Growth and Business Cycles with Imperfect Credit Markets

We study the process of growth and business cycles in an open economy which has access to international financial markets. The financial market imperfection originates from costly state verification and a positive probability of default on loans. The degree of credit market imperfection is endogenously derived. The results show that developed economies are able to borrow on easier terms than emerging countries. The credit market imperfection may cause some economies to fall into a development trap if the initial endowment of capital is too low. The financial market frictions also generate interesting business cycle dynamics. Financial market imperfections help in replicating the empirical fact that output growth shows positive autocorrelation at short horizons. The model also predicts that a poorer economy will experience a more severe and persistent e.ect on investment and output due to an exogenous shock

Systems Analysis of complex glaciological processes and application to calving of Amery Ice Shelf, East Antarctica

Calving is a complex process subject to several cooperating atmospheric, oceanographic and glaciological forcings that vary in space and time, and whose relative effects are challenging to separate. Statistical ‘Systems Analysis’ is commonly used in engineering and economics to extricate complex ‘force–response’ relationships. Here we apply Systems Analysis to the Amery rift system, East Antarctica. We develop a scalable ‘System Model’ driven by a coarsely-sampled dataset characteristic of glaciological observations in remote locations, and validate it using rift lengths observed in 2000–06 and 2012. In this initial demonstration, we forecast a detachment date of ∼2019 ± 5 years for the large tabular iceberg colloquially known as the ‘Loose Tooth’, for which relative humidity surprisingly emerges as the best statistical predictor. RACMO2 climate modelling reveals that relative humidity correlates best with surface albedo and snowmelt, both of which are intimately linked to firn compaction and ice shelf temperature and flow. We postulate that relative humidity can therefore serve as a proxy for internal stress, a known key control of ‘Loose Tooth’ calving. Although no physical causality is implied in Systems Analysis, postulates such as this can aid in setting priorities in studies of complex glaciological processes

Improving Community Healthcare for Patients with Parkinson's Disease: The Dutch Model

Because of the complex nature of Parkinson's disease, a wide variety of health professionals are involved in care. Stepwise, we have addressed the challenges in the provision of multidisciplinary care for this patient group. As a starting point, we have gained detailed insight into the current delivery of allied healthcare, as well as the barriers and facilitators for optimal care. To overcome the identified barriers, a tertiary referral centre was founded; evidence-based guidelines were developed and cost-effectively implemented within regional community networks of specifically trained allied health professionals (the ParkinsonNet concept). We increasingly use ICT to bind these professional networks together and also to empower and engage patients in making decisions about their health. This comprehensive approach is likely to be feasible for other countries as well, so we currently collaborate in a European collaboration to improve community care for persons with Parkinson's disease

Preparatory Effects of Distractor Suppression: Evidence from Visual Cortex

Spatial selective attention is the mechanism that facilitates the selection of relevant information over irrelevant information in the visual field. The current study investigated whether foreknowledge of the presence or absence of distractors surrounding an impending target stimulus results in preparatory changes in visual cortex. We cued the location of the target and the presence or absence of distractors surrounding the target while changes in blood oxygen level dependent (BOLD) signals were measured. In line with prior work, we found that top-down spatial attention resulted in an increased contralateral BOLD response, evoked by the cue throughout early visual cortex (areas V1, V2 and V3). In addition, cues indicating distractor presence evoked a substantial increase in the magnitude of the BOLD signal in visual area V3, but not in V2 or V1. This study shows that prior knowledge concerning the presence of a distractor results in enhanced attentional modulation of visual cortex, in visual areas where neuronal receptive fields are large enough to encompass both targets and distractors. We interpret these findings as evidence that top-down attentional control processes include active preparatory suppression mechanisms for irrelevant, distracting information in the visual scene

Using Medical Claims Analyses to Understand Interventions for Parkinson Patients.

