The Effect of Public Policies on Consumers' Preferences: Lessons from the French Automobile Market

In this paper, we investigate whether French consumers have modified their preferences towards environmentally-friendly vehicles between 2003 and 2008. We estimate a model of demand for automobiles incorporating both consumers' heterogeneity and CO2 emissions of the vehicles. Our results show that there has been a shift in preferences towards low-emitting cars, with an average increase of 367 euros of the willingness to pay for a reduction of 10 grams of carbon dioxide per kilometer. We also stress a large heterogeneity in the evolution of preferences between consumers. Rich and young people are more sensitive to environmental issues, and our results are in line with votes for the green party at the presidential elections. We relate these changes with two environmental policies that were introduced at these times, namely the obligation of indicating energy labels by the end of 2005 and a feebate based on CO2 emissions of new vehicles in 2008. Our results suggest that such policies have been efficient tools to shift consumers utility towards environmentally-friendly goods, the shift in preferences accounting for 20% of the overall decrease in average CO2 emissions of new cars on the period

Prémédication avant l'intubation néonatale

Premedication prior to neonatal intubation has been recommended for a long time. However no consensus exists to date for a standardised premedication regimen. Practices are consequently extremely heterogeneous. The objectives of the present thesis were to: Describe actual premedication practices at patients’ bedside in neonatal and pediatric ICUs located in the Paris area (EPIPPAIN study). Explore potential risk factors associated with the use or non-use of a specific premedication prior to neonatal intubation. Report a single unit (CHI Créteil) experience with the implementation of a new premedication protocol In the EPIPPAIN study 56% of intubations were preceded by a specific premedication. No patient or centre’s characteristic was identified as significantly associated with the use or non-use of a specific premedication. The association atropine-sufentanil-atracurium in a population of very premature infants (born before 32 weeks of gestational age) resulted in a 74% rate of successful first intubation attempt with good conditions. Desaturations and persistent elevated transcutaneous PCO2 were frequent There is a potential for large improvement in the frequency and nature of premedication use for neonatal intubations in French NICUs. A quality improvement process is feasible. However, more research and actions are needed in order to refine the risk/benefit ratio of available regimens for neonates and to implement good practices at a large scale.L'administration préalable à l'intubation d'une anesthésie/sédation ou prémédication est recommandée depuis longtemps chez le nouveau-né. Néanmoins, il n'existe pas de consensus sur ses modalités précises et les pratiques dans ce domaine sont extrêmement hétérogènes. Les objectifs de cette thèse étaient de :Décrire les pratiques de prémédication avant l'intubation des nouveau-nés observées au lit du patient, dans des services de réanimation néonatale ou pédiatrique en région parisienne (étude EPIPPAIN)Explorer les déterminants éventuels de l'administration ou non d'une prémédicationRapporter l'expérience d'un service de réanimation néonatale (CHI Créteil) sur la mise en place d'un changement de pratique de prémédication avant intubationDans l'étude EPIPPAIN, 56% des intubations étaient précédées d'une prémédication spécifique pour le geste. Aucun facteur lié à l'enfant ou au service n'a été identifié comme significativement associé à l'utilisation ou non d'une prémédication. L'association atropine-sufentanil-atracurium a permis, dans une population de très grands prématurés (âge gestationnel < 32 SA), un taux de succès de 74% de la première tentative d'intubation, dans de bonnes conditions. Les désaturations et l'élévation prolongée de la PCO2 transcutanée étaient fréquentes.Il existe une marge de progression importante concernant la fréquence et la qualité des prémédications utilisées avant intubation néonatale dans les services français. Une démarche d'amélioration des pratiques est faisable. Cependant d'autres travaux sont nécessaires afin d'affiner la balance bénéfice/risque pour les nouveau-nés et de mettre en place, à grande échelle, de bonnes pratiques

