Regional macroeconomic outcomes under alternative arrangements for the financing of urban infrastructure

Many studies, both of Australia and of comparable developed economies, have found that the economic benefits from investment in urban infrastructure are substantial. However the nature of this infrastructure is often such that it is under-provided by the private sector. In Australia, much of the responsibility for the provision of urban infrastructure rests with state and local government. However throughout the 1990’s many of Australia’s state governments embarked on a period of fiscal restraint, seeking to improve financial positions weakened by exposure to failed state government enterprises in the early 1990’s. Perhaps because of the deferred consequences of reducing spending on infrastructure, a large proportion of this fiscal adjustment appears to have been borne by spending on public infrastructure. Today, policy attention at the state government level is again focussing on public infrastructure. However in spite of the now robust fiscal positions of Australia’s state governments, there remains a reluctance on their part to finance public infrastructure through debt, and raising taxes is perceived as politically unpopular. Instead, governments are exploring alternative financing instruments, such as developer charges and public-private partnerships. This paper uses a dynamic multi-regional CGE model (MMRF) to evaluate the regional macro economic consequences of four alternative methods of financing an expansion in state government spending on public infrastructure. The four methods are developer charges, payroll tax, government debt, and residential rates. The paper confirms that the services provided by public infrastructure can have significant impacts on the regional macro economy. More importantly however, the paper demonstrates that the total gains from urban infrastructure are quite sensitive to the means chosen by government to finance infrastructure investment. In contrast to up-front financing methods (such as developer charges, payroll tax, and residential rates), the paper finds that the gains from urban infrastructure are greatest when the chosen financing method provides a closer match between the timing of the burden of financing the infrastructure and the timing of the benefits provided by the infrastructure. This can be achieved by instruments such as debt, public-private partnerships, and user charges. On this basis the paper finds that a greater reliance by regional government son debt financing might be warranted, and that the gains from infrastructure expenditure are least when that expenditure is financed by developer charges.

Hyperthyroidism and its impact on cardiovascular disease : with special emphasis on atrial fibrillation