The scientific evidence to support the value of a range of non-pharmacological interventions for people with Parkinson's disease (PD) is increasing. However, showing unequivocally that specific interventions are better than usual care is not straightforward because of generic drawbacks of clinical trials. Here, we address these challenges, specifically related to the context of evaluating complex non-pharmacological interventions for people with PD. Moreover, we discuss the potential merits of undertaking "real world" analyses using medical claims data. We illustrate this approach by discussing an interesting recent publication in The Lancet Neurology, which used such an approach to demonstrate the value of specialized physiotherapy for PD patients, over and above usual care physiotherapy.Professor Bastiaan R. Bloem is supported by a research grant of the Parkinson’s Foundation. Dr. Nienke M. de Vries is supported by a research grant from The Netherlands Organization for Health Research and Development. Dr. Allison Willis is supported by the Parkinson’s Foundation, the National Institutes of Health (R01-NS-099129-01A1), the Patient Centred Outcomes Research Institute, and the University of Pennsylvania

Spatial Response of Greenland's Firn Layer to NAO Variability

Firn on the Greenland Ice Sheet (GrIS) buffers meltwater, and has a variable thickness, complicating observations of volume change to mass change. In this study, we use a firn model (IMAU-FDM v1.2G) forced by a regional climate model (RACMO2.3p2) to investigate how the GrIS firn layer thickness and pore space have evolved since 1958 in response to variability in the large-scale atmospheric circulation. On interannual timescales, the firn layer thickness and pore space show a spatially heterogeneous response to variability in the North Atlantic Oscillation (NAO). Notably, a stronger NAO following the record warm summer of 2012 led the firn layer in the south and east of the ice sheet to regain thickness and pore space after a period of thinning and reduced pore space. In the southwest, a decrease in melt dominated after 2012, whereas in the east, the main driver was an increase in snow accumulation. At the same time, the firn in the northwestern ice sheet continued to lose pore space. The NAO also varies on intra-annual timescales, being typically stronger in winter than in summer. This impacts the amplitude of the seasonal cycle in GrIS firn thickness and pore space. In the wet southeastern GrIS, most of the snow accumulates during the winter, when melting and densification are relatively weak, leading to a large seasonal cycle in thickness and pore space. The opposite occurs in other regions, where snowfall peaks in summer or autumn. This dampens the seasonal amplitude of firn thickness and pore space

Increased variability in Greenland Ice Sheet runoff from satellite observations

Runoff from the Greenland Ice Sheet has increased over recent decades affecting global sea level, regional ocean circulation, and coastal marine ecosystems, and it now accounts for most of the contemporary mass imbalance. Estimates of runoff are typically derived from regional climate models because satellite records have been limited to assessments of melting extent. Here, we use CryoSat-2 satellite altimetry to produce direct measurements of Greenland's runoff variability, based on seasonal changes in the ice sheet's surface elevation. Between 2011 and 2020, Greenland's ablation zone thinned on average by 1.4 ± 0.4 m each summer and thickened by 0.9 ± 0.4 m each winter. By adjusting for the steady-state divergence of ice, we estimate that runoff was 357 ± 58 Gt/yr on average - in close agreement with regional climate model simulations (root mean square difference of 47 to 60 Gt/yr). As well as being 21 % higher between 2011 and 2020 than over the preceding three decades, runoff is now also 60 % more variable from year-to-year as a consequence of large-scale fluctuations in atmospheric circulation. Because this variability is not captured in global climate model simulations, our satellite record of runoff should help to refine them and improve confidence in their projections

A system of networks and continuing education for physical therapists in rheumatology: a feasibility study

PURPOSE: To evaluate the feasibility of regional physical therapy networks including continuing education in rheumatology. The aim of these networks was to improve care provided by primary care physical therapists by improving specific knowledge, technical and communicative skills and the collaboration with rheumatologists. METHODS: In two regions in The Netherlands continuing education (CE) programmes, consisting of a 5-day postgraduate training course followed by bimonthly workshops and teaching practices, were organised simultaneously. Network activities included consultations, newsletters and the development of a communication guideline. Endpoint measures included the participation rate, compliance, quality of the CE programme, teaching practices, knowledge, network activities, communication, number of patients treated and patient satisfaction. RESULTS: Sixty-three physical therapists out of 193 practices (33%) participated in the project. They all completed the education programmes and were formally registered. All evaluations of the education programmes showed positive scores. Knowledge scores increased significantly directly after the training course and at 18 months. A draft guideline on communication between physical therapists and rheumatologists was developed, and 4 newsletters were distributed. A substantial proportion of physical therapists and rheumatologists reported improved communication at 18 months. The mean number of patients treated by physical therapists participating in the networks increased significantly. Patients' satisfaction scores within the networks were significantly higher than those from outside the networks at 18 months. CONCLUSIONS: Setting up a system of networks for continuing education for physical therapists regarding the treatment of patients with rheumatic diseases is feasible. Further research will focus on the effectiveness of the system and its implementation on a larger scale