Predetermined Variables Research Articles

Trends in obstetric management of extreme preterm birth at 23 to 27 weeks’ gestation in a tertiary obstetric unit: A 10-year retrospective review

ObjectiveTo evaluate maternal and perinatal outcomes in deliveries from 23 + 0 to 26 + 6 weeks gestation in a tertiary hospital. Study DesignA 10-year retrospective analysis was performed which included all women who delivered between 23 + 0 and 26 + 6 weeks gestation in a tertiary obstetric unit from 01/01/2007 to 31/12/2017 inclusive. Data were collected from electronic patient records and individual chart reviews using predetermined variables. Results340 women and 402 infants were included. 84 % (282/340) were singleton pregnancy and 17 % (59/340) had multiple pregnancies. 36.8 % (125/340) of women were delivered by Caesarean section, 11.2 % (14/125) had a classical caesarean section.The leading indications for delivery were preterm premature ruptured membranes (PPROM) 28.2 % (96/340), 8.5 % (29/340) severe pre-eclampsia (PET) and 5.6 % (19/340) were delivered for suspected placental abruption. Of all infants (N = 402), 18.9 % (76/402) were stillborn. 300 infants were admitted to the Neonatal Intensive Care Unit (NICU). The NICU survival to discharge rate was 83.7 % (251/300). The overall perinatal mortality rate (PNMR) was 328.4/1000 and a further late neonatal mortality of 47.3/1000 births. Notably, at the 23 week gestation NNDs are the major contributor to the PNMR and at later gestations stillbirths are the largest contributor. ConclusionPregnant women delivering at extreme preterm gestations are at risk of maternal morbidity. Their infants have high rates of serious morbidity and mortality, with all survivors in this cohort affected by neonatal morbidity. Informed decision-making by providers and parents requires evidence based information on perceived outcomes, ideally individualized to the mother and pregnancy in question. Information from this retrospective cohort study can be used to counsel women and their families on potential morbidity and mortality and to manage expectations.

Identifying Modern Macro Equations with Old Shocks*

Abstract Despite decades of research, the consistent estimation of structural forward-looking macroeconomic equations remains a formidable empirical challenge because of pervasive endogeneity issues. Prominent cases—the estimation of Phillips curves, Euler equations, or monetary policy rules—have typically relied on using predetermined variables as instruments, with mixed success. In this work, we propose a new approach that consists in using sequences of independently identified structural shocks as instrumental variables. Our approach is robust to weak instruments and is valid regardless of the shocks’ variance contribution. We estimate a Phillips curve using monetary shocks as instruments and find that conventional methods substantially underestimate the slope of the Phillips curve.

Patient race, ethnicity, and care in the emergency department: A scoping review.

Health disparities between racial and ethnic groups have been documented in Canada, the United States, and Australia. Despite evidence that differences in emergency department (ED) care based on patient race and ethnicity exist, there are no comprehensive literature reviews in this area. The objective of this review is to provide an overview of the literature on the impact of patient ethnicity and race on the processes of ED care. A scoping review was conducted to capture the broad nature of the literature. A database search was conducted in MEDLINE/PubMed, EMBASE, CINAHL Plus, Social Sciences Citation Index, SCOPUS, and JSTOR. Five journals and reference lists of included articles were hand searched. Inclusion and exclusion criteria were defined iteratively to ensure literature captured was relevant to our research question. Data were extracted using predetermined variables, and additional extraction variables were added as familiarity with the literature developed. Searching yielded 1,157 citations, reduced to 153 following removal of duplicates, and title and abstract screening. After full-text screening, 83 articles were included. Included articles report that, in EDs, patient race and ethnicity impact analgesia, triage scores, wait times, treatments, diagnostic procedure utilization, rates of patients leaving without being seen, and patient subjective experiences. Authors of included studies propose a variety of possible causes for these disparities. Further research on the existence of disparities in care within EDs is warranted to explore the causes behind observed disparities for particular health conditions and population groups in specific contexts.