Automobile Prices in Market Equilibrium with Unobserved Price Discrimination

In markets where sellers are able to price discriminate, individuals pay different prices that may be unobserved by the econometrician. This paper considers the structural estimation of a demand and supply model à la Berry et al. (1995) with such price discrimination and limited information on prices taking the form of, e.g., observing list prices from catalogues or average prices. Within this framework, identification is achieved by using supply-side conditions, provided that the marginal costs of producing and selling the goods do not depend on the characteristics of the buyers. The model can be estimated by GMM using a nested fixed point algorithm that extends BLP’s algorithm to our setting. We apply our methodology to estimate the demand and supply in the French new automobile market. Our results suggest that discounting arising from price discrimination is important. The average discount is estimated to be 9.6%, with large variation depending on buyers’ characteristics and cars’ specifications. Our results are consistent with other evidence on transaction prices in France

Automobile Prices in Market Equilibrium with Unobserved Price Discrimination

This paper deals with the estimation of structural models of demand and supply with incomplete information on prices. When the seller is able to price discriminate, or the buyer to bargain, individuals pay different prices that are usually not collected in the data. This paper explores a method to estimate the supply and demand models jointly when only posted prices are observed. We consider that heterogenous transaction prices occur due to price discrimination by firms on observable characteristics of consumers. Within this framework, the identification is secured by (i) supposing that at least one group of individuals does pay the posted prices and (ii) assuming that the marginal costs of producing and selling the goods does not depend on the characteristics of the buyers. This methodology is applied to estimate the demand in the new automobile market in France. Results suggest that discounting arising from price discrimination is important. The average discount is estimated to be 5.2%, with large variation according to the buyers’ characteristics. Our results are in line with discounts generally observed in European and American automobile markets

Automobile Prices in Market Equilibrium with Unobserved Price Discrimination

This paper deals with the estimation of structural models of demand and supply with incomplete information on prices. When the seller is able to price discriminate, or the buyer to bargain, individuals pay different prices that are usually not collected in the data. This paper explores a method to estimate the supply and demand models jointly when only posted prices are observed. We consider that heterogenous transaction prices occur due to price discrimination by firms on observable characteristics of consumers. Within this framework, the identification is secured by (i) supposing that at least one group of individuals does pay the posted prices and (ii) assuming that the marginal costs of producing and selling the goods does not depend on the characteristics of the buyers. This methodology is applied to estimate the demand in the new automobile market in France. Results suggest that discounting arising from price discrimination is important. The average discount is estimated to be 5.2%, with large variation according to the buyers’ characteristics. Our results are in line with discounts generally observed in European and American automobile markets

Continuous-Infusion Vancomycin in Neonates: Assessment of a Dosing Regimen and Therapeutic Proposal

Introduction: Vancomycin remains the reference antibiotic in neonates for care-related infections caused by ß-lactam–resistant Gram-positive bacteria. Achieving the optimal serum vancomycin level is challenging because of high inter-individual variability and the drug's narrow therapeutic window. Continuous infusion might offer pharmacokinetic and practical advantages, but we lack consensus on the dosing regimen. The aim was to determine the proportion of neonates achieving an optimal therapeutic vancomycin level at the first vancomycin concentration assay and which dosing regimen is the most suitable for neonates.Methods: All neonates receiving continuous-infusion vancomycin (loading dose 15 mg/kg and maintenance dose 30 mg/kg/d) in a neonatal intensive care unit were retrospectively analyzed. The proportion of neonates reaching the target serum vancomycin level was calculated. After reviewing the literature to identify all published articles proposing a dosing regimen for continuous-infusion vancomycin for neonates, regimens were theoretically applied to our population by using maintenance doses according to covariate(s) proposed in the original publication.Results: Between January 2013 and December 2014, 75 neonates received 91 vancomycin courses by continuous infusion. Median gestational age, birth weight, and postnatal age were 27 weeks (interquartile range 26–30.5), 815 g (685–1,240), and 15 days (9–33). At the first assay, only 28/91 (30.8%) courses resulted in vancomycin levels between 20 and 30 mg/L (target level), 23/91 (25.3%) &gt;30 mg/L and 40/91 (43.9%) &lt;20 mg/L. We applied six published dosing regimens to our patients. One of these dosing regimens based on corrected gestational age (CGA) and serum creatinine level (SCR) would have allowed us to prescribe lower doses to neonates with high vancomycin levels and higher doses to neonates with low levels.Conclusions: A simplified dosing regimen of continuous-infusion vancomycin did not achieve therapeutic ranges in neonates; a patient-tailored dosing regimen taking into account CGA and SCR level or an individualized pharmacokinetic model can help to anticipate the inter-individual variability in neonates and would have been more suitable

