Bivalirudin for patients with acute coronary syndromes

Background: Current guidelines for patients with moderate- or high-risk acute coronary syndromes recommend an early invasive approach with concomitant antithrombotic therapy, including aspirin, clopidogrel, unfractionated or low-molecular-weight heparin, and glycoprotein IIb/IIIa inhibitors. We evaluated the role of thrombin-specific anticoagulation with bivalirudin in such patients. Methods: We assigned 13,819 patients with acute coronary syndromes to one of three antithrombotic regimens: unfractionated heparin or enoxaparin plus a glycoprotein IIb/IIIa inhibitor, bivalirudin plus a glycoprotein IIb/IIIa inhibitor, or bivalirudin alone. The primary end points were a composite ischemia end point (death, myocardial infarction, or unplanned revascularization for ischemia), major bleeding, and the net clinical outcome, defined as the combination of composite ischemia or major bleeding. Results: Bivalirudin plus a glycoprotein IIb/IIIa inhibitor, as compared with heparin plus a glycoprotein IIb/IIIa inhibitor, was associated with noninferior 30-day rates of the composite ischemia end point (7.7% and 7.3%, respectively), major bleeding (5.3% and 5.7%), and the net clinical outcome end point (11.8% and 11.7%). Bivalirudin alone, as compared with heparin plus a glycoprotein IIb/IIIa inhibitor, was associated with a noninferior rate of the composite ischemia end point (7.8% and 7.3%, respectively; P = 0.32; relative risk, 1.08; 95% confidence interval [CI], 0.93 to 1.24) and significantly reduced rates of major bleeding (3.0% vs. 5.7%; P<0.001; relative risk, 0.53; 95% CI, 0.43 to 0.65) and the net clinical outcome end point (10.1% vs. 11.7%; P = 0.02; relative risk, 0.86; 95% CI, 0.77 to 0.97). Conclusions: In patients with moderate- or high-risk acute coronary syndromes who were undergoing invasive treatment with glycoprotein IIb/IIIa inhibitors, bivalirudin was associated with rates of ischemia and bleeding that were similar to those with heparin. Bivalirudin alone was associated with similar rates of ischemia and significantly lower rates of bleeding. (ClinicalTrials.gov number, NCT00093158.)

The black-white test score gap widens with age?

We re-examine the theoretical concept of a production function for cognitive achievement, and argue that an indirect production function that depends upon the variables that constrain parents' choices is both moretractable from an econometric point of view, and more interesting from an economic point of view than is a direct production function that depends upon a detailed list of direct inputs such as number of books in the household. We estimate flexible econometric models of indirect production functions for two achievement measures from the Woodcock-Johnson Revised battery, using data from two waves of the Child Development Supplement to the PSID. Elasticities of achievement measures with respect to family income and parents' educational levels are positive and significant. Gaps between scores of black and white children narrow or remain constant as children grow older, a result that differs from previous findings in the literature. The elasticities of achievement scores with respect to family income are substantially higher for children of black families, and there are some notable difference in elasticities with respect to parents' educational levels across blacks and whites.

El dret a l'educació i la igualtat d'oportunitats. Perspectiva històrica

La importància del sistema educatiu per a la formació d���una consciència democràtica és un tema ja present en el pensament il•lustrat i recollit en la Constitució de 1812 on es pretenia que, amb els plans d���instrucció, a partir de l’any 1830 sabessin llegir i escriure tots els ciutadans. L’objectiu d���aquesta recerca és analitzar com el dret a l’educació és determinant per al desplegament de la nostra personalitat i per a la igualtat d���oportunitats. Molts dels problemes i de les tensions presents en la configuració d���un model de sistema educatiu per a la nostra societat democràtica són conseqüència de plantejaments no resolts des de fa dos segles. La consolidació, per primer cop en la nostra història, d���un ordenament jurídic democràtic, exigeix un esforç per part de tots els agents implicats en el sistema educatiu per a possibilitar una societat on sigui vigent el principi d���igualtat d���oportunitats.

"La paradisíaca estabilidad de la anteguerra". Elaboración de un índice de precios de consumo de España, 1830-1936.

Este artículo expone los aspectos básicos de la elaboración un nuevo, y auténtico, Índice de Precios de Consumo de España para el período 1830-1936. Los distintos apartados en que está organizado se dedican a definir el campo de observación y el ámbito analizados, las fuentes empleadas y la metodología utilizada, así como las similitudes y diferencias con otros índices actualmente disponibles. Contiene, asimismo, un contiene un primer y breve análisis de los resultados. La característica más sobresaliente desde la perspectiva de las tendencias de largo plazo del nuevo IPC es una gran estabilidad, quebrada de forma importante, tan sólo, durante los años 1914-1920 bajo la influencia de la Primera Guerra Mundial. La tasa de crecimiento para el conjunto del período no alcanzó siquiera el uno por cien anual, pese al cambio de nivel registrado en aquel breve brote inflacionista.

Service offshoring and white-collar employment

This paper empirically studies the effects of service offshoring on white-collar employment, using data for more than one hundred U.S. occupations. A model of firm behavior based on separability allows to derive the labor demand elasticity with respect to service offshoring for each occupation. Estimation is performed with Quasi-Maximum Likelihood, to account for high degrees of censoring in the employment variable. The estimated elasticities are then related to proxies for the skill level and the degree of tradability of the occupations. Results show that service offshoring increases high skilled employment and decreases medium and low skilled employment. Within each skill group, however, service offshoring penalizes tradable occupations and benefits non-tradable occupations.