An Overview of Lung and Breast Cancer Using the National Cancer Database.

Introduction:The National Cancer Database (NCDB) is a clinical oncology database utilized by many researchers and clinicians internationally. We sought to investigate the various trends in data of two of the most common cancers, breast and lung, published using the NCDB. Materials and Methods:We selected a multitude of pre-determined variables for analysis. We then performed two separate literature searches using an advanced PubMed search builder, and the data was combined to determine each variables’ association with journal impact factor (IF) using both univariate and multivariate analyses. Results:A total of 191 published studies were identified. We found that a journal IF > 5 was associated with a publication year prior to 2017 (univariate analysis OR 2.68, 95% CI 1.38-5.21, p-value 0.004 and multivariate analysis OR 3.47, 95% CI 1.62-7.42, p-value 0.001) and a sample size > 10,000 (univariate analysis OR 3.27, 95% CI 1.43-7.50, p-value 0.005 and multivariate analysis OR 4.68, 95% CI 1.89-11.6, p-value 0.0008). Variables such as number of authors, region, cancer type, stage, treatment outcome and treatment incidence were not significant for an association with an IF >5. Conclusion:Based on our data, studies published after 2017 using the NCDB were associated with a lower IF. This could suggest that the quality of the NCDB data may be declining over time, or NCDB is becoming more widely used.

Investigation of the Structural Relationship among Factors That Affect Digital Reading

The purpose of the study was to examine the structural relationship among factors that affect digital reading. PISA DRA data was analyzed to reveal 1) what factors (e.g., ICT factors, attitude, and navigation indices) affect Korean students’digital reading assessment scores in PISA DRA?; 2) What structural relationships are identified among factors (e.g., ICT factors, attitude and navigation indices)?. According to the research results, all three factors (ICT usage, positive attitude, navigation index) impact DRA achievement. When ranking the most influential variable, navigation index (.46) scored the highest followed by ICT usage at home for school (.22) and then positive attitude toward ICT (.10). Out of the pre-determined variables that affect digital reading achievement, navigation index showed to have the greatest impact. Following navigation, the next most influential factor affecting digital reading achievement was ICT usage at home for school. Since ICT usage is related to digital reading familiarity, an attempt was made to observe the direct and indirect effects of how ICT usage variables influence a student’s digital reading achievement. In summary, we empirically discovered that ICT usage, attitude toward ICT, webpage navigation and digital reading achievement are interconnected each other. Also, attitude toward ICT mediates between ICT usage and webpage navigation skills. Additionally, webpage navigation skills mediate between a positive attitude toward ICT and digital reading achievement. Based on these empirical evidences, a deliberate and thoughtful educational approach and policy should be made so to enhance students’ digital reading competencies.

Methotrexate exposure and risk of strongyloidiasis.

Rheumatologic disease patients receiving immunomodulating drugs such as methotrexate (MTX) have increased infection rates. Strongyloides, a global endemic intestinal parasite, can cause significant or fatal disease in immunocompromised patients. The risk of serious Strongyloides infection with MTX dosed for rheumatologic disease is unknown. We performed a systematic literature review searching EMBASE, Medline and Web of Science databases. All studies reporting humans exposed to MTX and tested for Strongyloides were reviewed. Exclusion criteria were bone marrow transplantation, intrathecal route and MTX exposure completed >1year prior to clinically apparent Strongyloides disease. After excluding duplicates, 294 articles were reviewed. Of these, 29 cases were described in 27 papers. Twenty cases (69%) had an underlying rheumatologic or dermatologic disease, the rest had a haematologic disease. Hyperinfection or dissemination was found in 59% of cases (52% low-dose MTX; 75% high-dose MTX). Death occurred in 34% of cases (19% low-dose MTX; 75% high-dose MTX, P<0.01). All eight patients on high-dose MTX received other immunosuppressants. Corticosteroids were taken in 18/21 patients on low-dose MTX. One of the three patients on MTX monotherapy had hyperinfection syndrome. None had disseminated Strongyloides. Serious Strongyloides infection can occur with low-dose MTX particularly when given with other immunosuppression. Global travel and greater awareness of rheumatologic conditions in low- to middle-income countries will increase the exposure of individuals prescribed MTX (with or without corticosteroids) to Strongyloides. Strongyloides screening and treatment should be considered for individuals receiving low-dose MTX therapy, particularly if combined with additional immunosuppression.

