The eclipse of the goal of zero inflation

William J. Barber's study of Alvin H. Hansen (1887-1975) emphasized the importance of the intellectual transformation that led to the "'Keynes-Hansen intellectual system that appeared to have compelling diagnostic and prescriptive power" (Barber 19X7. 205).1 Between 1936 and 1938, Hansen became a convert to Keynesian economics, and this led to the Hicks-Hansen IS-LM model. Subsequent authors (including Phillips in the 1950s) concluded that this approach, being an equilibrium model, did not capture the disequilibrium "essence" of Keynes (Lipsey 19X I, 547). The purpose of this article is to highlight a second intellectual transformation in Hansen's policy advocacy, and to suggest the possibility that, once again, Hansen contributed to a Keynesian economics that was in conflict with Keynes's stated position. I will also discuss a parallel transformation in the policy advocacy of Sumner H. Slichter ( 1892-1959), who was, like Hansen, a Harvard University professor

Cluster-based ensemble means for climate model intercomparison

Clustering – the automated grouping of similar data – can provide powerful and unique insight into large and complex data sets, in a fast and computationally efficient manner. While clustering has been used in a variety of fields (from medical image processing to economics), its application within atmospheric science has been fairly limited to date, and the potential benefits of the application of advanced clustering techniques to climate data (both model output and observations) has yet to be fully realised. In this paper, we explore the specific application of clustering to a multi-model climate ensemble. We hypothesise that clustering techniques can provide (a) a flexible, data-driven method of testing model–observation agreement and (b) a mechanism with which to identify model development priorities. We focus our analysis on chemistry–climate model (CCM) output of tropospheric ozone – an important greenhouse gas – from the recent Atmospheric Chemistry and Climate Model Intercomparison Project (ACCMIP). Tropospheric column ozone from the ACCMIP ensemble was clustered using the Data Density based Clustering (DDC) algorithm. We find that a multi-model mean (MMM) calculated using members of the most-populous cluster identified at each location offers a reduction of up to  ∼  20 % in the global absolute mean bias between the MMM and an observed satellite-based tropospheric ozone climatology, with respect to a simple, all-model MMM. On a spatial basis, the bias is reduced at  ∼  62 % of all locations, with the largest bias reductions occurring in the Northern Hemisphere – where ozone concentrations are relatively large. However, the bias is unchanged at 9 % of all locations and increases at 29 %, particularly in the Southern Hemisphere. The latter demonstrates that although cluster-based subsampling acts to remove outlier model data, such data may in fact be closer to observed values in some locations. We further demonstrate that clustering can provide a viable and useful framework in which to assess and visualise model spread, offering insight into geographical areas of agreement among models and a measure of diversity across an ensemble. Finally, we discuss caveats of the clustering techniques and note that while we have focused on tropospheric ozone, the principles underlying the cluster-based MMMs are applicable to other prognostic variables from climate models

Concentric left ventricular remodeling and aortic stiffness: A comparison of obesity and hypertension

Licensed under the Creative Commons Attribution Non-Commercial No Derivatives Licens

Real world hospital costs following stress echocardiography in the UK: a costing study from the EVAREST/BSE-NSTEP multi-centre study