Background Hyperthyroidism is a common disease throughout the world, affecting 0.5%-2% of women and one-tenth as many men at some time. Graves’ disease and toxic nodular goitre are the two most common etiologies. Cardiovascular symptoms are often prominent, and atrial fibrillation (AF) is a well-known complication. Several large register studies have indicated that patients treated for hyperthyroidism may be at increased risk of death compared to the general population; it appears that this difference in mortality is chiefly attributable to cardiovascular and endocrine diseases. However, these previous studies are quite heterogenous with sometimes contradictory results. Subclinical hyperthyroidism (SH) is a condition afflicting approximately 1% of the population, defined as serum levels of thyroid-stimulating hormone (TSH) below the normal range while levels of triiodothyroxine (T3) and thyroxine (T4) are within the reference range. Symptoms are similar to, but milder than those seen in regular hyperthyroidism. AF, in particular, appears to occur more often when SH is present. Aims The aim of this thesis is to further investigate the correlation between hyperthyroidism and cardiovascular disease. Using a very large cohort based on register data, long-term cardiovascular mortality and morbidity (Paper I) were assessed in patients treated for hyperthyroidism. Another study addressed differences in long-term effects between treatments for hyperthyroidism (Paper II). In the last article, we attempted to find out whether subclinical hyperthyroidism might be a common cause of AF (Paper III). Methods Papers I-II were both based on essentially the same data on individuals with thyroid disease: Information on patients who had undergone thyroidectomy (complete or partial removal of the thyroid gland) was gathered from the Swedish National Patient Register, and information on patients treated with radioactive iodine was based on a material consisting of local hospital records. Data on cardiovascular outcomes and death was collected from the Patient Register, the Causes of Death Register, and Statistics Sweden. The Swedish Prescription Register was also used for assessment of levothyroxine treatment. Study subjects had undergone either surgery or radioiodine treatment between the years 1976-2000, and the cohort was followed until 2012. In Paper I, patients treated for nontoxic nodular goitre were used as a control group, but comparisons were also made to the general population of Stockholm. Outcomes were assessed in terms of all-cause mortality, cardiovascular mortality, and cardiovascular morbidity. In Paper II, which included only patients with hyperthyroidism, thyroidectomy was compared to radioiodine treatment in terms of all-cause and cause-specific mortality. Three different statistical methods were applied: Cox regression, propensity score matching, and inverse probability matching. Paper III was a cross-sectional observational study in which thyroid status was assessed among patients who underwent electrophysiological ablation for cardiac arrhythmias. Cases of AF were compared to controls with AV-nodal re-entry tachycardia with regard to thyroid hormone levels. The hypothesis was that AF would correlate to a higher prevalence of subclinical hyperthyroidism, defined as a suppression of TSH levels and normal free T4 levels, compared to controls. Results In Paper I, an increased risk of all-cause mortality (hazard ratio (HR) 1.27 with a 95% confidence interval (CI) of 1.20-1.35) was found among the 12,239 patients treated for either Graves’ disease or toxic nodular goitre, compared to the 3,685 patients treated for nontoxic goitre. Increased cardiovascular mortality (HR 1.29, CI 1.17-1.42) and cardiovascular morbidity (HR 1.12, CI 1.06-1.18) was also seen, with AF being by far the most common finding at early follow-up. Furthermore, all of these outcomes were significantly more common in comparisons with the general population. The risk of death and cardiovascular disease was most evident in patients treated for toxic nodular goitre while only a weak association was seen among Graves’ disease patients. No decrease in risk was found among subjects included later (after 1990) compared to those included earlier. Paper II included 10,992 subjects with hyperthyroidism; 10,250 had been treated with radioiodine and 742 with thyroidectomy. Surgically treated subjects had lower all-cause mortality as assessed by cox regression (HR 0.82, CI 0.71 -0.96), propensity score matching (HR 0.80, CI 0.68-0.94), and inverse probability weighting (0.85, CI 0.72-1.00, p = 0.044) compared to subjects who received radioiodine. Significantly lower cardiovascular mortality was also found among thyroidectomised individuals in all three analyses while no clear differences were found regarding cancer mortality or other causes of death. In Paper III, 312 patients were included. Of these, 212 had AF, and 100 had AV-nodal reentry tachycardia. Analyses showed that subclinical hyperthyroidism was not more common among subjects with AF than among control subjects. However, it was found that levels of free T4 were significantly higher in the AF group (CI of difference 0.03-1-35, p = 0.039). Conclusions Hyperthyroidism is associated with an increased risk of cardiovascular disease and death. The mechanisms behind this observation remain unknown, but some factors – notably hyperthyroidism due to toxic nodular goitre and treatment with radioiodine – seem to represent a stronger association. As for the specific diagnosis of AF, we found no clear evidence to support that subclinical hyperthyroidism might be one of the predominant underlying causes, although we did make the interesting observation that levels of free T4 were significantly elevated among AF patients

Mechanisms of B cell autoimmunity in SLE

Systemic lupus erythematosus (SLE) is a systemic autoimmune disease that is known to be associated with polyclonal B-cell hyperreactivity. The underlying causes of the diffuse B-cell over-reactivity are unclear, but potential candidates include (a) intrinsic hyper-reactivity leading to polyclonal B-cell activation with disturbed activation thresholds and ineffective negative selection; (b) lack of immunoregulatory functions; (c) secondary effects of an overactive inflammatory environment, such as overactive germinal center and ectopic follicular activity; and/or (d) disturbed cytokine production by non-B immune cells. These mechanisms are not mutually exclusive and may operate to varying extents and at varying times in SLE. Phenotypic and molecular studies as well as the results of recent clinical trials have begun to provide new insights to address these possibilities. Of importance, new information has made it possible to distinguish between the contribution played by abnormalities in central checkpoints that could lead to a pre-immune repertoire enriched in autoreactive B cells, on the one hand, and the possibility that autoimmunity arises in the periphery from somatic hypermutation and abnormal selection during T cell-dependent B-cell responses on the other. There is an intriguing possibility that apoptotic material bound to the surface of follicular dendritic cells positively selects autoreactive B cells that arise from non-autoreactive B-cell precursors as a result of somatic hypermutation and thereby promotes the peripheral emergence of autoimmunity

The Economy-wide Impacts of a Rise in the Capital Adequacy Ratios of Australian Banks