Supporting women farmers in a changing climate: five policy lessons

Policies, institutions and services to help farmers develop new approaches to deal with climate change will need to produce results for women farmers as well as men. This brief provides five policy lessons to support this process, based on evidence from research in low- and middle- income countries and offers guidelines for crafting gender-responsive climate policies at global and national levels. This research was presented in March 2015 at a seminar in Paris on ‘Closing the gender gap in farming under climate change’, co-organized by the CGIAR Research Program on Climate Change, Agriculture and Food Security (CCAFS), the International Social Science Council (ISSC) and Future Earth

Premedication for neonatal intubation

L'administration préalable à l'intubation d'une anesthésie/sédation ou prémédication est recommandée depuis longtemps chez le nouveau-né. Néanmoins, il n'existe pas de consensus sur ses modalités précises et les pratiques dans ce domaine sont extrêmement hétérogènes. Les objectifs de cette thèse étaient de :Décrire les pratiques de prémédication avant l'intubation des nouveau-nés observées au lit du patient, dans des services de réanimation néonatale ou pédiatrique en région parisienne (étude EPIPPAIN)Explorer les déterminants éventuels de l'administration ou non d'une prémédicationRapporter l'expérience d'un service de réanimation néonatale (CHI Créteil) sur la mise en place d'un changement de pratique de prémédication avant intubationDans l'étude EPIPPAIN, 56% des intubations étaient précédées d'une prémédication spécifique pour le geste. Aucun facteur lié à l'enfant ou au service n'a été identifié comme significativement associé à l'utilisation ou non d'une prémédication. L'association atropine-sufentanil-atracurium a permis, dans une population de très grands prématurés (âge gestationnel < 32 SA), un taux de succès de 74% de la première tentative d'intubation, dans de bonnes conditions. Les désaturations et l'élévation prolongée de la PCO2 transcutanée étaient fréquentes.Il existe une marge de progression importante concernant la fréquence et la qualité des prémédications utilisées avant intubation néonatale dans les services français. Une démarche d'amélioration des pratiques est faisable. Cependant d'autres travaux sont nécessaires afin d'affiner la balance bénéfice/risque pour les nouveau-nés et de mettre en place, à grande échelle, de bonnes pratiques.Premedication prior to neonatal intubation has been recommended for a long time. However no consensus exists to date for a standardised premedication regimen. Practices are consequently extremely heterogeneous. The objectives of the present thesis were to: Describe actual premedication practices at patients’ bedside in neonatal and pediatric ICUs located in the Paris area (EPIPPAIN study). Explore potential risk factors associated with the use or non-use of a specific premedication prior to neonatal intubation. Report a single unit (CHI Créteil) experience with the implementation of a new premedication protocol In the EPIPPAIN study 56% of intubations were preceded by a specific premedication. No patient or centre’s characteristic was identified as significantly associated with the use or non-use of a specific premedication. The association atropine-sufentanil-atracurium in a population of very premature infants (born before 32 weeks of gestational age) resulted in a 74% rate of successful first intubation attempt with good conditions. Desaturations and persistent elevated transcutaneous PCO2 were frequent There is a potential for large improvement in the frequency and nature of premedication use for neonatal intubations in French NICUs. A quality improvement process is feasible. However, more research and actions are needed in order to refine the risk/benefit ratio of available regimens for neonates and to implement good practices at a large scale