Optimization of the process variables of roller compaction, on the basis of granules characteristics (flow, mechanical strength, and disintegration behavior): an application of SeDeM-ODT expert system

The objective of the study was application of SeDeM-ODT expert system for optimization of process variables for roller compaction and for the preparation of granules with better flow, compressibility, and disintegration behavior. In the present study, granules were prepared at pre-determined (on the basis of factorial design) process variables and characterized using SeDeM-ODT expert system. Compatibility of ribavirin with excipients (microcrystalline cellulose, tablettose-80, cross carmellose sodium, and magnesium stearate) was evaluated by binary mixture approach, using FTIR. According to the SeDeM-ODT expert system, granules were characterized for various parameters related to flow, compressibility and disintegration behavior and Index of Good Compressibility and Buccodispersibility (IGCB) was calculated. The process variables resulting in highest IGCB value were considered as optimum. Ribavirin was found compatible with all the excipients used in the study and characteristics peaks were present in FTIR spectra after subjecting to stress conditions (75% relative humidity at 45 ± 5 °C) for 30 days. Both Ribavirin powder and Ribavirin containing powder blend had poor flow and compressibility while disintegration behavior was good due to higher water solubility. Screw speed of 35 rpm and roller speed at 12 rpm resulted in granules with acceptable characteristics. The IGCB value (5.63) of the granules was highest of all, indicating its better characteristics. SeDeM-ODT expert system presents a more practical picture of the granules and also predicts the mechanical strength and disintegration behavior of the tablets prepared from the granules. By proper optimization of screw and roller speed, efficiency of the process can be improved.

Reconciling heterogeneous results on the returns to skills in Africa

ABSTRACT Recent evidence indicates substantial heterogeneity in the returns to skills across countries, but only a few studies have explained the varying patterns in the return to skills. Using the 2013 STEP data for Ghana and Kenya, we estimate the causal effect of cognitive and noncognitive skills on a large set of labour market outcomes by controlling for important predetermined variables. We find that cognitive skill remains an important predictor of labour market outcomes but its effect is largely mediated by the year of schooling. We document that the labour market effects of noncognitive skills are smaller than reading proficiency, but with large variation across labour market outcomes. Interestingly, we show that schooling does not mediate the effect of noncognitive skills, meaning most of these skills are acquired outside the classroom. A decomposition analysis shows that local labour market characteristics, such as formal jobs and skilled labour demand, explains the lion share of the heterogeneity whereas the job-skill matching quality plays a significant role in the unexplained part.

High-Dimensional Sparse Financial Networks Through a Regularised Regression Model

We propose a shrinkage and selection methodology specifically designed for network inference using high dimensional data through a regularised linear regression model with Spike-and-Slab prior on the parameters. The approach extends the case where the error terms are heteroscedastic, by adding an ARCH-type equation through an approximate Expectation-Maximisation algorithm. The proposed model accounts for two sets of covariates. The first set contains predetermined variables which are not penalised in the model (i.e., the autoregressive component and common factors) while the second set of variables contains all the (lagged) financial institutions in the system, included with a given probability. The financial linkages are expressed in terms of inclusion probabilities resulting in a weighted directed network where the adjacency matrix is built “row by row. In the empirical application, we estimate the network over time using a rolling window approach on 1248 world financial firms (banks, insurances, brokers and other financial services) both active and dead from 29 December 2000 to 6 October 2017 at a weekly frequency. Findings show that over time the shape of the out degree distribution exhibits the typical behavior of financial stress indicators and represents a significant predictor of market returns at the first lag (one week) and the fourth lag (one month).

