI measures were derived from height-adjusted indices of resistance (R/H), reactance (Xc/H), and phase angle (PA) and considered to reflect body fluids and soft tissue in BI vector analysis (BIVA). Results: We studied 183 children with SAM (55% edematous; age 23.0 ± 12.0 months; 54% male) and 42 community participants (age 20.1 ± 12.3 months; male 62%). Compared to community participants, the BIVA of children with edematous SAM were short with low PA and positioned low on the hydration axis which reflects severe fluid retention. In contrast, children with severe wasting had elongated vectors with a PA that was higher than children with edematous SAM but lower than community participants. Their BIVA position fell within the top right quadrant linked to leanness and dehydration. BIVA from severely wasted and edematous SAM patients differed between groups and from community children both at admission and after stabilization (p < 0.001). Vector position shifted during treatment only in children with edematous SAM (p < 0.001) and showed a upward translation suggestive of fluid loss. While PA was lower in children with SAM, PA did not contribute more than anthropometry alone towards explaining mortality, length of stay, or time-to-discharge or time-to-mortality. The variability and heterogeneity in BI measures was high and their overall added predictive value for prognosis of individual children was low. Conclusions: BIVA did not add prognostic value over using anthropometry alone to predict clinical outcome. Several implementation challenges need to be optimized. Thus, in low-resource settings, the routine use of BI in the management of pediatric malnutrition is questionable without improved implementation

SWEET AND SOUR INVESTMENT: A Sentiment Analysis of Chinese Investment in Europe

Media reports and political rhetoric widely claim that Chinese Foreign Direct Investment (FDI) has politically impacted Europe, causing various countries to disagree over the consequences of Chinese investments for national security and the desirability of screening mechanisms to vet incoming investments. Given this phenomenon at the international level, Chinese investments may be dividing the European public at the sub-national level as well. This thesis investigates how Chinese foreign investments have impacted national politics since their first substantial presence in Europe after the 2008 Financial Crisis. The work employs large-scale computer-automated sentiment analysis of newspaper articles to discover the relationship between public opinion toward Chinese investments and the levels of Chinese investment in European countries over the last decade – a relationship yet to be explored. After presenting some background on the evolution of Chinese direct investment both worldwide and specifically in Europe, I propose three hypotheses representing the current scholarly research on the political tensions induced by foreign investment: 1) The Traditional Political hypothesis places the debate between free markets and labor rights at the center of Chinese investment’s political divisiveness 2) The Globalism hypothesis focuses on issues of international growth, in competition with nationalism, as the main political wedge regarding Chinese investments 3) The Null Constant hypothesis posits that no relationship exists between public sentiment toward Chinese investments and the volume of investment. In order to test these hypotheses, I first developed a computer program to web-scrape national European newspapers and created an original dataset, which could potentially be used by other scholars. I then conducted sentiment analysis on every article within this dataset, in the original language of the text, to quantitatively track public opinion towards Chinese investment from 2008 to 2019 for various permutations of nationality and political leaning. Through a correlation analysis of Chinese investment levels and sentiment toward Chinese investments as found in national newspapers, this thesis finds unique political circumstances in each nation. A further factor analysis identified the principal components of each newspaper allowing me to identify the central discussion surrounding Chinese investments in each country. In France, the conservatives favored Chinese investments, focusing the discussion on the benefits of a free market, while liberals proved less inclined toward Chinese investments, directing their complaints toward abuses of labor rights. In Germany, the liberals favored Chinese investments more, centering their reporting around the benefits of international growth and cooperation, while German conservatives favored Chinese investments less, arguing for increased national protection from foreigners. Dutch political attitudes towards Chinese investment failed to exhibit any change over the last ten years on either side of the political spectrum, due to a long history of the Netherlands welcoming foreign investment. These results show the nuanced conditions under which national divisions toward Chinese investment occur and highlight how the unique historical traditions and domestic politics of each case-study country influenced these political divisions. Understanding national tensions surrounding the topic of Chinese investments is critical not only for Chinese investors but also for national policymakers and other foreign investors. The EU can only unify its collective policies once each country comprehends its own internal struggles and member states understand the root of their division

