Shale Gas Royalties in New Brunswick: An Evaluation

In 2014, the government of New Brunswick implemented a new royalty regime for natural gas in the context of their regulatory review of shale gas. Advocates of shale gas stressed the additional government revenues that would result. However, the government provided no background documentation to explain their methodology or substantiate their claims. This study provides such estimates, utilizing a methodology that incorporates the intricacies of the New Brunswick system and assumptions drawn from economic and productivity analysis of the North American shale gas industry. Our study challenges previous revenue estimates and provides a transparent methodology to inform public policy.En 2014, le gouvernement du Nouveau Brunswick a mis en oeuvre un nouveau régime de redevances pour le gaz naturel dans le cadre de son examen réglementaire du gaz de schiste. Des défenseurs du gaz de schiste ont souligné les recettes publiques supplémentaires qui en résulteraient. Toutefois, le gouvernement n’a pas fourni de documentation de référence pour expliquer sa méthodologie ou étayer ses affirmations. La présente étude fournit de telles estimations, grâce à une méthodologie qui tient compte des complexités du système du Nouveau Brunswick et des hypothèses établies à partir de l’analyse de l’économie et de la productivité de l’industrie nord-américaine du gaz de schiste. Notre étude remet en question les dernières estimations des recettes et présente une méthodologie transparente permettant d’orienter les politiques publiques

Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.

Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

The ethics of care and the Newfoundland Paid Family Caregiver Program: An assessment

The ethics of care has gained traction as a feminist normative lens from which to examine policies and policy issues (Hankivksy 2004; Mahon and Robinson 2011; Sevenhuijsen 2003; Sevenhuijsen et al. 2006). This paper aims to contribute to this growing literature by employing a critical ethics of care lens to assess a long-term care initiative in the province of Newfoundland and Labrador, Canada. This initiative, called the Newfoundland Paid Family Caregiver Program (NPFCP), allows eligible participants to pay family members for some care services. This analysis uncovers numerous tensions, both practical and theoretical, related to the way this program (re)shapes the caring relations of participants. Specifically, the paper discusses the ways in which this program downloads caring responsibilities onto the family, characterizes care as a private concern, and fails to facilitate competent and consistent care.RésuméL’éthique du care (voir aussi éthique de la sollicitude) a gagné en popularité en tant que notion féministe qui examine les politiques et les enjeux politiques (Hankivksy 2004; Mahon and Robinson 2011; Sevenhuijsen 2003; Sevenhuijsen et al. 2006). Cet article a pour but de contribuer à cette littérature grandissante en abordant l’éthique du care d’un oeil critique afin d’interpréter l’initiative de soin de longue durée dans la province de Terre-Neuve-et Labrador au Canada. Cette initiative, appelée Newfoundland Paid Family Caregiver Program (NPFCP) est un programme permettant aux participants admissibles d’obtenir des soins rémunérés d’un membre de sa famille. Cette analyse décèle de nombreuses tensions, pratiques et théoriques, liées à la manière dont le programme redéfinit la sollicitude des participants. Plus précisément, cet article aborde la façon dont ce programme transfert la responsabilité des soins à la famille, traite les soins comme une affaire privée et ne facilite pas les soins professionnels et continus.Mots clé: Éthique du care crucial ; soin de longue durée ; programmes de financement direct ; analyse normative des politique

The ethics of care and the Newfoundland Paid Family Caregiver Program: An assessment

The ethics of care has gained traction as a feminist normative lens from which to examine policies and policy issues. This paper aims to contribute to this growing literature by employing a critical ethics of care lens to assess a new long-term care initiative in the province of Newfoundland and Labrador, Canada. This initiative, called the Newfoundland Paid Family Caregiver Program, allows eligible participants to pay family members for some care services. This analysis uncovers numerous tensions, both practical and theoretical, related to the way this program (re)organizes care. Specifically, the ways in which this program downloads caring responsibilities onto the family, characterizes care as a private concern, and monetizes caring relations is discussed.