Brexit will exacerbate long-term challenges facing the UK economy

Leaving the EU represents the largest change in the UK’s relationship with the rest of the world in half a century. The impact won’t be a one-off event. Structural changes will take place over the long term, as capital and labour adjust to the new trading arrangements. Household incomes will decrease as a result of a weaker pound and lower investment and trade. But we should not expect changes to the UK’s overall services focus and export specialisation. Swati Dhingra, Emily Fry, Sophie Hale, and Ningyuan Jia write that understanding the scale and nature of this change, and the extent of progress so far, is crucial for policymakers looking to reset the country’s economic strategy

Model-based financial regulations impair the transition to net-zero carbon emissions

Investments via the financial system are essential for fostering the green transition. However, the role of existing financial regulations in influencing investment decisions is understudied. Here we analyse data from the European Banking Authority to show that existing financial accounting frameworks might inadvertently be creating disincentives for investments in low-carbon assets. We find that differences in the provision coverage ratio indicate that banks must account for nearly double the loan loss provisions for lending to low-carbon sectors as compared with high-carbon sectors. This bias is probably the result of basing risk estimates on historical data. We show that the average historical financial risk of the oil and gas sector has been consistently estimated to be lower than that of renewable energy. These results indicate that this bias could be present in other model-based regulations, such as capital requirements, and possibly impact the ability of banks to fund green investments

(Cost)effectiveness of life review for Older Adults: Design of a randomized controlled trial

Background Depression in older adults is a serious health problem with a poor prognosis. There is a need for indicated preventive psychological interventions for older adults, that show to be promising in preventing depressive disorders. Methods/design This manuscript describes the design of a study evaluating 'Looking for Meaning', a newly developed prevention course for older adults with depressive symptoms, based on life-review. Both clinical and economic effectiveness are evaluated in a pragmatic randomized controlled trial. The control condition of this 12-session preventive intervention is a 20-minute video movie. The primary outcome is symptoms of depression at post-treatment and follow-up (6 months after post-treatment). Secondary outcomes are symptoms of anxiety, satisfaction with life, mastery, reminiscence styles, quality of life, and health care costs. An additional result of this study is the insight into the working elements of the course, provided by the qualitative study. The qualitative data, mainly based on 20 open-ended interviews with participants, are to be analyzed with an emphasis on newly emerging insight. Discussion This study will add to the existing scientific knowledge in several ways, especially by also including an economic evaluation and a qualitative study to gain insight into the working mechanisms of the course, both rather new in the field of life review. Positive results of this study will make an evidence-based intervention to improve public health among older people available

The silicon isotope composition of Ethmodiscus rexlaminated diatom mats from the tropical West Pacific: Implications for silicate cycling during the Last Glacial Maximum

The cause of massive blooms of Ethmodiscus rex laminated diatom mats (LDMs) in the eastern Philippine Sea (EPS) during the Last Glacial Maximum (LGM) remains uncertain. In order to better understand the mechanism of formation of E. rex LDMs from the perspective of dissolved silicon (DSi) utilization, we determined the silicon isotopic composition of single E. rex diatom frustules (δ30SiE. rex) from two sediment cores in the Parece Vela Basin of the EPS. In the study cores, δ30SiE. rex varies from −1.23‰ to −0.83‰ (average −1.04‰), a range that is atypical of marine diatom δ30Si and that corresponds to the lower limit of reported diatom δ30Si values of any age. A binary mixing model (upwelled silicon versus eolian silicon) accounting for silicon isotopic fractionation during DSi uptake by diatoms was constructed. The binary mixing model demonstrates that E. rex dominantly utilized DSi from eolian sources (i.e., Asian dust) with only minor contributions from upwelled seawater sources (i.e., advected from Subantarctic Mode Water, Antarctic Intermediate Water, or North Pacific Intermediate Water). E. rex utilized only ~24% of available DSi, indicating that surface waters of the EPS were eutrophic with respect to silicon during the LGM. Our results suggest that giant diatoms did not always use a buoyancy strategy to obtain nutrients from the deep nutrient pool, thus revising previously proposed models for the formation of E. rex LDMs

Rapid increase in pertactin-deficient Bordetella pertussis isolates, Australia

Acellular vaccines against Bordetella pertussis were introduced in Australia in 1997. By 2000, these vaccines had replaced whole-cell vaccines. During 2008–2012, a large outbreak of pertussis occurred. During this period, 30% (96/320) of B. pertussis isolates did not express the vaccine antigen pertactin (prn). Multiple mechanisms of prn inactivation were documented, including IS481 and IS1002 disruptions, a variation within a homopolymeric tract, and deletion of the prn gene. The mechanism of lack of expression of prn in 16 (17%) isolates could not be determined at the sequence level. These findings suggest that B. pertussis not expressing prn arose independently multiple times since 2008, rather than by expansion of a single prn-negative clone. All but 1 isolate had ptxA1, prn2, and ptxP3, the alleles representative of currently circulating strains in Australia. This pattern is consistent with continuing evolution of B. pertussis in response to vaccine selection pressure.Connie Lam, Sophie Octavia, Lawrence Ricafort, Vitali Sintchenko, Gwendolyn L. Gilbert, Nicholas Wood, Peter McIntyre, Helen Marshall, Nicole Guiso, Anthony D. Keil, Andrew Lawrence, Jenny Robson, Geoff Hogg, and Ruiting La

Fulvestrant for the treatment of advanced breast cancer

Introduction: The current issues with endocrine therapy for treatment of advanced breast cancer include balance of efficacy of therapy versus tolerability as well as hormone resistance. The efficacy of fulvestrant, a selective oestrogen receptor degrader (SERD), has been demonstrated in hormone receptor positive patients previously untreated or treated with hormonal therapy. Areas covered: This article discusses the journey of fulvestrant licensing, its efficacy in combination with other endocrine therapies and the future role it may have within breast cancer treatment. Expert commentary: Within phase III trials, fulvestrant has demonstrated equivalent or improved clinical efficacy when compared with established endocrine agents. In the recent decade, fulvestrant has achieved licensing as a second line agent in non-operative advanced breast cancer at initially 250mg, increasing to 500mg. Presently, fulvestrant is licensed globally as first line endocrine management for advanced breast cancer in post-menopausal women. Early combination trials of fulvestrant and cyclin dependent kinase 4/6 inhibitors have demonstrated good clinical efficacy with improved progression free survival when compared to fulvestrant alone