Background - Stress echocardiography is widely used to detect coronary artery disease, but little evidence on downstream hospital costs in real-world practice is available. We examined how stress echocardiography accuracy and downstream hospital costs vary across NHS hospitals and identified key factors that affect costs to help inform future clinical planning and guidelines. Methods - Data on 7636 patients recruited from 31 NHS hospitals within the UK between 2014 and 2020 as part of EVAREST/BSE-NSTEP clinical study, were used. Data included all diagnostic tests, procedures, and hospital admissions for 12 months after a stress echocardiogram and were costed using the NHS national unit costs. A decision tree was built to illustrate the clinical pathway and estimate average downstream hospital costs. Multi-level regression analysis was performed to identify variation in accuracy and costs at both patient, procedural, and hospital level. Linear regression and extrapolation were used to estimate annual hospital cost-savings associated with increasing predictive accuracy at hospital and national level. Results – Stress echocardiography accuracy varied with patient, hospital and operator characteristics. Hypertension, presence of wall motion abnormalities andhigher number of hospital cardiology outpatient attendances annually reduced accuracy, adjusted odds ratio of 0.78 (95% CI: 0.65 to 0.93), 0.27 (95% CI: 0.15 to 0.48), 0.99 (95% CI: 0.98 to 0.99) respectively, whereas a prior myocardial infarction, angiotensin receptor blocker medication, and greater operator experience increased accuracy, adjusted odds ratio of 1.77 (95% CI: 1.34 to 2.33), 1.64 (95% CI: 1.22 to 2.22), and 1.06 (95% CI: 1.02 to 1.09) respectively. Average downstream costs were £646 per patient (SD 1796) with significant variation across hospitals. The average downstream costs between the 31 hospitals varied from £384-1730 per patient. False positive and false negative tests were associated with average downstream costs of £1446 (SD £601) and £4192 (SD 3332) respectively, driven by increased non-elective hospital admissions, adjusted odds ratio 2.48 (95% CI: 1.08 to 5.66), 21.06 (95% CI: 10.41 to 42.59) respectively. We estimated that an increase in accuracy by 1 percentage point could save the NHS in the UK £3.2 million annually. Conclusion – This study provides real-world evidence of downstream costs associated with stress echocardiography practice in the UK and estimates how improvements in accuracy could impact healthcare expenditure in the NHS. A real-world downstream costing approach could be adopted more widely in evaluation of imaging tests and interventions to reflect actual value for money and support realistic planning

Obese Subjects Show Sex-Specific Differences in Right Ventricular Hypertrophy

As right ventricular (RV) remodeling in obesity remains underinvestigated, and the impact of left ventricular (LV) diastolic dysfunction on RV hypertrophy is unknown, we aimed to investigate whether (1) sex-specific patterns of RV remodeling exist in obesity and (2) LV diastolic dysfunction in obesity is related to RV hypertrophy.Seven hundred thirty-nine subjects (women, n=345; men, n=394) without identifiable cardiovascular risk factors (body mass index [BMI], 15.3-59.2 kg/m2) underwent cardiovascular magnetic resonance (1.5 T) to measure RV mass (g), RV end-diastolic volume (mL), RV mass/volume ratio, and LV diastolic peak filling rate (mL/s). All subjects were normotensive (average, 119±11/73±8 mm Hg), normoglycaemic (4.8±0.5 mmol/L), and normocholesterolaemic (4.8±0.9 mmol/L) at the time of scanning. Across both sexes, there was a moderately strong positive correlation between BMI and RV mass (men, +0.8 g per BMI point increase; women, +1.0 g per BMI point increase; both P<0.001). Whereas women exhibited RV cavity dilatation (RV end-diastolic volume, +1.0 mL per BMI point increase; P<0.001), BMI was not correlated with RV end-diastolic volume in men (R=0.04; P=0.51). Concentric RV remodeling was present in both sexes, with RV mass/volume ratio being positively correlated to BMI (men, R=0.41; women, R=0.51; both P<0.001). Irrespective of sex, the LV peak filling rate was negatively correlated with both RV mass (men, R=-0.43; women, R=-0.44; both P<0.001) and RV mass/volume ratio (men, R=-0.37; women, R=-0.35; both P<0.001).A sex difference in RV remodeling exists in obesity. Whereas men exhibit concentric RV remodeling, women exhibit a mixed pattern of eccentric and concentric remodeling. Regardless of sex, reduced LV diastolic function is associated with concentric RV remodeling

A meta-synthesis of qualitative data exploring the experience of living with temporomandibular disorders: The patients' voice

