Intellectual property and antitrust limitations on contract: comment

In their chapter in Dynamic Competition and Public Policy (2001, Cambridge University Press), Burtis and Kobayashi never defined their model's discount rate, making replicating their simulation results difficult. Through our own simulations, we were able to verify their results when using a discount rate of 0.10. We also identified two new types of equilibria that the authors overlooked, doubling the number of distinct equilibria in the model.

Measuring the Economic Impact of High Speed Rail Construction for California and the Central Valley Region

The nation’s first high-speed rail project is under construction in California’s Central Valley as of the date of this report. This research analyzes the immediate economic impacts, focused on employment and spending generated by California High-Speed Rail (HSR) Construction Package 1 (CP1) in the Central Valley and the rest of California. The authors use a two-pronged approach that combines original economic analysis and modeling with case study vignettes that explore the economic impacts through the lens of a sample of businesses and individuals directly impacted by this phase of HSR development. Overall, the economic analysis suggests that CP1-related spending (forecasted through to 2019) will lead to more than 31,500 additional jobs (both part-time and full-time) by the year 2029. Growth is concentrated in Fresno County, with the number of additional jobs estimated at more than 15,500. The analysis considers job growth across a number of alternative scenarios, converting the raw jobs estimates to full-time equivalent job-years. Under the most conservative HSR spending scenario considered, over the 15-year period evaluated, more than 25,000 full-time equivalent job-years are created. This amount to 14,900 jobs per billion (real) dollars of spending, or a cost of approximately $67,200 per job-year

Does Political Incorporation Matter? The Impact of Minority Mayors Over Time

The authors assess the effects of minority political incorporation in large cities. An interrupted time-series research design is used to determine whether the election of a city’s first minority mayor has any short-term or long-term impact on fiscal policies. The authors examined six cities that elected black or Latino mayors and six cities with white mayors from 1972 to 1992. In general, they find that minority political incorporation did not significantly change fiscal policies in different ways from that which occurred in cities without minority incorporation

Local Government Fiscal Burden in Nonmetropolitan America

Rising fiscal pressure on local governments in rural areas of the United States is documented in this study. The level of fiscal burden on taxpayers to support local governments in nonmetropolitan areas is found to be higher than that in metropolitan areas between 1977 and 1987. Using a model from the urban fiscal literature, the level of fiscal burden in nonmetropolitan areas is found to be influenced by a combination of demographic, socioeconomic, intergovernmental, and historical factors. Intergovernmental revenue transfers from the state and federal government play a critical role in determining the level of fiscal burden rural taxpayers bear. These findings have implications for rural economic development and for understanding how rural areas are influenced by the larger society

Toxicity of Lunar and Martian Dust Simulants to Alveolar Macrophages Isolated from Human Volunteers

NASA is planning to build a habitat on the Moon and use the Moon as a stepping stone to Mars. JSC-1, an Arizona volcanic ash that has mineral properties similar to lunar soil, is used to produce lunar environments for instrument and equipment testing. NASA is concerned about potential health risks to workers exposed to these fine dusts in test facilities. The potential toxicity of JSC-1 and a Martian soil simulant (JSC-Mars-1, a Hawaiian volcanic ash) was evaluated using human alveolar macrophages (HAM) isolated from volunteers; titanium dioxide and quartz were used as reference dusts. This investigation is a prerequisite to studies of actual lunar dust. HAM were treated in vitro with these test dusts for 24 h; assays of cell viability and apoptosis showed that JSC-1 and TiO2 were comparable, and more toxic than saline control, but less toxic than quartz. HAM treated with JSC-1 or JSC-Mars 1 showed a dose-dependent increase in cytotoxicity. To elucidate the mechanism by which these dusts induce apoptosis, we investigated the involvement of the scavenger receptor (SR). Pretreatment of cells with polyinosinic acid, an SR blocker, significantly inhibited both apoptosis and necrosis. These results suggest HAM cytotoxicity may be initiated by interaction of the dust particles with SR. Besides being cytotoxic, silica is known to induce shifting of HAM phenotypes to an immune active status. The immunomodulatory effect of the simulants was investigated. Treatment of HAM with either simulant caused preferential damage to the suppressor macrophage subpopulation, leading to a net increase in the ratio of activator (RFD1+) to suppressor (RFD1+7+) macrophages, a result similar to treatment with silica. It is recommended that appropriate precautions be used to minimize exposure to these fine dusts in large-scale engineering applications

Improving kidney care for people with severe mental health difficulties:A thematic analysis of personal and family members’ perspectives

