Some workers win, others lose from currency depreciation

A depreciation is probably good news for low-skilled workers, write Boris Kaiser and Michael Siegenthale

The impact of physician exits in primary care: A study of practice handovers.

Recent studies on physician exits suggest that general practitioners (GPs) have an important impact on health care utilization and costs, but the transmission channels - interpersonal dis- continuities of care, practice style differences and deterioration in access - are usually not clear. Our objective is to estimate the short-run and long-run impacts of switches in GPs on patients' health care utilization and costs, while all other factors of the health care setting remain the same. To do this, we collect data on handovers of primary care practices in Switzerland, occurring between 2007 and 2015. We link this data to rich insurance claims to construct a panel dataset of roughly 240,000 patients. Employing a difference-in-difference type framework, we find transitory increases in overall visits and costs, which are likely caused by the entering GP's initial re-assessment of patients' health care needs. Additionally, we find long-term increases in specialist health care utilization and ambulatory costs. The latter finding can be explained by changes in practice styles between the exiting GP and her successor, who is typically much younger and more likely to be female. In contrast to the literature on practice closures, we do not find evidence on reduced overall utilization rates. An important lesson for health policy is thus to preserve patients' access to care in the case of GP exits

Der Einfluss des demografischen Wandels auf die Wirtschaftsstruktur der Schweiz

Die Bevölkerungsstruktur wird sich in den nächsten Jahrzehnten bedeutend verändern: Gemäss den Bevölkerungsszenarien des Bundesamts für Statistik wird der Altersquotient in der Schweiz (Anteil der über-64-Jährigen in Relation zu den 20- bis 64-Jährigen) von 30% im Jahr 2017 auf 48% im Jahr 2045 steigen. Vor diesem Hintergrund untersucht die vorliegende Studie, wie sich der künftige demografische Wandel auf die Branchenstruktur der Schweizer Volkswirtschaft auswirken könnte. Dabei wird sowohl die demografische Entwicklung im Inland als auch im Ausland einbezo-gen. Die empirische Analyse basiert auf detaillierten Mikrodaten zu den Konsumausgaben von Schwei-zer Privathaushalten, Daten der Schweizer Input-Output-Tabelle (IOT), der Welt-Input-Output Da-tenbank (WIOD) sowie Bevölkerungs- und Haushaltsszenarien für das In-und Ausland. Auf Grund-lage ökonometrischer Schätzungen wird simuliert, wie sich die Wertschöpfungsanteile der Schwei-zer Branchen verändern würden, wenn man die Bevölkerungsstruktur gemäss der Projektion für das Jahr 2060 unterstellt. Der Effekt der demografischen Veränderung wird dabei stets isoliert be-trachtet, sodass andere Entwicklungen, wie der technologische Fortschritt, ausgeklammert wer-den. Die Ergebnisse der Simulationen zeigen, dass sich der demografische Wandel im Inland haupt-sächlich auf staatsnahe, binnenorientierte Dienstleistungsbranchen positiv auswirkt. Die Verände-rung der Bevölkerungsstruktur bis 2060 dürfte dazu führen, dass der Anteil der Branche Gesund-heitswesen an der gesamtwirtschaftlichen Wertschöpfung um ca. 1.6 Prozentpunkte und jener der Branche Heime und Sozialwesen um rund 1.8 Prozentpunkte ansteigt. Zur Einordnung sei darauf hingewiesen, dass 1% der gesamtwirtschaftlichen Wertschöpfung rund 6 Milliarden Franken ent-spricht (Jahr 2012). Gleichzeitig dürfte der demografische Wandel im Ausland hauptsächlich zu einem starken Anstieg der pharmazeutischen Exporte und zu einem stärkeren Rückgang der Ex-porte von Finanzdienstleistungen führen. Dies wiederum könnte den Anteil der Pharmabranche an der