Effects of heart rate reduction with ivabradine on the international ındex of erectile function (IIEF-5) in patients with heart failure

Introduction: The presence of concomitant erectile dysfunction (ED) with heart failure (HF) is not surprising, because endothelial dysfunction is pathophysiologic signature of both ED and HF. ED significantly and adversely affects quality of life in patients with HF. It was demonstrated that ivabradine treatment can improve endothelial function and ED in experimental models. In this study, we aimed to determine the effect of ivabradine treatment on ED in patients with HF via International Index of Erectile Function (IIEF-5) questionaire.

Material and methods: Consequently, 29 patients, between 18 and 70?years of age, male with chronic HF known for at least 1?year, New York Heart Association functional class I–II, left ventricule ejection fraction less than 40%, in sinus rhythm with a resting HR of at least 70 beats per minute (b.p.m.), who were intended to be treated with ivabradine according to the decision of their physicians were evaluated to determine ED. We used the Turkish version of the IIEF-5 questionnaire to evaluate ED on the last 6-month period. Twenty-four of 29 patients who scored ≤21 were considered to have ED and included to the study. IIEF-5 scores for each question and domains were calculated for all responders at baseline and at 6-month follow-up visit in order to determine any effect of ivabradine treatment on ED in patients with HF.

Results: According to the data of survey, Cronbach's alpha coeffient for all of the patients who were included into the study were 0.84 and detected highly reliable. IEFF-5 questionnaire scores increased significantly (p?=?.003) after the ivabradine treatment, on the contrary, significant decrease in HR was revealed as expected. HR is decreased steadily after ivabradine treatment and mean decrease in HR was 11.5?±?9.4 in this study population. Likewise, negative correlation was demonstrated between decrease in HR (p?p?=?.003).

Conclusion: Although lack of patients with HF have been evaluated in this study population, initial results seem promising that ivabradine has favorable effects on ED. These findings were postulated to be dependent exclusively on HR reduction. As a sequel, cardiologist should avoid neglecting ED to improve medical compliance as well as quality of life in patients with heart failure. This pilot study provide some data for further randomized controlled studies.     

哥梯尔的"协议道德"理论评析

哥梯尔在<协议道德>一书中,试图完全从个人利益出发推导出道德的原则.具体地讲,哥梯尔极力想证明第一,有理性的个人在相互交往中,遇到类似"囚徒悖论"情景中的次佳化问题时,愿意接受公正的、不偏不倚的限制性条款(即道德的原则),用以限制个人无止境地追求个人利益,从而避免次佳化问题,并实现共同的利益;第二,一旦达成限制性条款或协议,各方遵守条款或协议是符合理性的,即符合各方的个人利益的.以上两点在"重复性的囚徒悖论"情景中得到了很好的证明,但哥梯尔的"协议道德"理论仍然有其局限性.     

Analysis of a long-term study of neurotic disorder, with insights into the process of non-response

Summary.  The paper studies the non-response process in a long-term study of neurotic dis-order by comparing the analysis based on the responses that were collected by the established practice of interviewing the subjects, at dates arranged in advance (appointments), with the analysis of the nearly complete set of responses that were collected by an extensive effort that involved attempts to interview without seeking a prior agreement. The method of multiple imputation is applied, and its properties are explored in a setting that is not perfectly suited for its application: a relatively small sample size, ordinal score outcomes and the likelihood that the outcomes are missing not at random.     

Large Sample Approximation of the Distribution for Convex-Hull Estimators of Boundaries

Abstract.  Given n independent and identically distributed observations in a set G  = {( x ,  y ) ∈ [0, 1] ^p  ×  R  : 0 ≤  y  ≤  g ( x )} with an unknown function g , called a boundary or frontier, it is desired to estimate g from the observations. The problem has several important applications including classification and cluster analysis, and is closely related to edge estimation in image reconstruction. The convex-hull estimator of a boundary or frontier is also very popular in econometrics, where it is a cornerstone of a method known as 'data envelope analysis'. In this paper, we give a large sample approximation of the distribution of the convex-hull estimator in the general case where p  ≥ 1. We discuss ways of using the large sample approximation to correct the bias of the convex-hull and the DEA estimators and to construct confidence intervals for the true function.     

On the Markov property of order statistics

The order statistics from a sample of size n≥3 from a discrete distribution form a Markov chain if and only if the parent distribution is supported by one or two points. More generally, a necessary and sufficient condition for the order statistics to form a Markov chain for (n≥3) is that there does not exist any atom x₀ of the parent distribution F satisfying F(x₀-)>0 and F(x₀)<1. To derive this result a formula for the joint distribution of order statistics is proved, which is of an interest on its own. Many exponential characterizations implicitly assume the Markov property. The corresponding putative geometric characterizations cannot then be reasonably expected to obtain. Some illustrative geometric characterizations are discussed.     

On the relationship between the Hicksian measures of change in welfare and the Pareto principle

The change of welfare for one individual can be measured by the compensating variation (CV) or equivalent variation; the change for a whole society can be evaluated by summing up the individual gains and losses (e.g. CV). Generally there is no equivalence between the positive sign of this sum and a potential improvement for all individuals by redistribution of incomes. In this paper the CV-measure is corrected in a manner such that the new measure is equivalent to the Pareto principle. This correction is defined in a general equilibrium framework and takes into account the attainability of allocations. Finally characterizations of compensation tests are derived.The author thanks D. Elixmann and U. Schweizer for helpful comments. The suggestions of an editor of this journal and of two anonymous references are gratefully acknowledged     

Are immigrants and natives perfect substitutes in production?

This article discusses whether immigrant and native labor are perfect substitutes in production when conventional measures of skill and demographic characteristics are held constant. The ratio of immigrant to native labor and the ratio of immigrant to native earnings are studied in 5 major immigrant receiving countries with other variables held constant. Countries included are 1) the US and Britian, where the foreign born are only about 5% to 6% of the adult male labor force; 2) Canada and Australia, where they are about 20% and 30%, respectively; and 3) Israel, where the foreign born are about 3/4 of the Jewish adult male labor force. The relative earnings of adult male immigrants and the adult male native-born sons of immigrants are found to be lower when the labor supply of immigrants is greater. The estimated elasticity of substitution between immigrant and native labor is high, but significantly less than infinity. Workers who are relatively more intensively in the favorable self selection characteristics of immigrants are not perfect substitutes for workers relatively more intensive in country-specific skills. As immigrants increase in the labor force, their relative earnings tend to fall, although the decline is small. Economies have sufficiently flexible markets and develop institutional arrangements to mitigate the relative fail in immigrant earnings as their relative supply increase.     

Cross-Cultural Differences in Risk Perception: A Model-Based Approach

The present study assessed cross-cultural differences in the perception of financial risks. Students at large universities in Hong Kong, Taiwan, the Netherlands, and the U.S., as well as a group of Taiwanese security analysts rated the riskiness of a set of monetary lotteries. Risk judgments differed with nationality, but not with occupation (students vs. security analysts) and were modeled by the Conjoint Expected Risk (CER) model.⁽¹⁾ Consistent with cultural differences in country uncertainty avoidance,⁽²⁾ CER model parameters of respondents from the two Western countries differed from those of respondents from the two countries with Chinese cultural roots: The risk judgments of respondents from Hong Kong and Taiwan were more sensitive to the magnitude of potential losses and less mitigated by the probability of positive outcomes.