Regulators are requiring banks to raise additional equity to finance their activities. The benefits are understood in terms of reducing the risks of another financial crisis. But there are potential costs, including the potential for unanticipated macroeconomic impacts as banks reduce leverage. We use a financial computable general equilibrium model, containing disaggregated treatment of financial agents, to explore the economy-wide consequences of an increase in bank capital adequacy ratios. We find that the macroeconomic consequences are small

Failure of Autologous Fresh Frozen Plasma to Reduce Blood Loss and Transfusion Requirements in Coronary Artery Bypass Surgery

Background: Previous studies failed to demonstrate any benefit from prophylaxis with fresh frozen plasma (FFP) after cardiopulmonary bypass (CPB). The results, however, were limited by either retrospective study design or use of FFP in subtherapeutic doses (2-3 units). The authors evaluated whether a therapeutic dose (15 ml/kg) of FFP reduces blood loss and transfusion requirements in elective coronary artery bypass surgery. The risks of multiple allogeneic blood donor exposure were circumvented by using autologous plasma. Methods: Sixty adult patients scheduled for elective primary coronary artery bypass grafting were randomized to receive, after CPB, an intravenous infusion of 15 ml/kg of either autologous FFP (30 patients) or 6% hydroxyethyl starch 450/0.7 (HES; 30 patients). Autologous plasma was obtained by plateletpoor plasmapheresis several weeks before surgery. Perioperative blood transfusions were administered per protocol. Postoperative blood loss was defined as the chest tube drainage during the first 24 h after surgery. Results: The data from 56 patients (FFP group, 27 patients; HES group, 29 patients) who completed the study according to protocol were analyzed. Median postoperative blood loss was 630 ml (range, 450 -1,840 ml) and 830 ml (range, 340 -1,980 ml) in the FFP and HES groups, respectively (P ‫؍‬ 0.08). Both postoperative (0 -24 h) and total perioperative erythrocyte transfusion requirements did not differ significantly between the groups (P ‫؍‬ 0.32 and 0.14, respectively). Conclusion: The prophylactic administration of a therapeutic dose (15 ml/kg) of autologous FFP after CPB failed to reduce blood loss and transfusion requirements in patients undergoing uncomplicated, elective, primary coronary artery bypass surgery

Cardiovascular disease, risk factors and heart rate variability in the elderly general population: Design and objectives of the CARdiovascular disease, Living and Ageing in Halle (CARLA) Study

BACKGROUND: The increasing burden of cardiovascular diseases (CVD) in the ageing population of industrialized nations requires an intensive search for means of reducing this epidemic. In order to improve prevention, detection, therapy and prognosis of cardiovascular diseases on the population level in Eastern Germany, it is necessary to examine reasons for the East-West gradient of CVD morbidity and mortality, potential causal mechanisms and prognostic factors in the elderly. Psychosocial and nutritional factors have previously been discussed as possible causes for the unexplained part of the East-West gradient. A reduced heart rate variability appears to be associated with cardiovascular disease as well as with psychosocial and other cardiovascular risk factors and decreases with age. Nevertheless, there is a lack of population-based data to examine the role of heart rate variability and its interaction with psychosocial and nutritional factors regarding the effect on cardiovascular disease in the ageing population. There also is a paucity of epidemiological data describing the health situation in Eastern Germany. Therefore, we conduct a population-based study to examine the distribution of CVD, heart rate variability and CVD risk factors and their associations in an elderly East German population. This paper describes the design and objectives of the CARLA Study. METHODS/DESIGN: For this study, a random sample of 45–80 year-old inhabitants of the city of Halle (Saale) in Eastern Germany was drawn from the population registry. By the end of the baseline examination (2002–2005), 1750 study participants will have been examined. A multi-step recruitment strategy aims at achieving a 70 % response rate. Detailed information is collected on own and family medical history, socioeconomic, psychosocial, behavioural and biomedical factors. Medical examinations include anthropometric measures, blood pressure of arm and ankle, a 10-second and a 20-minute electrocardiogram, a general physical examination, an echocardiogram, and laboratory analyses of venous blood samples. On 200 participants, a 24-hour electrocardiogram is recorded. A detailed system of quality control ensures high data quality. A follow-up examination is planned. DISCUSSION: This study will help to elucidate pathways to CVD involving autonomic dysfunction and lifestyle factors which might be responsible for the CVD epidemic in some populations

Populist Mobilization: A New Theoretical Approach to Populism*

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/112280/1/j.1467-9558.2011.01388.x.pd