Are prices reduced from direct competition in high-speed rail? Some unexpected evidences from Italy

The literature on open-access rail competition has been quite unanimous in pointing out the positive effects of the entry of the (few) newcomers in their respective markets. Generally speaking, quality has increased and frequency too. The effect on prices has also generally been what everybody expected: the newcomer is pricing less than the incumbent and overall the prices on the liberalised market are lower than the counterfactual ones. Without denying all the positive effects that rail competition in Italy has brought since 2012, thanks to the large-scale direct competition of NTV/Italo vs. the incumbent Trenitalia, in this paper we will provide the first evidence of something new, happened in the last 12 months. Since 2018, in fact, while frequencies and passengers continue to grow, for the first time also the average prices started increasing, even in those routes just opened to competition. The scope of this work is limited to analyse everyday train prices in a period of three years on numerous Italian routes, showing how prices changed over time and in particular according to the presence of competition and route characteristics. Findings are interesting: prices do not fall in all routes where competition starts, or at least just for a short period. In general, 2019 saw a consistent realignment of prices to a higher level than 2017-2018, for both competitors. One obvious explanation could be that the competitors are just apparently competing, or that production costs have raised (or both). This would be by far the worst outcome of a liberalisation process: costs up and cartel prices up with the costs. But the same phenomenon could be explained differently if there is no overcapacity: competition is working on parameters different than average prices (quality, frequency, product differentiation, price discrimination). We are still not able to demonstrate the existence of a cartel, so this work is just intended to show what has happened, and not why

Are prices reduced from direct competition in high-speed rail? Some unexpected evidences from Italy

The literature on open-access rail competition has been quite unanimous in pointing out the positive effects of the entry of the (few) newcomers in their respective markets. Generally speaking, quality has increased and frequency too. The effect on prices has also generally been what everybody expected: the newcomer is pricing less than the incumbent and overall the prices on the liberalised market are lower than the counterfactual ones. Without denying all the positive effects that rail competition in Italy has brought since 2012, thanks to the large-scale direct competition of NTV/Italo vs. the incumbent Trenitalia, in this paper we will provide the first evidence of something new, happened in the last 12 months. Since 2018, in fact, while frequencies and passengers continue to grow, for the first time also the average prices started increasing, even in those routes just opened to competition. The scope of this work is limited to analyse everyday train prices in a period of three years on numerous Italian routes, showing how prices changed over time and in particular according to the presence of competition and route characteristics. Findings are interesting: prices do not fall in all routes where competition starts, or at least just for a short period. In general, 2019 saw a consistent realignment of prices to a higher level than 2017-2018, for both competitors. One obvious explanation could be that the competitors are just apparently competing, or that production costs have raised (or both). This would be by far the worst outcome of a liberalisation process: costs up and cartel prices up with the costs. But the same phenomenon could be explained differently if there is no overcapacity: competition is working on parameters different than average prices (quality, frequency, product differentiation, price discrimination). We are still not able to demonstrate the existence of a cartel, so this work is just intended to show what has happened, and not why

Role of KASH domain lengths in the regulation of LINC complexes.

The linker of the nucleoskeleton and cytoskeleton (LINC) complex is formed by the conserved interactions between Sad-1 and UNC-84 (SUN) and Klarsicht, ANC-1, SYNE homology (KASH) domain proteins, providing a physical coupling between the nucleoskeleton and cytoskeleton that mediates the transfer of physical forces across the nuclear envelope. The LINC complex can perform distinct cellular functions by pairing various KASH domain proteins with the same SUN domain protein. For example, in Caenorhabditis elegans, SUN protein UNC-84 binds to two KASH proteins UNC-83 and ANC-1 to mediate nuclear migration and anchorage, respectively. In addition to distinct cytoplasmic domains, the luminal KASH domain also varies among KASH domain proteins of distinct functions. In this study, we combined in vivo C. elegans genetics and in silico molecular dynamics simulations to understand the relation between the length and amino acid composition of the luminal KASH domain, and the function of the SUN-KASH complex. We show that longer KASH domains can withstand and transfer higher forces and interact with the membrane through a conserved membrane proximal EEDY domain that is unique to longer KASH domains. In agreement with our models, our in vivo results show that swapping the KASH domains of ANC-1 and UNC-83, or shortening the KASH domain of ANC-1, both result in a nuclear anchorage defect in C. elegans