People with severe mental health difficulties (SMHDs) often have poorer access to kidney healthcare. To better understand the barriers and facilitators to kidney healthcare for this population, we conducted interviews with nine individuals with SMHDs and four family members. Through reflexive thematic analysis, we generated three themes: (1) ‘One size doesn’t fit all’ describes the need for individualised kidney healthcare, adapted to meet the specific needs of each person with a SMHD. (2) ‘You just can’t say, “I’m only dealing with your kidney here”’ describes how fragmentation of physical and mental healthcare services can lead to poorer outcomes for people with SMHDs, underscoring the need for coordinated care. (3) ‘Just treat me with respect’ describes the impact of healthcare provider attitudes. Overall, participants praised the dedication and kindness of renal clinicians. However, some participants also described experiences of stigma and discrimination, and called for additional education for healthcare providers regarding SMHDs

Improving kidney care for people with severe mental health difficulties: a thematic analysis of twenty-two healthcare providers’ perspectives

IntroductionPeople with severe mental health difficulties (SMHDs) and concurrent kidney disease have less access to quality kidney care and worse clinical outcomes. Our research investigates the barriers and facilitators to effective kidney care for people with SMHDs, and how care might be improved for this underserved population.MethodsWe conducted semi-structured interviews with twenty-two physical (n = 14) and mental (n = 8) healthcare professionals with experience working with people with SMHDs and concurrent kidney disease. Interview data were analysed and interpreted using reflexive thematic analysis.ResultsFour themes were generated from the data: 1. “It’s about understanding their limitations and challenges, without limiting their rights” describes how some people with SMHDs need additional support when accessing kidney care due to challenges with their mental state, motivation, cognitive difficulties, or mistrust of the healthcare system. 2. “There are people falling through the cracks” describes how the separation of physical and mental healthcare, combined with under-resourcing and understaffing, results in poorer outcomes for people with SMHDs. 3. “Psychiatry is a black spot in our continuing medical education” describes how many renal healthcare providers have limited confidence in their understanding of mental health and their ability to provide care for people with SMHDs. 4. “When they present to a busy emergency department with a problem, the staff tend to go ‘…psych patient”” describes how stigma towards people with SMHDs can negatively impact quality of care.ConclusionHealthcare professionals accounts’ describe how people with SMHDs and kidney disease can have favourable outcomes if they have appropriate hospital, community and social supports. Findings indicate that effective management of kidney disease for people with SMHDs requires integrated physical and mental health care, which takes an individualised “whole person” approach to addressing the interaction between kidney disease and mental health

Design and baseline characteristics of the finerenone in reducing cardiovascular mortality and morbidity in diabetic kidney disease trial

Background: Among people with diabetes, those with kidney disease have exceptionally high rates of cardiovascular (CV) morbidity and mortality and progression of their underlying kidney disease. Finerenone is a novel, nonsteroidal, selective mineralocorticoid receptor antagonist that has shown to reduce albuminuria in type 2 diabetes (T2D) patients with chronic kidney disease (CKD) while revealing only a low risk of hyperkalemia. However, the effect of finerenone on CV and renal outcomes has not yet been investigated in long-term trials. Patients and Methods: The Finerenone in Reducing CV Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial aims to assess the efficacy and safety of finerenone compared to placebo at reducing clinically important CV and renal outcomes in T2D patients with CKD. FIGARO-DKD is a randomized, double-blind, placebo-controlled, parallel-group, event-driven trial running in 47 countries with an expected duration of approximately 6 years. FIGARO-DKD randomized 7,437 patients with an estimated glomerular filtration rate >= 25 mL/min/1.73 m(2) and albuminuria (urinary albumin-to-creatinine ratio >= 30 to <= 5,000 mg/g). The study has at least 90% power to detect a 20% reduction in the risk of the primary outcome (overall two-sided significance level alpha = 0.05), the composite of time to first occurrence of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. Conclusions: FIGARO-DKD will determine whether an optimally treated cohort of T2D patients with CKD at high risk of CV and renal events will experience cardiorenal benefits with the addition of finerenone to their treatment regimen. Trial Registration: EudraCT number: 2015-000950-39; ClinicalTrials.gov identifier: NCT02545049

Infant mortality and health care in Mexican communities

Data from the 1976-1977 Mexican Fertility Survey show a high degree of correlation among community background characteristics, access to medical services and utilization of health care in a sample of 125 localities. All of these factors are related to infant mortality at the bivariate level. Use of prenatal and infant health care, but not proximity to medical personnel and facilities, is found to affect infant survival independently of the community's degree of socio-economic development. The findings point to the need to employ separate measures of medical access and health utilization.infant mortality prenatal care medical access Mexico