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The clinical efficacy of ticagrelor versus clopidogrel has not been replicated in East Asian populations. The pronounced bleeding risk with ticagrelor was of concern given the increased bleeding tendency in Asian populations. This study evaluated efficacy and safety of ticagrelor versus clopidogrel in patients with non-ST-elevation myocardial infarction (NSTEMI) in the entire Taiwan. We used the Taiwan National Health Insurance Research Database to identify 6203 patients aged ≥ 20 years with NSTEMI hospitalization and prescription of dual antiplatelets at discharge between January 2014 and December 2014. Cohorts of ticagrelor and clopidogrel were matched 1:1 based on propensity score matching to balance baseline covariates. The primary composite efficacy endpoints included death from any cause, non-fatal myocardial infarction, and non-fatal stroke. The secondary efficacy endpoints were the individual components. The primary safety endpoint was major bleeding requiring hospitalization. The incidence of primary efficacy endpoint was 20.3% in the ticagrelor users and 20.7% in the clopidogrel users (adjusted HR 0.94; 95% CI 0.73–1.22), with the median (interquartile range, IQR) follow-up period of 5.2 (2.3–8.5) months. The incidence of primary safety endpoint was 2.3% in the ticagrelor users and 3.2% in the clopidogrel users (adjusted HR 0.67; 95% CI 0.33–1.35). Regarding the secondary efficacy endpoint, patients treated with ticagrelor had significantly lower incidence of stroke (adjusted HR 0.44; 95% CI 0.21–0.94; p = 0.033). In this nationwide Taiwanese cohort of NSTEMI, treatment with ticagrelor after discharge, as compared to clopidogrel, had similar rates of ischemic composite events and major bleeding. Nevertheless, the median follow-up time was only 5.2 months, and the reduced stroke events with ticagrelor compared to clopidogrel needs further verification. [ABSTRACT FROM AUTHOR]

According to the Green Solow model, the rise or fall of emissions over time depends on a scale effect and a technique effect, and, if the latter effect is held constant, changes in population growth will influence profiles of the environmental Kuznets curve (EKC). Utilizing four alternative measures of population size as threshold variables, this paper reexamines the effect of foreign direct investment (FDI) on carbon dioxide (CO2) emissions and further tests EKC profiles for different population sizes. Our threshold test shows a double-threshold effect on CO2 emissions, implying the existence of three population regimes: least, moderately, and most populated. Our results show that an inverted U-shaped EKC relationship exists between CO2 emissions and economic development across different population regimes, when population density and absolute population in turn are used as a threshold variable. In addition, in the least populated regime, CO2 emissions significantly converge with increasing FDI. [ABSTRACT FROM AUTHOR]

The aim of this paper is to investigate the threshold effect of foreign direct investment (FDI) on environmental degradation. In empirical analysis, FDI and environmental degradation are jointly determined under the given threshold variable and other exogenous variables. Using carbon dioxide (CO) emissions per capita as a proxy for environmental degradation, the results show that increasing FDI worsens CO emissions after a threshold level of corruption has been reached. Our results demonstrate that increasing FDI will increase CO emissions when the degree of corruptibility is relatively high. The study suggests that further FDI and improved environmental quality are competing rather than compatible objectives in high-corruption countries and are compatible rather than competing objectives in low-corruption countries. Higher trade liberalization in low-corruption countries could contribute to negative environmental consequences because of the increased output or economic activity which results from increased trade. The robustness estimation confirms the evidence that pollution and economic development increase together up to a certain income level, after which the trend reverses. [ABSTRACT FROM AUTHOR]

In-hospital bleeding (IHB) is associated with the risk of subsequent cardiovascular events (CVE) in acute coronary syndrome (ACS). We investigated whether increased risk of CVE by IHB is influenced by chronic kidney disease (CKD) or both have detrimental effects on CVE. In a Taiwan national-wide registry, 2819 ACS patients were enrolled. CKD is defined as an estimated glomerular filtration rate of <60 ml/min per 1.73 m. The primary end point is the composite of death, non-fatal myocardial infarction and non-fatal stroke at 12 months. 53 (1.88 %) and 949 (33.7 %) patients suffered from IHB and CKD, respectively. Both IHB and CKD are independently associated with increased risk of the primary end point (HR 2.04, 95 % CI 1.05-3.99, p = 0.037 and HR 2.17, 95 % CI 1.63-2.87, p < 0.01, respectively). The Kaplan-Meier curves show significantly higher event rates among those with IHB and CKD in the whole, ST-elevation and non-ST elevation populations (all p < 0.01). Patients with IHB(+)/CKD(−), IHB(−)/CKD(+) and IHB(+)/CKD(+) have 1.88-, 2.13- and 2.98-fold risk to suffer from the primary end point compared with those without IHB and CKD ( p = 0.23, <0.01 and <0.01, respectively). IHB or CKD is independently associated with poor cardiovascular outcome and patients with both IHB and CKD have the worst outcome in ACS. [ABSTRACT FROM AUTHOR]

This paper uses a threshold model to estimate the regime-specific marginal effect of trade liberalization and other determinants of environmental degradation in regimes with different levels of corruption. The results show that increasing trade liberalization leads to an increase in carbon dioxide ( $$\mathrm{{CO}_{2}}$$ ) emissions in countries with a high level of corruption but to an decrease in countries with low corruption. A U-shaped relationship between $$\mathrm{{CO}_{2}}$$ emissions and income exists in low-corruption countries but not in high-corruption countries. Our results also show that an increase in energy use per $1,000 in gross domestic product and fossil-fuel energy consumption will increase $$\mathrm{{CO}_{2}}$$ emissions in any country. Moreover, increases in agricultural value and foreign direct investment can decrease environmental degradation in any country. [ABSTRACT FROM AUTHOR]