gesamtwirtschaftlichen Wertschöpfung um ca. 2.8 Prozentpunkte erhöhen und den Anteil der Finanzdienstleistungen um ca. 1 Prozentpunkt reduzieren. Bei den meisten Branchen hatdie Alte-rung jedoch nur einen geringfügigen Einfluss auf deren Anteil an der Gesamtwirtschaft. Zusammengenommen legen die Ergebnisse den Schluss nahe, dass der demografische Wandel zu spürbaren strukturellen Veränderungen der Schweizer Wirtschaftsstruktur in Richtung Gesund-heitswesen, Heime und Sozialwesen und pharmazeutische Erzeugnisse führen könnte. Mit lang-fristig gesetzten, institutionellen Rahmenbedingungen kann die Wirtschaftspolitik dazu beitragen, dass sich die Volkswirtschaft möglichst friktionslos an den demografischen Wandel anpassen kann. Bei der Einordnung der Ergebnisse ist zu beachten, dass die „Demografie-Effekte“ nur einen Teil des Strukturwandels der Volkswirtschaft abbilden, der von anderen Entwicklungen (z.B. dem technologischen Fortschritt oder der internationalen Verflechtung) überlagert werden könnte. La structure démographique subira d’importantes modifications au cours des prochaines décen-nies: selon les scénarios correspondants de l’Office fédéral de la statistique, le rapport de dépen-dance des personnes âgées en Suisse (part des individus de plus de 64 ans comparée à celle des 20-64 ans) passera de 30% en 2017 à 48% en 2045. Dans ce contexte, la présente étude évalue les effets que les changements démographiques futurs pourraient exercer sur la structure écono-mique du pays. Ce faisant, elle s’appuie sur les développements démographiques en Suisse, mais aussi à l’étranger.L’analyse empirique repose sur des données microéconomiques relatives aux dépenses de con-sommation des ménages suisses, sur des données du tableau suisse des entrées et sorties (IOT), sur la banque de données mondiale des entrées et sorties (WIOD), ainsi que sur des scénarios démographiques et budgétaires des ménages en Suisse et à l’étranger. Des estimations écono-métriques permettent de simuler l’évolution des parts de la valeur ajoutée dans les branches éco-nomiques suisses, compte tenu d’une projection de la structure démographique à l’horizon 2060. Ce faisant, l’effet du changement démographique est toujours considéré de manière isolée, de sorte que l’effet d’autres développements, à l’exemple des progrès technologiques, en soit exclu. Les simulations révèlent que l’évolution démographique en Suisse aura des effets positifs surtout pour les branches de services proches de l’État et tournées vers le marché intérieur. Les change-ments de la structure démographique d’ici à 2060 devraient entraîner une hausse d’environ 1.6 points de pourcentage de la contribution de la branche de la santé à la valeur ajoutée de l’ensemble de l’économie, et de près de 1.8 points de pourcentage de la branche de l’hébergement médico-social et social et de l’action sociale. À titre de clarification, il faut préciser que 1% de la valeur ajoutée de l’ensemble de l’économie représente près de 6 milliards de francs (valeur 2012). Simul-tanément, l’évolution démographique à l’étranger devrait se traduire pour la Suisse par une forte hausse des exportations de produits pharmaceutiques et à un recul de l’exportation des services financiers. Il en résultera une augmentation de la part de la branche pharmaceutique à la valeur ajoutée de l’ensemble de l’économie de près de 2.8 points de pourcentage, et une baisse de celle des services financiers de 1 point de pourcentage. Dans la majorité des autres secteurs, en re-vanche, le vieillissement démographique n’exercera qu’une influence à faible portée sur l’évolution de leur contribution à l’ensemble de l’économie.En résumé, il apparaît que l’évolution démographique pourrait entraîner des changements percep-tibles de la structure économique suisse en