Agricultural protection in OECD countries: its cost to less-developed countries

Farm produce., Food supply., Organisation for Economic Co-operation and Development., Commercial policy.,

Impact of type of oral anticoagulants in patients with cerebral microbleeds after atrial fibrillation-related ischemic stroke or TIA: Results of the NOACISP-LONGTERM registry.

Background Cerebral microbleeds (CMBs) may have a differential impact on clinical outcome in stroke patients with atrial fibrillation (AF) treated with different types of oral anticoagulation (OAC). Methods Observational single-center study on AF-stroke-patients treated with OAC. Magnetic-resonance-imaging was performed to assess CMBs. Outcome measures consisted of recurrent ischemic stroke (IS), intracranial hemorrhage (ICH), death, and their combined analysis. Functional disability was assessed by mRS. Using adjusted logistic regression and Cox proportional-hazards models, we assessed the association of the presence of CMBs and OAC type (vitamin K antagonists [VKAs] vs. direct oral anticoagulants [DOACs]) with clinical outcome. Results Of 310 AF-stroke patients treated with OAC [DOACs: n = 234 (75%); VKAs: n = 76 (25%)], CMBs were present in 86 (28%) patients; of these, 66 (77%) received DOACs. In both groups, CMBs were associated with an increased risk for the composite outcome: VKAs: HR 3.654 [1.614; 8.277]; p = 0.002; DOACs: HR 2.230 [1.233; 4.034]; p = 0.008. Patients with CMBs had ~50% higher absolute rates of the composite outcome compared to the overall cohort, with a comparable ratio between treatment groups [VKAs 13/20(65%) vs. DOACs 19/66(29%); p < 0.01]. The VKA-group had a 2-fold higher IS [VKAs:4 (20%) vs. DOACs:6 (9%); p = 0.35] and a 10-fold higher ICH rate [VKAs: 3 (15%) vs. DOACs: 1 (1.5%); p = 0.038]. No significant interaction was observed between type of OAC and presence of CMBs. DOAC-patients showed a significantly better functional outcome (OR 0.40 [0.17; 0.94]; p = 0.04). Conclusions In AF-stroke patients treated with OAC, the presence of CMBs was associated with an unfavorable composite outcome for both VKAs and DOACs, with a higher risk for recurrent IS than for ICH. Strokes were numerically higher under VKAs and increased in the presence of CMBs. Clinical trial registration http://www.clinicaltrials.gov, Unique identifier: NCT03826927

Global Cortical Atrophy Is Associated with an Unfavorable Outcome in Stroke Patients on Oral Anticoagulation.

INTRODUCTION Measures of cerebral small vessel disease (cSVD), such as white matter hyperintensities (WMH) and cerebral microbleeds (CMB), are associated with an unfavorable clinical course in stroke patients on oral anticoagulation (OAC) for atrial fibrillation (AF). Here, we investigated whether similar findings can be observed for global cortical atrophy (GCA). METHODS Registry-based prospective observational study of 320 patients treated with OAC following AF stroke. Patients underwent magnetic resonance imaging (MRI) allowing assessment of GCA. Using the simplified visual Pasquier scale, the severity of GCA was categorized as follows: 0: no atrophy, 1: mild atrophy; 2: moderate atrophy, and 3: severe atrophy. Using adjusted logistic and Cox regression analysis, we investigated the association of GCA using a composite outcome measure, comprising: (i) recurrent acute ischemic stroke (IS); (ii) intracranial hemorrhage (ICH); and (iii) death. RESULTS In our time to event analysis after adjusting for potential confounders (i.e., WMH, CMB, age, sex, diabetes, arterial hypertension, coronary heart disease, hyperlipidemia, and antiplatelet use), GCA was associated with an increased risk for the composite outcome in all three degrees of atrophy (grade 1: aHR 3.95, 95% CI 1.34-11.63, p = 0.013; grade 2: aHR 3.89, 95% CI 1.23-12.30, p = 0.021; grade 3: aHR 4.16, 95% CI 1.17-14.84, p = 0.028). CONCLUSION GCA was associated with our composite outcome also after adjusting for other cSVD markers (i.e., CMB, WMH) and age, indicating that GCA may potentially serve as a prognostic marker for stroke patients with atrial fibrillation on oral anticoagulation

The impact of competing stroke etiologies in patients with atrial fibrillation.