Seroprevalence of canine Leishmania infantum infection in the Mediterranean region and identification of risk factors: The example of North-Eastern and Pyrenean areas of Spain

The Mediterranean basin is an endemic region for canine leishmaniosis (CanL), where it represents a major veterinary problem and raises human health concerns. However, the distribution of the disease is heterogeneous and not all countries and locations have been equally studied and characterized. This work describes the situation of CanL in Girona province (Catalonia, Spain), for which no data has been previously reported, and presents a relevant study to exemplify other areas with similar characteristics across the region. Four cross-sectional seroprevalence surveys were performed from 2012 to 2016 throughout the province, including 36 sampling stations in 26 localities and a total of 593 dogs. For each animal, individual and location variables were also collected. Additionally, each dog owner answered a questionnaire about their knowledge of CanL and preventive methods used. Blood samples were analysed by an in-house ELISA and a mixed logistic regression model was used to assess the relationship between pre-determined variables and dog seropositivity. A Spearman’s correlation was used to assess the association between dog owners’ perceived risk of CanL and Leishmania infantum seropositivity in dogs at a given location. The overall true seroprevalence estimated for Girona province was 19.5% (95%CI: 15.5–23.5), of which only 6.8% (10/146) were considered symptomatic. Age of the dog [OR = 1.21 (95%CI: 1.11-1.31); p < 0.001] and altitude [OR = 0.02 (95%CI: 0.001-0.19); p = 0.001] were identified as risk factors for the infection. The results obtained in this study are expected to aid in the implementation of directed control programmes in CanL endemic areas throughout Europe, as well as to provide suitable data for the design of better risk assessment maps of the disease.

Longitudinal echocardiographic and clinical follow-up of patients undergoing mitral valve surgery without concomitant tricuspid valve repair

BackgroundIn patients with mild to moderate functional tricuspid regurgitation (TR) and absence of right ventricular dysfunction or tricuspid annulus (TA) dilatation, there is currently no indication for concomitant tricuspid valve (TV) repair during elective mitral valve (MV) surgery. However, long-term results are conflicting. Here, we sought to determine the clinical outcome of this cohort, the rate of TR progression after MV surgery and the role of MV aetiology.MethodsPatients for elective MV surgery without concomitant TV repair were retrospectively analysed with longitudinal echocardiographic and clinical follow-up, focusing on TR progression and MV aetiology. Linear regression analysis was performed for change in TR at follow-up, using pre-determined variables and confounders.ResultsIn total 204 patients without TV repair were analysed. Development of more than moderate TR after a median of 3.1 [1.6–4.6] years was rarely seen: only in 2 out of 161 patients (1.2%) with known TR grade at follow-up. Overall, median preoperative and late postoperative TR grade were equal (p = 0.116). Subanalysis showed no significant difference in MV aetiology subgroups. Preoperative TR grade and male gender were inversely correlated to change in TR. Mortality was not influenced by the 1‑year postoperative TR severity.ConclusionOur data showed that in a study population of patients with mild to moderate TR undergoing MV surgery without concomitant TV repair, significant late TR was rarely seen. Based on our study, it is safe to waive concomitant TV repair in this specific patient cohort.Electronic supplementary materialThe online version of this article (10.1007/s12471-018-1159-4) contains supplementary material, which is available to authorized users.

Evaluation of mitral regurgitation by an integrated 2D echocardiographic approach in patients undergoing transcatheter aortic valve replacement