matière de santé publique, de l’hébergement médico-social et social, de l’action social et de la production pharmaceutique. Avec des conditions-cadre institutionnelles projetées sur le long terme, la politique économique peut contribuer à une adapta-tion sans à-coups de l’économie nationale à l’évolution démographique. Pour l’appréciation des résultats de l’étude, il convient de se rappeler que les « effets démographiques» ne représentent qu’une part limitée du changement structurel de l’ensemble de l’économie, qui pourrait être super-posée d’autres développements, tels les progrès technologiques ou les imbrications internationales. La struttura della popolazione cambierà significativamente nei prossimi decenni: secondo gli sce-nari demografici dell’Ufficio federale di statistica,il rapporto di dipendenza in Svizzera (quota delle persone di età superiore ai 64 anni rispetto alla fascia di età 20-64 anni) passerà dal 30% nel 2017 al 48% nel 2045. In tale contesto, il presente studio esamina gli effetti del futuro cambiamento demografico sulla struttura settoriale dell’economia, tenendo conto dello sviluppo demografico sia in Svizzera, sia all’estero. L’analisi empirica si basa su microdati dettagliati relativi alle spese per i consumi delle economie domestiche svizzere, su dati della tavola input-output (OIT) svizzera, della banca dati mondiale input-output (WIOD) e scenari demografici e relativi alle economie domestiche in Svizzera e all’estero. Applicando una struttura demografica basata sulle proiezioni per l'anno 2060, attraverso stime econometriche si effettuano simulazioni che mostrano come cambierebbero le quote di crea-zione di valore dei settori svizzeri. L’effetto del cambiamento demografico viene considerato in maniera isolata, di modo che si possano escludere altri sviluppi, come i progressi tecnologici. I risultati delle simulazioni dimostrano che il mutamento demografico in Svizzera si ripercuoterà positivamente in particolare sui settori dei servizi parastatali orientati al mercato interno. In seguito al cambiamento della struttura della popolazione entro il 2060, nel settore della sanità la quota della creazione di valore a livello macroeconomico aumenterà di circa 1,6 punti percentuali e nel settore dei servizi di assistenza residenziale e assistenza sociale di circa 1,8 punti percentuali. A titolo di chiarificazione va notato che l’1% della creazione di valore a livello macroeconomico corrisponde a circa 6 miliardi di franchi (anno 2012). Al contempo, il mutamento demografico all’estero potrebbe portare principalmente a un forte aumento delle esportazioni farmaceutiche e a un calo maggiore delle esportazioni di servizi finanziari. Ciò comporterebbe a sua volta, sempre a livello dell’intera economia, un aumento di circa 2,8 punti percentuali della creazione di valore nelsettore farmaceu-tico e una riduzione di circa 1 punto percentuale della quota di servizi finanziari. Per quanto riguarda gli altri settori tuttavia, l’invecchiamento influisce solo in maniera esigua sulla rispettiva quota eco-nomica. Complessivamente, i risultati inducono a ritenere che il cambiamento demografico potrebbe com-portare sensibili cambiamenti strutturali dell’economia svizzera a vantaggio dei settori sanità, e di servizi di assistenza residenziale e assistenza sociale e prodotti farmaceutici. Attraverso condizioni quadro istituzionali lungimiranti, la politica economica può contribuire a far sì che l’economia possa adattarsi al cambiamento demografico nel modo più scorrevole possibile. Nell’ambito della classi-ficazione dei risultati va notato che gli «effetti demografici» rappresentano soltanto una parte del mutamento strutturale dell’economia: altri sviluppi (p. es. progresso tecnologico o integrazione in-ternazionale) potrebbero sovrapporvisi

