RESUMO
We propose a method for forecasting global human migration flows. A Bayesian hierarchical model is used to make probabilistic projections of the 39,800 bilateral migration flows among the 200 most populous countries. We generate out-of-sample forecasts for all bilateral flows for the 2015 to 2020 period, using models fitted to bilateral migration flows for five 5-y periods from 1990 to 1995 through 2010 to 2015. We find that the model produces well-calibrated out-of-sample forecasts of bilateral flows, as well as total country-level inflows, outflows, and net flows. The mean absolute error decreased by 61% using our method, compared to a leading model of international migration. Out-of-sample analysis indicated that simple methods for forecasting migration flows offered accurate projections of bilateral migration flows in the near term. Our method matched or improved on the out-of-sample performance using these simple deterministic alternatives, while also accurately assessing uncertainty. We integrate the migration flow forecasting model into a fully probabilistic population projection model to generate bilateral migration flow forecasts by age and sex for all flows from 2020 to 2025 through 2040 to 2045.
Assuntos
Emigração e Imigração , Teorema de Bayes , Emigração e Imigração/tendências , Previsões , Migração Humana/tendências , Humanos , Internacionalidade , Modelos EstatísticosRESUMO
AIMS: Optimal blood pressure (BP) control is imperative to reduce complications, especially strokes, in continuous flow ventricular assist device (VAD) patients. Doppler BP has been shown to be an accurate and reliable non-invasive BP measurement method in HeartMate II and HVAD patients. We examined whether Doppler BP is also accurate in patients with the HeartMate 3 VAD. METHODS AND RESULTS: In a prospective, longitudinal cohort of HeartMate 3 patients, arterial line BP and simultaneously measured Doppler opening pressure were obtained. Correlation and agreement between Doppler opening pressure and arterial line mean arterial pressure (MAP) versus systolic blood pressure (SBP) were analysed, as well as the effect of pulse pressure on the accuracy of Doppler opening pressure. A total of 589 pairs of simultaneous Doppler opening pressure and arterial line pressure readings were obtained in 43 patients. Doppler opening pressure had good correlation with intra-arterial MAP (r = 0.754) and more closely approximated MAP than SBP (mean error 2.0 vs. -8.6 mmHg). Pulse pressure did not have a clinically significant impact on the accuracy of the Doppler BP method. These results in HeartMate 3 patients are very similar to previous results in HeartMate II and HVAD patients. CONCLUSIONS: Doppler BP method should be the default non-invasive BP measurement method in continuous flow VAD patients including patients implanted with the HeartMate 3.
RESUMO
AIMS: Accurate blood pressure (BP) measurement in continuous-flow ventricular assist device (CF-VAD) patients is imperative to reduce stroke risk. This study assesses the accuracy of the Doppler opening pressure method compared with the gold standard arterial line method in CF-VAD patients. METHODS AND RESULTS: In a longitudinal cohort of HeartMate II and HVAD patients, arterial line BP and simultaneously measured Doppler opening pressure were obtained. Overall correlation, agreement between Doppler opening pressure and arterial line mean vs. systolic pressure, and the effect of arterial pulsatility on the accuracy of Doppler opening pressure were analysed. A total of 1933 pairs of Doppler opening pressure and arterial line pressure readings within 1 min of each other were identified in 154 patients (20% women, mean age 55 ± 15, 50% HeartMate II and 50% HVAD). Doppler opening pressure had good correlation with invasive mean arterial pressure (r = 0.742, P < 0.0001) and more closely approximated mean than systolic BP (mean error 2.4 vs. -8.4 mmHg). Arterial pulsatility did not have a clinically significant effect on the accuracy of the Doppler opening pressure method. CONCLUSIONS: Doppler opening pressure should be the standard non-invasive method of BP measurement in CF-VAD patients.