The purpose of this study was to evaluate mitral regurgitation (MR) severity in patients undergoing transcatheter aortic valve replacement (TAVR) by standardized assessment of two-dimensional (2D) transthoracic echocardiography (TTE) and 1-year echocardiographic and clinical outcomes. Pre- and post-procedural TTE’s of patients undergoing TAVR between 2008 and 2014 were analyzed. MR was graded according to current guidelines with a systematic and integrated approach. Longitudinal echocardiographic and clinical results were analyzed. Regression analysis was performed for change in MR grade at follow-up, using pre-determined variables and confounders. Pre- and post-procedural TTE were available in 213 subjects. Significant MR was seen in 22% at baseline and 15% at follow-up; MR grade ≥ 3 in < 10%. Severity did not change in 61%, and decreased in 20% of the patients. Overall, the prevalence of MR grades pre- and post TAVR was not significantly different, nor influenced by MR etiology or TAVR prosthesis type. However, higher MR grades and pacemaker absence at baseline, were independently correlated to more improvement of MR after TAVR. Regarding clinical outcomes, NYHA class improved in two-thirds of the patients, irrespective of the baseline MR grade. Overall survival was not significantly different amongst MR grades post-TAVR. MR grading using an systematic 2D echocardiographic approach in patients undergoing TAVR is feasible in clinical practice. Our data revealed a relatively frequent prevalence of significant MR (although grade ≥ 3 was scarce), overall no change in the MR grade at 1 year follow-up, improvement of functional NYHA class, and no significant differences in long-term survival amongst the post-TAVR MR grades.

Reference Values for Physical Stress Echocardiography in Asymptomatic Patients after Mitral Valve Repair.

Clinical decision-making in symptomatic patients after mitral valve (MV) repair remains challenging as echocardiographic reference values are lacking. In native MV disease intervention is recommended for mean transmitral pressure gradient (TPG) >15 mmHg or systolic pulmonary artery pressure (SPAP) >60 mmHg at peak exercise. Insight into standard stress echo parameters after MV repair may therefore aid to clinical decision-making during follow-up. Stress echocardiography derived parameters in asymptomatic patients after successful MV repair differ from current guidelines for native valves. In 25 patients (NYHA I) after MV repair stress echocardiography was performed on a semi-supine bicycle. Doppler flow records and MV related hemodynamics at rest and peak were obtained. Linear regression analysis was performed for mean TPG and SPAP at peak, using predetermined variables and confounders. Mean TPG at rest (3.2 ± 1.4 mmHg) significantly increased at peak (15.0 ± 3.4 mmHg) but was always <25 mmHg. Mean SPAP at rest (21.4 ± 3.8 mmHg) significantly increased at peak (41.8 ± 8.9 mmHg) but was never >57 mmHg. Only the indexed MV ring diameter was inversely correlated to mean TPG at peak in a multivariable model. In contrast to current recommendations in native MV disease, our data indicate that the standard value for mean TPG during stress echocardiography in asymptomatic patients after successful MV repair was above the guideline threshold of 15 mmHg in >50%, but always <25 mmHg. For SPAP, patients never reached the guideline cutoff (60 mmHg). Long-term follow-up data are needed to provide insight in clinical consequences. Baseline stress echocardiography may indicate individual reference values to compare with during follow-up. https://clinicaltrials.gov/ct2/show/NCT02371863?term=chamuleau+AND+Mitral&rank=1.

Pathological S-wave in lead I in left bundle branch block is associated with MRI scar and reduced left ventricular function

Background The 2009 electrocardiographic Selvester QRS score for LBBB (2009 LBSS) is prognostic in CRT-patients. Previous studies show limited diagnostic performance in detecting and quantifying left ventricular (LV) scar determined by cardiovascular magnetic resonance imaging (CMR). We aimed to develop an improved method for ECG detection of scar using a large and broadly selected dataset of patients with LBBB. Methods and results We retrospectively identified LBBB patients (n = 325) with available ECG and late gadolinium enhancement (LGE) CMR exams from four centers (142 [44%] with > 0% CMR scar). ECG metrics were measured digitally and semi-automatically, and were compared to CMR-determined scar presence and extent. The 2009 LBSS did not accurately detect or quantify CMR scar (R 2 = 0.04, Area under the Receiver operating characteristic curve [AUC]: 0.60, [95% confidence interval: 0.54–0.66]). Multivariable stepwise logistic regression applied in 44 pre-determined ECG variables resulted in an improved 6-variable ECG model to detect CMR-scar (AUC 0.72 [0.66–0.77]). Furthermore, a single ECG variable (Lead I R/S amplitude ratio) was predictive of both scar presence (AUC 0.71 [0.65–0.77]) and of LV ejection fraction 2 = 0.21) Conclusions The 2009 LBSS does not accurately detect or quantify CMR scar. Extensive comparison of ECG and CMR identified a single ECG measure (lead I R/S amplitude ratio