Effect of pioglitazone treatment on behavioral symptoms in autistic children

INTRODUCTION: Autism is complex neuro-developmental disorder which has a symptomatic diagnosis in patients characterized by disorders in language/communication, behavior, and social interactions. The exact causes for autism are largely unknown, but is has been speculated that immune and inflammatory responses, particularly those of Th2 type, may be involved. Thiazolidinediones (TZDs) are agonists of the peroxisome proliferator activated receptor gamma (PPARγ), a nuclear hormone receptor which modulates insulin sensitivity, and have been shown to induce apoptosis in activated T-lymphocytes and exert anti-inflammatory effects in glial cells. The TZD pioglitazone (Actos) is an FDA-approved PPARγ agonist used to treat type 2 diabetes, with a good safety profile, currently being tested in clinical trials of other neurological diseases including AD and MS. We therefore tested the safety and therapeutic potential of oral pioglitazone in a small cohort of children with diagnosed autism. CASE DESCRIPTION: The rationale and risks of taking pioglitazone were explained to the parents, consent was obtained, and treatment was initiated at either 30 or 60 mg per day p.o. A total of 25 children (average age 7.9 ± 0.7 year old) were enrolled. Safety was assessed by measurements of metabolic profiles and blood pressure; effects on behavioral symptoms were assessed by the Aberrant Behavior Checklist (ABC), which measures hyperactivity, inappropriate speech, irritability, lethargy, and stereotypy, done at baseline and after 3–4 months of treatment. DISCUSSION AND EVALUATION: In a small cohort of autistic children, daily treatment with 30 or 60 mg p.o. pioglitazone for 3–4 months induced apparent clinical improvement without adverse events. There were no adverse effects noted and behavioral measurements revealed a significant decrease in 4 out of 5 subcategories (irritability, lethargy, stereotypy, and hyperactivity). Improved behaviors were inversely correlated with patient age, indicating stronger effects on the younger patients. CONCLUSION: Pioglitazone should be considered for further testing of therapeutic potential in autistic patients

Randomized Controlled Trial of Individualized Arousal-Biofeedback for children and adolescents with Disruptive Behavior Disorders (DBD)

Background: Disruptive behavior disorders (including conduct disorder (CD) and oppositional defiant disorder (ODD)) are common childhood and adolescent psychiatric conditions often linked to altered arousal. The recommended first-line treatment is multi-modal therapy and includes psychosocial and behavioral interventions. Their modest effect sizes along with clinically and biologically heterogeneous phenotypes, emphasize the need for innovative personalized treatment targeting impaired functions such as arousal dysregulation. Methods: A total of 37 children aged 8-14 years diagnosed with ODD/CD were randomized to 20 sessions of individualized arousal biofeedback using skin conductance levels (SCL-BF) or active treatment as usual (TAU) including psychoeducation and cognitive-behavioral elements. The primary outcome was the change in parents´ ratings of aggressive behavior measured by the Modified Overt Aggression Scale. Secondary outcome measures were subscales from the Child Behavior Checklist, the Inventory of Callous-Unemotional traits and the Reactive-Proactive Aggression Questionnaire. Results: The SCL-BF treatment was neither superior nor inferior to the active TAU. Both groups showed reduced aggression after treatment with small effects for the primary outcome and large effects for some secondary outcomes. Importantly, successful learning of SCL self-regulation was related to reduced aggression at post-assessment. Conclusions: Individualized SCL-BF was not inferior to active TAU for any treatment outcome with improvements in aggression. Further, participants were on average able to self-regulate their SCL, and those who best learned self-regulation showed the highest clinical improvement, pointing to specificity of SCL-BF regulation for improving aggression. Further studies with larger samples and improved methods, for example by developing BF for mobile use in ecologically more valid settings are warranted

The tomato receptor CuRe1 senses a cell wall protein to identify Cuscuta as a pathogen

Parasitic plants of the genus Cuscuta penetrate shoots of host plants with haustoria and build a connection to the host vasculature to exhaust water, solutes and carbohydrates. Such infections usually stay unrecognized by the host and lead to harmful host plant damage. Here, we show a molecular mechanism of how plants can sense parasitic Cuscuta. We isolated an 11 kDa protein of the parasite cell wall and identified it as a glycine-rich protein (GRP). This GRP, as well as its minimal peptide epitope Crip21, serve as a pathogen-associated molecular pattern and specifically bind and activate a membrane-bound immune receptor of tomato, the Cuscuta Receptor 1 (CuRe1), leading to defense responses in resistant hosts. These findings provide the initial steps to understand the resistance mechanisms against parasitic plants and further offer great potential for protecting crops by engineering resistance against parasitic plants