SWEET AND SOUR INVESTMENT: A Sentiment Analysis of Chinese Investment in Europe

Media reports and political rhetoric widely claim that Chinese Foreign Direct Investment (FDI) has politically impacted Europe, causing various countries to disagree over the consequences of Chinese investments for national security and the desirability of screening mechanisms to vet incoming investments. Given this phenomenon at the international level, Chinese investments may be dividing the European public at the sub-national level as well. This thesis investigates how Chinese foreign investments have impacted national politics since their first substantial presence in Europe after the 2008 Financial Crisis. The work employs large-scale computer-automated sentiment analysis of newspaper articles to discover the relationship between public opinion toward Chinese investments and the levels of Chinese investment in European countries over the last decade – a relationship yet to be explored. After presenting some background on the evolution of Chinese direct investment both worldwide and specifically in Europe, I propose three hypotheses representing the current scholarly research on the political tensions induced by foreign investment: 1) The Traditional Political hypothesis places the debate between free markets and labor rights at the center of Chinese investment’s political divisiveness 2) The Globalism hypothesis focuses on issues of international growth, in competition with nationalism, as the main political wedge regarding Chinese investments 3) The Null Constant hypothesis posits that no relationship exists between public sentiment toward Chinese investments and the volume of investment. In order to test these hypotheses, I first developed a computer program to web-scrape national European newspapers and created an original dataset, which could potentially be used by other scholars. I then conducted sentiment analysis on every article within this dataset, in the original language of the text, to quantitatively track public opinion towards Chinese investment from 2008 to 2019 for various permutations of nationality and political leaning. Through a correlation analysis of Chinese investment levels and sentiment toward Chinese investments as found in national newspapers, this thesis finds unique political circumstances in each nation. A further factor analysis identified the principal components of each newspaper allowing me to identify the central discussion surrounding Chinese investments in each country. In France, the conservatives favored Chinese investments, focusing the discussion on the benefits of a free market, while liberals proved less inclined toward Chinese investments, directing their complaints toward abuses of labor rights. In Germany, the liberals favored Chinese investments more, centering their reporting around the benefits of international growth and cooperation, while German conservatives favored Chinese investments less, arguing for increased national protection from foreigners. Dutch political attitudes towards Chinese investment failed to exhibit any change over the last ten years on either side of the political spectrum, due to a long history of the Netherlands welcoming foreign investment. These results show the nuanced conditions under which national divisions toward Chinese investment occur and highlight how the unique historical traditions and domestic politics of each case-study country influenced these political divisions. Understanding national tensions surrounding the topic of Chinese investments is critical not only for Chinese investors but also for national policymakers and other foreign investors. The EU can only unify its collective policies once each country comprehends its own internal struggles and member states understand the root of their division

SWEET AND SOUR INVESTMENT: A Sentiment Analysis of Chinese Investment in Europe

Media reports and political rhetoric widely claim that Chinese Foreign Direct Investment (FDI) has politically impacted Europe, causing various countries to disagree over the consequences of Chinese investments for national security and the desirability of screening mechanisms to vet incoming investments. Given this phenomenon at the international level, Chinese investments may be dividing the European public at the sub-national level as well. This thesis investigates how Chinese foreign investments have impacted national politics since their first substantial presence in Europe after the 2008 Financial Crisis. The work employs large-scale computer-automated sentiment analysis of newspaper articles to discover the relationship between public opinion toward Chinese investments and the levels of Chinese investment in European countries over the last decade – a relationship yet to be explored. After presenting some background on the evolution of Chinese direct investment both worldwide and specifically in Europe, I propose three hypotheses representing the current scholarly research on the political tensions induced by foreign investment: 1) The Traditional Political hypothesis places the debate between free markets and labor rights at the center of Chinese investment’s political divisiveness 2) The Globalism hypothesis focuses on issues of international growth, in competition with nationalism, as the main political wedge regarding Chinese investments 3) The Null Constant hypothesis posits that no relationship exists between public sentiment toward Chinese investments and the volume of investment. In order to test these hypotheses, I first developed a computer program to web-scrape national European newspapers and created an original dataset, which could potentially be used by other scholars. I then conducted sentiment analysis on every article within this dataset, in the original language of the text, to quantitatively track public opinion towards Chinese investment from 2008 to 2019 for various permutations of nationality and political leaning. Through a correlation analysis of Chinese investment levels and sentiment toward Chinese investments as found in national newspapers, this thesis finds unique political circumstances in each nation. A further factor analysis identified the principal components of each newspaper allowing me to identify the central discussion surrounding Chinese investments in each country. In France, the conservatives favored Chinese investments, focusing the discussion on the benefits of a free market, while liberals proved less inclined toward Chinese investments, directing their complaints toward abuses of labor rights. In Germany, the liberals favored Chinese investments more, centering their reporting around the benefits of international growth and cooperation, while German conservatives favored Chinese investments less, arguing for increased national protection from foreigners. Dutch political attitudes towards Chinese investment failed to exhibit any change over the last ten years on either side of the political spectrum, due to a long history of the Netherlands welcoming foreign investment. These results show the nuanced conditions under which national divisions toward Chinese investment occur and highlight how the unique historical traditions and domestic politics of each case-study country influenced these political divisions. Understanding national tensions surrounding the topic of Chinese investments is critical not only for Chinese investors but also for national policymakers and other foreign investors. The EU can only unify its collective policies once each country comprehends its own internal struggles and member states understand the root of their division