Objective: The aim of this review was to systematically review the qualitative evidence related to the experience of patients with temporomandibular disorder (TMD) and to explore the effect it has on their lives. Materials and methods: The following databases were searched systemically: Medline, Embase, PsycINFO, Web of Science, CINAHL Complete and the Cochrane database. Thematic synthesis was used to analyse and synthesise the data from the qualitative studies which explored the experience of adult patients with TMD. The Critical Appraisal Skills Programme (CASP) tool was used to critically appraise the quality of the included studies. Results: The search strategies yielded 3588 articles across all databases. A total of 20 articles were eventually included. Six themes were derived: TMD causes uncertainty and doubt, TMD had disruptive effects on life, TMD causes distress, understanding TMD—the illness and the causes, dealing with the pain and aims and hopes. Conclusion: The findings highlight the impact TMD could have on the quality of life and confirms the psychological and social challenges these patients experience

Neurohumoral and ambulatory haemodynamic adaptations following isometric exercise training in unmedicated hypertensive patients

Objective: Hypertension remains the leading modifiable risk factor for cardiovascular disease (CVD). Isometric exercise training (IET) has been shown to be a useful non-pharmacological intervention for reducing resting blood pressure (BP). This study aimed to measure alterations in office BP, ambulatory BP, cardiac autonomic modulation and inflammatory and vascular biomarkers following a programme of IET in unmedicated hypertensive patients. Methods: Twenty-four unmedicated stage 1 hypertensive patients (age 43.8±7.3 years; height, 178.1±7 cm; weight 89.7±12.8 kg) were randomly assigned in a cross-over study design, to 4-weeks of home based IET and control period, separated by a 3-week washout period. Office and Ambulatory BP, cardiac autonomic modulation, and inflammatory and vascular biomarkers were recorded pre and post IET and control periods. Results: Clinic and 24-hour ambulatory BP significantly reduced following IET by 12.4/6.2 mmHg and 11.8/5.6 mmHg in systolic/diastolic BP, respectively (p<0.001 for both), compared to the control. The BP adaptations were associated with a significant (p=0.018) reduction in the average real variability of 24-hour ambulatory BP following IET, compared to control. Cardiac autonomic modulation improved by 11% (p<0.001), baroreceptor reflex sensitivity improved by 47% (p<0.001), and interleukin-6 and asymmetric dimethylarginine reduced by 10% (p=0.022) and 19% (p=0.023), respectively, which differed significantly to the control period. Conclusion: This is the first evidence of durable BP reduction and wider CVD risk benefits of IET in a relevant patient population. Our findings support the role of IET as a safe and viable therapeutic and preventative intervention in the treatment of HTN

Nitrogen deposition does not enhance Sphagnum decomposition

Long-term additions of nitrogen (N) to peatlands have altered bryophyte growth, species dominance, N content in peat and peat water, and often resulted in enhanced Sphagnum decomposition rate. However, these results have mainly been derived from experiments in which N was applied as ammonium nitrate (NH4NO3), neglecting the fact that in polluted areas, wet deposition may be dominated either by NO3- or NH4+. We studied effects of elevated wet deposition of NO3- vs. NH4+ alone (8 or 56 kg N ha(-1) yr(-1) over and above the background of 8 kg N ha(-1) yr(-1) for 5 to 11 years) or combined with phosphorus (P) and potassium (K) on Sphagnum quality for decomposers, mass loss, and associated changes in hummock pore water in an ombrotrophic bog (Whim). Adding N, especially as NH4+, increased N concentration in Sphagnum, but did not enhance mass loss from Sphagnum. Mass loss seemed to depend mainly on moss species and climatic factors. Only high applications of N affected hummock pore water chemistry, which varied considerably over time. Overall, C and N cycling in this N treated bog appeared to be decoupled. We conclude that moss species, seasonal and annual variation in climatic factors, direct negative effects of N (NH4+ toxicity) on Sphagnum production, and indirect effects (increase in pH and changes in plant species dominance under elevated NO3- alone and with PK) drive Sphagnum decomposition and hummock C and N dynamics at Whim. (C) 2016 Elsevier B.V. All rights reserved.Peer reviewe