TIC 378898110: A Bright, Short-Period AM CVn Binary in TESS

AM CVn-type systems are ultracompact, helium-accreting binary systems which are evolutionarily linked to the progenitors of thermonuclear supernovae and are expected to be strong Galactic sources of gravitational waves detectable to upcoming space-based interferometers. AM CVn binaries with orbital periods $\lesssim$ 20--23 min exist in a constant high state with a permanently ionised accretion disc. We present the discovery of TIC 378898110, a bright ($G=14.3$ mag), nearby ($309.3 \pm 1.8$ pc), high-state AM CVn binary discovered in TESS two-minute-cadence photometry. At optical wavelengths this is the third-brightest AM CVn binary known. The photometry of the system shows a 23.07172(6) min periodicity, which is likely to be the `superhump' period and implies an orbital period in the range 22--23 min. There is no detectable spectroscopic variability. The system underwent an unusual, year-long brightening event during which the dominant photometric period changed to a shorter period (constrained to $20.5 \pm 2.0$ min), which we suggest may be evidence for the onset of disc-edge eclipses. The estimated mass transfer rate, $\log (\dot{M} / \mathrm{M_\odot} \mathrm{yr}^{-1}) = -6.8 \pm 1.0$, is unusually high and may suggest a high-mass or thermally inflated donor. The binary is detected as an X-ray source, with a flux of $9.2 ^{+4.2}_{-1.8} \times 10^{-13}$ erg cm$^{-2}$ s$^{-1}$ in the 0.3--10 keV range. TIC 378898110 is the shortest-period binary system discovered with TESS, and its large predicted gravitational-wave amplitude makes it a compelling verification binary for future space-based gravitational wave detectors.Comment: 15 pages, 14 figures. Accepted to MNRA

Molecular transformation and degradation of refractory dissolved organic matter in the Atlantic and Southern Ocean

More than 90% of the global ocean dissolved organic carbon (DOC) is refractory, has an average age of 4,000–6,000 years and a lifespan from months to millennia. The fraction of dissolved organic matter (DOM) that is resistant to degradation is a long-term buffer in the global carbon cycle but its chemical composition, structure, and biochemical formation and degradation mechanisms are still unresolved. We have compiled the most comprehensive molecular data set of 197 Fourier transform ion cyclotron resonance mass spectrometry (FT-ICR MS) analyses from solid-phase extracted marine DOM covering two major oceans, the Atlantic sector of the Southern Ocean and the East Atlantic Ocean (ranging from 50° N to 70° S). Molecular trends and radiocarbon dating of 34 DOM samples (comprising Δ14C values from -229 to -495‰) were combined to model an integrated degradation rate for bulk DOC resulting in a predicted age of >24 ka for the most persistent DOM fraction. First order kinetic degradation rates for 1,557 mass peaks indicate that numerous DOM molecules cycle on timescales much longer than the turnover of the bulk DOC pool (estimated residence times of >100 ka) and the range of validity of radiocarbon dating. Changes in elemental composition were determined by assigning molecular formulae to the detected mass peaks. The combination of residence times with molecular information enabled modelling of the average elemental composition of the slowest degrading fraction of the DOM pool. In our dataset, a group of 361 molecular formulae represented the most stable composition in the oceanic environment (“island of stability”). These most persistent compounds encompass only a narrow range of the elemental ratios H/C (average of 1.17 ± 0.13), and O/C (average of 0.52 ± 0.10) and molecular masses (360 ± 28 and 497 ± 51 Da). In the Weddell Sea DOC concentrations in the surface waters were low (46.3 ± 3.3 μM) while the organic radiocarbon was significantly more depleted than that of the East Atlantic, indicating average surface water DOM ages of 4,920 ± 180 a. These results are in accordance with a highly degraded DOM in the Weddell Sea surface water as also shown by the molecular degradation index IDEG obtained from FT-ICR MS data. Further, we identified 339 molecular formulae which probably contribute to an increased DOC concentration in the Southern Ocean and potentially reflect an accumulation or enhanced sequestration of refractory DOC in the Weddell Sea. These results will contribute to a better understanding of the persistent nature of marine DOM and its role as an oceanic carbon buffer in a changing climate