BACKGROUND Data on the impact of competing stroke etiologies in stroke patients with atrial fibrillation (AF) are scarce. METHODS We used prospectively obtained data from an observational registry (Novel-Oral-Anticoagulants-in-Ischemic-Stroke-Patients-(NOACISP)-LONGTERM) of consecutive AF-stroke patients treated with oral anticoagulants. We compared the frequency of (i) the composite outcome of recurrent ischemic stroke (IS), intracerebral hemorrhage (ICH) or all-cause death as well as (ii) recurrent IS alone among AF-stroke patients with versus without competing stroke etiologies according to the TOAST classification. We performed cox proportional hazards regression modeling adjusted for potential confounders. Furthermore, the etiology of recurrent IS was assessed. RESULTS Among 907 patients (median age 81, 45.6% female), 184 patients (20.3%) had competing etiologies, while 723 (79.7%) had cardioembolism as the only plausible etiology. During 1587 patient-years of follow-up, patients with additional large-artery atherosclerosis had higher rates of the composite outcome (adjusted HR [95% CI] 1.64 [1.11, 2.40], p = 0.017) and recurrent IS (aHR 2.96 [1.65, 5.35 ], p < 0.001), compared to patients with cardioembolism as the only plausible etiology. Overall 71 patients had recurrent IS (7.8%) of whom 26.7% had a different etiology than the index IS with large-artery-atherosclerosis (19.7%) being the most common non-cardioembolic cause. CONCLUSION In stroke patients with AF, causes other than cardioembolism as competing etiologies were common in index or recurrent IS. Concomitant presence of large-artery-atherosclerosis seems to indicate an increased risk for recurrences suggesting that stroke preventive means might be more effective if they also address competing stroke etiologies in AF-stroke patients. CLINICAL TRIAL REGISTRATION NCT03826927

Agricultural Protection in OECD Countries: Its Cost to Less-Developed Countries

Many less-developed countries (LDCs) are finding it increasingly difficult to obtain the foreign exchange to pay for growing imports of basic food staples as well as the capital goods and raw materials necessary for their growth and modernization. Agricultural performance particularly is affected by a country’s capacity to import fertilizers and other agricultural inputs. Traditionally agriculture for developing countries and is a logical place to turn for increased earnings. The extent to which agricultural exports can be increased affects the patterns of output growth as well as the allocations of resources to crop-specific research and other inputs. In addition, increasing agricultural exports can lead to an increase in the level of income and employment among low-income families in LDCs. This study examines the effect a reduction in agricultural trade restrictions of selected OECD countries would have on the export earning and import expenditures of developing countries. It indicates the minimum effect a 50 percent reduction in the trade barriers of 99 commodities would have on export revenues and import expenditures as well as how agricultural production in the LDCs would be generally affected. This is not the first trade-oriented study undertaken by IFPRI. Although the bulk if IFPRI’s research focuses on areas of study related to improved domestic policy in the LDCs, occasionally background information is needed on developed country-policies that so strongly affect those of LDCs. IFPRI has commissioned studies on the effects of developed-country policies on the food security of LDCs and on the future course of grain imports by the Soviet Union in an effort to accumulate such information. These studies interacted with IFPRI’s work on production trade-offs between food crops for domestic consumption and export. Other international organizations share IFPRI’s concern with these important issues. In July 1978 the FOOD and Agriculture Organization of the United Nations asked IFPRI to further develop its earlier model for trade analysis and to provide estimates of the effect of OECD trade reductions for its Agriculture Towards 2000 study. This report is an expansion and refinement of that effort. The findings of the Valdes and Zietz research are clear. A major reduction in trade restrictions on agricultural commodities by the OCED countries would provide substantial additional foreign exchange earnings to less-developed countries; in fact, earning that are slightly larger than current foreign aid flow to agricultural development. In addition, the resulting expansion of production in LDCs would raise the level of income and employment in agriculture in developing countries. Although reduction of trade barriers by the Soviet bloc was not analyzed, undoubtedly it would add to the benefits. The policy implications or this research are complex at best. Although developing countries would realize substantial benefits, an amount equivalent to two thirds of all the developing-country increment in export revenues is concentrated in three developed countries: the United States, Canada, and Australia. Theses positions change substantially if a few temperate-latitude comities are removed from the list of selected goods, but that would affect the benefits to the developing countries as well. Furthermore, the bulk of the import adjustment falls on four development countries. Three are members of the European Community, with a major share of this adjustment arising from trade within the community. In view of the research results, future IFPRI research will emphasize potential for selective reduction in trade restrictions by OECD countries and the rapidly rising potential for intra-Third World Trade. It is notable that while such trade has in the past accounted for only one quarter of total developing-country trade, today it is growing, dynamic, and has great potential. IFPRI is commencing its research on this issue with in-depth analyses of selected cases and will carry it out to implications for the agricultural production patterns and resource allocations of the less-developed countries. A final note. The developing countries’ share a world trade is declining in some agricultural commodities. This suggests that they are problems of trade restrictions. Some of these result from the increase in domestic demand that accompanies economic growth. Some are due to difficult production and trade policy problems. Future IFPRI research is expected to shed light on these complex policy issues

An Unobserved Components Forecasting Model of Non-Farm Employment for the Nashville MSA

The study demonstrates how unobserved component modeling, also known as structural time series modeling, can be usefully applied to forecast non-farm employment for the Nash-ville MSA. Short-term out-of-sample forecasts are provided for total employment and its three components: services, construction, and manufacturing. The forecasts are compared to those of a simple vector autoregression. It is shown that the suggested methodology provides very ac-curate short-term forecasts even in the absence of a full set of independent regressors. In addition, it makes it possible to back out long-term trends, which aid the forecaster in making long-term projections of sectoral employment

Determinants of House Prices: A Quantile Regression Approach

Hedonic price function, Quantile regression, Spatial lag, R31, C21, C29,

Oral Anticoagulants in Atrial Fibrillation Patients With Recent Stroke Who Are Dependent on the Daily Help of Others.

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