A Fuzzy Based Early Warning System to Predict Banking Distress on Selected Asia-Pacific Countries

This study develops an early warning system (EWS) to prevent the banking crisis. The proposed system incorporates both the perspective of crises and fundamental characteristics of the banking system in each economy. A fuzzy logic method with data from 1990-2009 is employed to construct the EWS of banking crisis based on 21 pre-determined variables from the aspect of total economy, financial and banking sectors. Our results show: Firstly, South Korea recorded higher probability to have a banking crisis in 1997 as there was large foreign debt in dollars. Secondly, China, Australia and New Zealand banking systems appear to be vulnerable to the crisis in 2007. The surge of China export, FDIs and booming stock market were signs of a heated economy. Australia with high commodity prices was also vulnerable to crisis. Thirdly, Australia, China, Japan and New Zealand banking systems appear to be exposed to the higher chance of a crisis in 2010. Japan with deflation coupled with expensive yen did not augur well for its export. Overall, the findings show that in Asian Financial Crisis 1997/98 and Global Financial Crisis 2008/09, many economies are exposed to a higher probability of having the crisis and this shows an urgent need of having surveillance in these economies.

Influence of Extrinsic Risk Factors on National Football League Injury Rates.

Background:The risk of injury associated with American football is significant, with recent reports indicating that football has one of the highest rates of all-cause injury, including concussion, of all major sports. There are limited studies examining risk factors for injuries in the National Football League (NFL).Purpose:To identify risk factors for NFL concussions and musculoskeletal injuries.Study Design:Case-control study; Level of evidence, 3.Methods:Injury report data were collected prospectively for each week over the 2012-2013 and 2013-2014 regular seasons for all 32 teams. Poisson regression models were used to identify the relationship between predetermined variables and the risk of the 5 most frequent injuries (knee, ankle, hamstring, shoulder, and concussion).Results:A total of 480 games or 960 team games (TGs) from the 2012-2013 and 2013-2014 regular seasons were included in this study. A trend to an increasing risk of concussion and TG ankle injury with decreasing mean game-day temperature was observed. The risk of TG concussion (incidence rate ratio [IRR], 2.16; 95% CI, 1.35-3.45; P = .001) and TG ankle injury (IRR, 1.48; 95% CI, 1.10-1.98; P = .01) was significantly greater for TGs played at a mean game-day temperature of ≤9.7°C (≤49.5°F) compared with a mean game-day temperature of ≥21.0°C (≥69.8°F). The risk of TG shoulder injury was significantly increased for TGs played on grass surfaces (IRR, 1.36; 95% CI, 1.02-1.81; P = .038) compared with synthetic surfaces. The risk of TG injury was not associated with time in season, altitude, time zone change prior to game, or distance traveled to a game.Conclusion:This study evaluated extrinsic risk factors for injury in the NFL. A hazardous association was identified for risk of concussion and ankle injury with colder game-day temperature. Further research should be conducted to substantiate this relationship and its potential implication for injury prevention initiatives.