Detection of volatile organic compounds as potential novel biomarkers for chorioamnionitis - proof of experimental models

Background: Histologic chorioamnionitis is only diagnosed postnatally which prevents interventions. We hypothesized that volatile organic compounds (VOCs) in the amniotic fluid might be useful biomarkers for chorioamnionitis and that VOC profiles differ between amnionitis of different origins. Methods: Time-mated ewes received intra-amniotic injections of media or saline (controls), or live Ureaplasma parvum serovar 3 (Up) 14, 7 or 3d prior to c-section at day 124 gestational age (GA). 100 μg recombinant ovine IL-1α was instilled at 7, 3 or 1d prior to delivery. Headspace VOC profiles were measured from amniotic fluids at birth using ion mobility spectrometer coupled with multi-capillary columns. Results: 127 VOC peaks were identified. 27 VOCs differed between samples from controls and Up- or IL-1α induced amnionitis. The best discrimination between amnionitis by Up vs. IL-1α was reached by 2-methylpentane, with a sensitivity/specificity of 96/95% and a positive predictive value/negative predictive values of 96 and 95%. The concentration of 2-methylpentane in VOCs peaked 7d after intra-amniotic instillation of Up. Discussion: We established a novel method to study headspace VOC profiles of amniotic fluids. VOC profiles may be a useful tool to detect and to assess the duration of amnionitis induced by Up. 2-methylpentane was previously described in the exhalate of women with pre-eclampsia and might be a volatile biomarker for amnionitis. Amniotic fluids analyzed by ion mobility spectrometry coupled with multi-capillary columns may provide bedside diagnosis of amnionitis and understanding inflammatory mechanisms during pregnancy

Supersonic turbulence in shock-bound interaction zones I: symmetric settings

Colliding hypersonic flows play a decisive role in many astrophysical objects. In this paper, we look at the idealized model of a 2D plane parallel isothermal slab (CDL) and at symmetric settings, where both flows have equal parameters. We performed a set of high-resolution simulations with upwind Mach numbers, 5 < M_u < 90. We find that the CDL is irregularly shaped and has a patchy and filamentary interior. The size of these structures increases with l_cdl, the extension of the CDL. On average, but not at each moment, the solution is about self-similar and depends only on M_u. We find the root mean square Mach number to scale as M_rms ~ 0.2 M_u. Independent of M_u is the mean density, rho_m ~ 30 rho_u. The fraction f_eff of the upwind kinetic energy that survives shock passage scales as f_eff= 1 - M_rms^(-0.6). This dependence persists if the upwind flow parameters differ from one side to the other of the CDL, indicating that the turbulence within the CDL and its driving are mutually coupled. In the same direction points the finding that the auto-correlation length of the confining shocks and the characteristic length scale of the turbulence within the CDL are proportional. In summary, larger upstream Mach numbers lead to a faster expanding CDL with more strongly inclined confining interfaces relative to the upstream flows, more efficient driving, and finer interior structure relative to the extension of the CDL.Comment: version sent to publisher, final language/typo corrections made. 23 pages, 19 figures, accepted for publication in A&A, version with high quality color images can be found at http://www.astro.phys.ethz.ch/papers/folini/folini_p_nf.htm