32 research outputs found

    Essays on Fiscal Rule Design and its implications

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    The three chapters of this thesis examine different aspects of the design of fiscal rules and their implications on the effects of policy interventions and how policy reacts to the economy.Chapter 1 focuses on the design of fiscal rules in DSGE models, which has been shown to matter crucially in identifying the effects of policy interventions and analyses two mechanically distinct components of fiscal policy rules: fiscal rule interactions and multimodality.In a first exercise, a set of alternative fiscal rules is considered for the benchmark Leeper, Plante and Traum (2010) model, with the main design feature being across budget block (expenditure vs taxation) interactions. The models are compared using the Bayesian data density. The results show that the Leeper, Plante and Traum (2010) model is competitive in the set but may be improved by including across-budget component interaction with taxes ordered first. Mechanically, the budget component interactions trickle down to how policy interventions are financed, showing increased coordination across blocks. In the benchmark, a government consumption shock raises the federal government's expenditures, and along the path, taxation increases to bring the debt level back to the steady state. In the recursive block models, budget impacts can be temporarily purely expansionary in that expenditure increases and taxation is reduced. Combining both aspects, it seems to reflect a temporary but coordinated approach to raise output across the expenditure and taxation categories.Secondly, I explore the role of multimodality in fiscal rules. Herbst and Schorfheide (2016) showed that fiscal parameters in the aforementioned model can become multimodal, leading to multimodal impulse responses. In essence, what that means is that fiscal policy may have varied impacts depending on the exact posterior parameter draw. For the Leeper, Plante and Traum (2010) model, I argue using graphs and demonstrate that the source of multimodality in the model is likely the structural design of the rules. Furthermore, building on the analysis in Herbst and Schorfheide (2016), I apply bi-modal regions to the highest posterior density regions as intervals tend to overestimate uncertainty of bi-modal distributions. The results show that the effects of consumption taxation shocks not only predict different scenarios depending on the mode but also disjointed impact scenarios. In particular, for consumption taxation shocks, the average effect of a structural shock is not a particularly likely event by itself.In Chapter 2, I explore how fiscal policy decisions relate to the business cycle and, building on that, how the effects of policy interventions may vary depending on when policy is conducted in the business cycle. To assess this, I estimate a small to medium-sized DSGE model with expressive non-linear fiscal and monetary rules using a higher-order approximation.The estimation procedure employed in this chapter combines several existing approaches developed by Herbst and Schorfheide (2016), Jasra et al. (2010), Buchholz, Chopin and Jacob (2021) and Amisano and Tristani (2010) to trade off computation time and inference quality. The model is estimated using Sequential Monte Carlo techniques to estimate the posterior parameter distribution and particle filter techniques to estimate the likelihood. Together, the estimation procedure reduces the estimation from weeks to days by up to 94%, depending on the comparison basis.To assess the behaviour of the effects of fiscal policy interventions, I sample impulse responses conducted along the historical data. The results present time-varying policy rules in which the effects of fiscal shocks go through deep cycles depending on the initial conditions of the economy. Among the set of fiscal instruments, government consumption goes through the most persistent cycles in its effectiveness in stimulating output. In particular, the effects of government consumption stimulus are estimated to be more effective during the financial crisis and, later, the Covid crisis, while being less effective in periods of above steady state output like the early 2000s.Relating the effects of specific stimulating shocks to the initial conditions using regression techniques, I show that fiscal policy is more effective at stimulating output if the interest rate and debt are low. Furthermore, the effects of government consumption are estimated to be increasing in output while tax cuts are decreasing.As a last contribution of Chapter 2, I explore how the behaviour of the central bank and government varies depending on the business cycle by analysing sampled policy rule gradients constructed on historical data. For the central bank, the results show that in phases of high output growth, the central bank puts more emphasis on controlling inflation and less on output. As the economy shifts into crisis, the central bank reduces its focus on inflation and shifts towards bringing output growth back to target. For the fiscal side, the behaviour is heavily governed by the current debt level, and, for example, during the high debt periods of the 1990s, labour taxation became increasingly responsive to debt to stabilize the budget.Chapter 3 applies the model developed in Chapter 2 to a forecasting exercise using the DSGE-VAR framework. The analysis confirms previous results of the literature that the DSGE-VAR framework and, by extension, DSGE models are frequently useful in aiding forecasting performance for output compared to standard models. Furthermore, I show that DSGE-VAR models can help aid forecasting performance of governmental variables like government consumption and debt quite significantly. However, there seems to be no single best methodology across all data series and forecasting settings considered, similar to the results in Gürkaynak, Kısacıkoğlu and Rossi (2014). Rather, the best-performing methodology may depend on factors like sample selection, modelling framework and potentially others.In a novel exercise, I explore the utility of a variation of the Chapter 2 model with a Zero Lower Bound constraint for forecasting. Overall, the model performs well but is not necessarily competitive with the much simpler DSGE-VAR. However, the ZLB model does show some strength in forecasting fiscal variables