The Influence of Country-of-origin on Consumer Purchase Intention: The Mobile Phones Brand from China

Abstract In modern and competitive era which global marketing is growing day by day, consumer perceptions towards product country-of-origin has changed from one to other new perspective. The new perception might results in both possibilities either in favourable or unfavourable dimensions, not excluded products from China. Growth of electronic devices in China such as mobile phones is among relevant to be studied. Thus, this study aims to investigate the determinant factors of country-of-origin that consumer considers in purchasing mobile phones brand that originated from China. Country image, perceived product quality and brand familiarity have been used as pre-determined factors in measuring consumer's purchase intention. A total of 200 set of questionnaires were distributed randomly in Klang Valley. The hypotheses which were tested using Pearson Correlation have revealed that all pre-determined variables are significant and highly correlated in influencing consumer purchase intention towards mobile phones brand from China. Other than providing a remarkable change of people perceptions towards mobile phone brand from China, the findings would also be very useful to consumers and marketers especially who involve directly and indirectly with the country of China as their product and service providers’ origin.

Economic Forces and Stock Markets Under Arbitrage Price Theory: Empirical Evidence from Turkey

Our aim is to identify common risk factors among some pre-determined macroeconomic variables in a way that whether they are presented significant risk premiums in pricing equation that was given above. First we identified number of potential factors explaining returns in Turkish markets as suggested by Ross (1980) when presented APT. We found two factors were significantly explaining returns and then to find out which factor they are. we have used methodology of Chen, Roll, Ross (1986) where we have ranked portfolios according to size (market capitalization) and portfolio returns are calculated as log-returns. Our main results have showed that stock returns are exposed to systematic economic news that they are priced in accordance with their exposures. Those variables in our study are MP, DEI, BIST 100, BIST 30 and CG that must be given importance for considering their impact on stock returns.

Abstract 44: Time to Epinephrine Impacts Mortality Following Pediatric In-Hospital Nonshockable Cardiac Arrest

Background: Delay in administration of the first epinephrine dose has been shown to be associated with a lower chance of good outcome in adult, in-hospital, non-shockable cardiac arrest. Whether this association is true in pediatric in-hospital non-shockable cardiac arrest remains unknown. Methods: We utilized the Get With the Guidelines - Resuscitation national registry to identify pediatric patients (age &lt; 18 years) with an in-hospital cardiac arrest between 2000 and 2010. We included patients with an initial non-shockable rhythm who received at least one dose of epinephrine. To assess the association between time to epinephrine administration and survival to discharge we used multivariate logistic regression models with adjustment for multiple predetermined variables including age, gender, illness category, pre-existing mechanical ventilation, monitored, witnessed, location, time of the day/week, year of arrest, insertion of an airway, initial rhythm, time to initiation of cardiopulmonary resuscitation, hospital type and hospital teaching status. Secondary outcomes included return of spontaneous circulation (ROSC) and neurological outcome. Results: 1,131 patients were included. Median age was 9 months (quartiles: 21 days - 6 years) and 46% were female. Overall survival to hospital discharge was 29%. Longer time to epinephrine was negatively associated with survival to discharge in multivariate analysis (OR: 0.94 [95%CI: 0.90 - 0.98], per minute delay). Longer time to epinephrine was negatively associated with ROSC (OR: 0.93 [95%CI: 0.90 - 0.97], per minute delay) but was not statistically significantly associated with survival with good neurological outcome (OR: 0.95 [95%CI: 0.89 - 1.03], per minute delay). Conclusions: Delay in administration of epinephrine during pediatric in-hospital cardiac arrest with a non-shockable rhythm is associated with a lower chance of ROSC and lower survival to hospital discharge.

State Dependence of Aggregated Risk Aversion: Evidence for the German Stock Market

We propose a dynamic generalization of the Capital Asset Pricing Model (CAPM) that allows for a time-varying market price of risk (MPR) reflecting both cross market dependence and future investment opportunities. The realized volatility approach is employed to determine market risk. The advocated state space model takes autoregressive dynamics of the MPR and predetermined state variables into account. For the case of the DAX, the major German stock index, the empirical analysis strongly underpins time variation of risk compensation. The MPR is conditioned upon the EURIBOR, a national and an international term spread, returns of the Dow-Jones-Industrial-Average-Index (DOW), and a dummy variable hinting at excess activity of noise traders. Moreover, we document forecasting results based on a short horizon trading strategy. The proposed model is characterized by strong market timing ability.