Disaggregate Real Exchange Rate Behaviour

In this paper, we re-examine the “PPP Puzzle” using sectoral disaggregated data. Specifically, we first analyse the mean reversion speeds of real exchange rates for a number of different sectors in eleven industrial economies and then focus on relating these rates to variables identified in the literature as key determinants of CPI-based real exchange rates, namely: the trade balance, productivity and the mark up. In particular, we seek to understand to what extent the relationships existing at the aggregate level are borne out at the disaggregate level. We believe that this analysis can help shed light on the PPP puzzle.Real Exchange Rates, Sectoral Prices, Panel Data Methods

Global vegetation variability and its response to elevated CO2, global warming, and climate variability – a study using the offline SSiB4/TRIFFID model and satellite data

Abstract. The climate regime shift during the 1980s had a substantial impact on the terrestrial ecosystems and vegetation at different scales. However, the mechanisms driving vegetation changes, before and after the shift, remain unclear. In this study, we used a biophysical-dynamic vegetation model to estimate large-scale trends in terms of carbon fixation, vegetation growth, and expansion during the period 1958–2007, and to attribute these changes to environmental drivers including elevated atmospheric CO2 concentration (hereafter eCO2), global warming, and climate variability (hereafter CV). Simulated Leaf Area Index (LAI) and Gross Primary Product (GPP) were evaluated against observation-based data. Significant spatial correlations are found (correlations > 0.87), along with regionally varying temporal correlations of 0.34–0.80 for LAI and 0.45–0.83 for GPP. More than 40 % of the global land area shows significant trends in LAI and GPP since the 1950s: 11.7 % and 19.3 % of land has consistently positive LAI and GPP trends, respectively; while 17.1 % and 20.1 % of land, saw LAI and GPP trends respectively, reverse during the 1980s. Vegetation fraction cover (FRAC) trends, representing vegetation expansion/shrinking, are found at the edges of semi-arid areas and polar areas. Overall, eCO2 consistently contributes to positive LAI and GPP trends in the tropics. Global warming is shown to mostly affected LAI, with positive effects in high latitudes and negative effects in subtropical semi-arid areas. CV is found to dominate the variability of FRAC, LAI, and GPP in the semi-humid and semi-arid areas. The eCO2 and global warming effects increased after the 1980s, while the CV effect reversed during the 1980s. In addition, plant competition is shown to have played an important role in determining which driver dominated the regional trends. This paper presents a new insight into ecosystem variability and changes in the varying climate since the 1950s

Medical, Ethical and Legal Considerations of Electroconvulsive Therapy

How can it be determined whether a patient has consented to electroconvulsive therapy? Under what circumstances should therapy be given against a patient\u27s will? Peter MacDonald addresses these questions from a medical, ethical and legal perspective

The effect of alcohol intoxication on haemodynamic physiology of acute cardiac tamponade

It is generally accepted that alcohol impairs haemodynamic physiology in normal subjects. Alcohol is also thought to have a detrimental effect in shock states. However, most research has concentrated on haemorrhagic shock, whereas in cardiac tamponade, the pathophysiology of shock is very different. Although some studies have mentioned alcohol as a negative factor in patients with cardiac tamponade, none have adequately assessed its effect. In a clinical study of 50 patients who presented to Groote Schuur Hospital Trauma Unit with acute cardiac tamponade due to penetrating chest injury, those who were intoxicated fared the same as their sober counterparts. Although more patients in the intoxicated group were "moribund" or "in extremis" on admission, this did not lead to a higher overall mortality. Haemodynamic parameters and results of special investigations in the two groups were also similar. These findings suggested that intoxicated patients with cardiogenic shock, specifically acute cardiac tamponade, behaved differently from intoxicated patients with haemorrhagic shock. However, the multitude of variables and the stress involved in treating patients with life-threatening acute conditions, makes studies such as this difficult. Because of these limitations, an animal model of acute cardiac tamponade was developed, so that actions of alcohol on haemodynamic physiology could be studied in a controlled environment. Fourteen young pigs were randomly assigned to receive either 30% alcohol or tap-water via a gastrostomy. The former resulted in blood alcohol levels which were compatible with moderate to severe intoxication. Cardiac tamponade was then induced by instilling warmed plasmalyte-8 into the pericardia! sac using a pressure-cycled system. Despite the fact that animals in the tamponade/alcohol group were more hypotensive, and reflex increase in heart rate was inhibited, cardiac output was similar in the two groups. The actions of alcohol in isolation were also studied in eight sham-operated pigs. The only noticeable effect in this instance were higher pulmonary artery wedge pressures in the sham/non-alcohol group. In other words, cardiac performance in both the tamponade/alcohol and sham/alcohol groups was at least equal to, or even better than that in animals that did not receive alcohol. It would seem therefore, that alcohol does not have a negative effect on haemodynamic physiology of acute cardiac tamponade. Theoretically, alcohol may "protect" patients with acute cardiac tamponade by decreasing peripheral vascular resistance and "afterload". It is also possible that inhibitory actions on the respiratory centre may prevent hyperpnoea or tachypnoea, and thereby diminish competitive filling of the right and left ventricles. However, further studies of cardiac function in intoxicated subjects with tamponade using more sophisticated techniques are necessary, before mechanisms will become apparent. In practice, an aggressive approach should be adopted towards moribund patients with penetrating chest injuries; if they have acute cardiac tamponade and are intoxicated, their prognosis is not necessarily dismal. This is of particular relevance in Cape Town, where both alcohol abuse and assault are endemic. As for a therapeutic effect of alcohol, these studies do not support its use for pharmacological manipulation of cardiac tamponade

Long-term condition management in adults with intellectual disability in primary care: a systematic review

Background: Adults with intellectual disabilities have higher morbidity and earlier mortality than the general population. Access to primary health care is lower, despite a higher prevalence of many long-term conditions. Aim: To synthesise the evidence for the management of long-term conditions in adults with intellectual disabilities and identify barriers and facilitators to management in primary care. Design & setting: Mixed-methods systematic review. Method: Seven electronic databases were searched to identify both quantitative and qualitative studies concerning identification and management of long-term conditions in adults with intellectual disability in primary care. Both the screening of titles, abstracts, and full texts, and the quality assessment were carried out in duplicate. Findings were combined in a narrative synthesis. Results: Fifty-two studies were identified. Adults with intellectual disabilities are less likely than the general population to receive screening and health promotion interventions. Annual health checks may improve screening, identification of health needs, and management of long-term conditions. Health checks have been implemented in various primary care contexts, but the long-term impact on outcomes has not been investigated. Qualitative findings highlighted barriers and facilitators to primary care access, communication, and disease management. Accounts of experiences of adults with intellectual disabilities reveal a dilemma between promoting self-care and ensuring access to services, while avoiding paternalistic care. Conclusion: Adults with intellectual disabilities face numerous barriers to managing long-term conditions. Reasonable adjustments, based on the experience of adults with intellectual disability, in addition to intervention such as health checks, may improve access and management, but longer-term evaluation of their effectiveness is required