    Synthesis of Tobermorite Structure with Non-traditional Silica Components

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    The main aim of the article is research of kinetics of creation of calcium silicate hydrate (CSH) and calcium aluminate hydrate (CAH) phases in the autoclaved aerated concrete in dependence on type of raw materials. Regarding materials, this will be unique combinations of lime with fly ash, quartz sand or silica fume. The aim will be to prove the influence of ratio of individual types of materials on the CSH phase to determine optimal combinations of raw materials. The research focuses first on detailed analysis of the used materials. Next focus is kinetics of the creation of microstructures of silicate phases under ideal conditions of small-sized autoclave reactors (250 ml, 190 °C, 1.3 MPa). The produced samples are further analysed using of x-ray diffraction (XRD) and scanning electron microscopy (SEM) for qualitative valuation of created microcrystalline phases. The results show that the most suitable non-traditional silica component is ash from coal combustion. The optimal combination of amorphous and crystalline silicon in combination with Al2O3 provided the highest proportion of synthesized tobermorite even in more economical autoclaving variants

    The interrelation of needs and quality of life in first-episode schizophrenia

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    The interrelation between needs for care and quality of life has been described and replicated by several studies. The present work aims to add to the understanding of longitudinal interrelations between needs for care, quality of life, and other outcome measures by analyzing a sample of patients at the onset of schizophrenia. This study relied on data from the EUFEST trial, designed to compare first- and second-generation antipsychotics during 1year. At baseline, 498 patients have been included. The first (baseline) and the last assessment (12months after baseline) were used for the analyses. Predictors of quality of life were determined using regression analyses. We tested the complex longitudinal interrelations between baseline and outcome measures with structural equation models. Unmet needs were not definitively confirmed as a predictor of subsequent quality of life, unless unmet needs changing to no needs were separated from unmet needs changing to met needs. Each unmet need that changed to no need enhanced the quality of life (mean score 1-7) by 0.136 scale points. This study suggests that when studying quality of life and needs for treatment, it is crucial to differentiate whether unmet needs disappeared or whether they were met, as the former has a stronger impact on quality of lif

    Prevalence and severity of antipsychotic related constipation in patients with schizophrenia: a retrospective descriptive study

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    <p>Abstract</p> <p>Background</p> <p>Antipsychotic are the cornerstone in the treatment of schizophrenia. They also have a number of side-effects. Constipation is thought to be common, and a potential serious side-effect, which has received little attention in recent literature.</p> <p>Method</p> <p>We performed a retrospective study in consecutively admitted patients, between 2007 and 2009 and treated with antipsychotic medication, linking different electronic patient data to evaluate the prevalence and severity of constipation in patients with schizophrenia under routine treatment conditions.</p> <p>Results</p> <p>Over a period of 22 months 36.3% of patients (99) received at least once a pharmacological treatment for constipation. On average medication for constipation was prescribed for 273 days. Severe cases (N = 50), non-responsive to initial treatment, got a plain x-ray of the abdomen. In 68.4% fecal impaction was found.</p> <p>Conclusion</p> <p>A high prevalence of constipation, often severe and needing medical interventions, was confirmed during the study period. Early detection, monitoring over treatment and early intervention of constipation could prevent serious consequences such as ileus.</p

    Care for patients with severe mental illness: the general practitioner's role perspective

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    BACKGROUND: Patients with severe mental illness (SMI) experience distress and disabilities in several aspects of life, and they have a higher risk of somatic co-morbidity. Both patients and their family members need the support of an easily accessible primary care system. The willingness of general practitioners and the impeding factors for them to participate in providing care for patients with severe mental illness in the acute and the chronic or residual phase were explored. METHODS: A questionnaire survey of a sample of Dutch general practitioners spread over the Netherlands was carried out. This comprised 20 questions on the GP's 'Opinion and Task Perspective', 19 questions on 'Treatment and Experiences', and 27 questions on 'Characteristics of the General Practitioner and the Practice Organisation'. RESULTS: 186 general practitioners distributed over urban areas (49%), urbanised rural areas (38%) and rural areas (15%) of the Netherlands participated. The findings were as follows: GPs currently considered themselves as the first contact in the acute psychotic phase. In the chronic or residual phase GPs saw their core task as to diagnose and treat somatic co-morbidity. A majority would be willing to monitor the general health of these patients as well. It appeared that GP trainers and GPs with a smaller practice setting made follow-up appointments and were willing to monitor the self-care of patients with SMI more often than GPs with larger practices.GPs also saw their role as giving support and information to the patient's family.However, they felt a need for recognition of their competencies when working with mental health care specialists. CONCLUSION: GPs were willing to participate in providing care for patients with SMI. They considered themselves responsible for psychotic emergency cases, for monitoring physical health in the chronic phase, and for supporting the relatives of psychotic patients

    A core outcome set for evaluating self-management interventions in people with comorbid diabetes and severe mental illness : study protocol for a modified Delphi study and systematic review

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    BACKGROUND: People with diabetes and comorbid severe mental illness (SMI) form a growing population at risk of increased mortality and morbidity compared to those with diabetes or SMI alone. There is increasing interest in interventions that target diabetes in SMI in order to help to improve physical health and reduce the associated health inequalities. However, there is a lack of consensus about which outcomes are important for this comorbid population, with trials differing in their focus on physical and mental health. A core outcome set, which includes outcomes across both conditions that are relevant to patients and other key stakeholders, is needed. METHODS: This study protocol describes methods to develop a core outcome set for use in effectiveness trials of self-management interventions for adults with comorbid type-2 diabetes and SMI. We will use a modified Delphi method to identify, rank, and agree core outcomes. This will comprise a two-round online survey and multistakeholder workshops involving patients and carers, health and social care professionals, health care commissioners, and other experts (e.g. academic researchers and third sector organisations). We will also select appropriate measurement tools for each outcome in the proposed core set and identify gaps in measures, where these exist. DISCUSSION: The proposed core outcome set will provide clear guidance about what outcomes should be measured, as a minimum, in trials of interventions for people with coexisting type-2 diabetes and SMI, and improve future synthesis of trial evidence in this area. We will also explore the challenges of using online Delphi methods for this hard-to-reach population, and examine differences in opinion about which outcomes matter to diverse stakeholder groups. TRIAL REGISTRATION: COMET registration: http://www.comet-initiative.org/studies/details/911 . Registered on 1 July 2016

    Efficacy of antipsychotic drugs against hostility in the European First-Episode Schizophrenia Trial (EUFEST)

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    To compare the effects of haloperidol, amisulpride, olanzapine, quetiapine, and ziprasidone on hostility in first-episode schizophrenia, schizoaffective disorder, or schizophreniform disorder. We used the data acquired in the European First-Episode Schizophrenia Trial, an open, randomized trial (conducted in 14 countries) comparing 5 antipsychotic drugs in 498 patients aged 18-40 years with first-episode schizophrenia, schizoaffective disorder, or schizophreniform disorder. DSM-IV diagnostic criteria were used. Patients were assessed between December 23, 2002 and January 14, 2006. Most subjects joined the study as inpatients and then continued with follow-ups in outpatient clinic visits. The Positive and Negative Syndrome Scale (PANSS) was administered at baseline and at 1, 3, 6, 9, and 12 months after randomization. We analyzed the scores on the PANSS hostility item in a subset of 302 patients showing at least minimal hostility (a score > 1) at baseline. We hypothesized (1) that the treatments would differ in their efficacy for hostility and (2) that olanzapine would be superior to haloperidol. Our primary statistical analysis tested the null hypothesis of no difference among the treatment groups in change in hostility over time. Secondary analysis addressed the question of whether the effects on hostility found in the primary analysis were specific to this item. All our analyses were post hoc. The primary analysis of hostility indicated an effect of differences between treatments (F(4,889) = 4.02, P = .0031). Post hoc treatment-group contrasts for hostility change showed that, at months 1 and 3, olanzapine was significantly superior (P <.05) to haloperidol, quetiapine, and amisulpride in reducing hostility. Secondary analyses demonstrated that these results were at least partly specific to hostility. Both hypotheses were supported. Olanzapine appears to be a superior treatment for hostility in early phases of therapy for first-episode schizophrenia, schizoaffective disorder, and schizophreniform disorder. This efficacy advantage of olanzapine must be weighed against its adverse metabolic effects and propensity to cause weight gain. ISRCTN Register Identifier: ISRCTN6873663
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