Reductive Elimination at Carbon under Steric Control

It has been previously demonstrated that stable singlet electrophilic carbenes can behave as metal surrogates in the activation of strong E-H bonds (E = H, B, N, Si, P), but it was believed that these activations only proceed through an irreversible activation barrier. Herein we show that, as is the case with transition metals, the steric environment can be used to promote reductive elimination at carbon centers

Long-distance rail in Europe: Comparing the forms of head-on competition across Europe

Europe is finally entering a season of liberalisation in the long-distance rail passenger market, which takes the form of on-track competition among public and private operators. The paper provides a broad-scope comparison of relevant European markets, belonging to liberalised and non-liberalised countries, aiming to point out the patterns in terms of supply, competition model and prices. The paper is based on a sample of heterogeneous 69 city-pairs, analysed in two fourteen days periods in 2019 (May/June and November). All available modes are observed, collecting info on companies, frequency of services, and cheapest price. The analysis starts from a schematisation of different business models, based on literature. Then, using the database, we study the country's supply structure, size, and level of intermodal and intra-modal competition through HHIs. Prices are analysed in two steps: the average prices and the price dispersion, searching for their main determinants, including but not limited to competition. Results show that a higher competition level is not always corresponding to low prices, which are instead determined by many other factors such as size of market, demand, socio-economic characteristics, subsidies, production costs, speed advantage, strength of the incumbent, etc. The competition level, instead, directly influences the quality, the supplied capacity, and the price dispersion

Coping with an Advanced Stage Lung Cancer Diagnosis: Patient, Caregiver, and Provider Perspectives on the Role of the Health Care System

Although lung cancer is the leading cause of cancer death in the USA, there have been few studies on patient-centered advanced lung cancer treatment practices. As part of a larger research study on how to use a patient-inclusive approach in late-stage lung cancer treatment, this present study describes patient, caregiver, and provider perspectives on the role of the health care system in helping patients cope with an advanced stage lung cancer diagnosis. Four focus group sessions were conducted with six to eleven participants per group for a total of 36 participants. Two focus groups were held with patients and family members/caregivers and two with physicians and nurses. A major theme that emerged concerned coping with an advanced lung cancer diagnosis, which is the subject of this paper. The patients, caregivers, and providers spoke passionately about interactions with the health care system and volunteered examples of supportive and non-supportive relationships between patients and clinicians. They advocated for better patient-provider communication practices as well as the expanded use of patient navigation and new patient orientation programs. This study contributes additional knowledge by including the perspectives of caregivers and providers who live and work closely with patients with advanced lung cancer. The findings can inform the development of comprehensive patient-centered care plans for patients living with an advanced lung cancer diagnosis

CARACTERIZAÇÃO DA MORBIMORTALIDADE DE CRIANÇAS COM HIV/AIDS

http://dx.doi.org/10.5902/223658345768 Objetivou-se caracterizar a morbimortalidade de crianças com HIV/AIDS atendidas em um Hospital Universitário no Sul do Brasil. Estudo quantitativo, documental, retrospectivo, descritivo. Foram incluídas crianças menores de 13 anos com HIV/AIDS. As informações foram extraídas dos prontuários, de maio de 2011 a janeiro de 2012. Das 47 crianças 44,7% encontravam-se entre 10 a 12 anos. Em 91,5% o modo de transmissão foi o vertical e em 93,6% dos prontuários não apresentava descrição sobre a revelação do diagnóstico. Em 2010, 46,8% das crianças tiveram entre 4 a 6 consultas e das crianças que se encontravam em tratamento, 31,1% com tempo de tratamento de 1 a 3 anos. Identificou-se 6,4% óbitos. Evidenciou-se a necessidade de um cuidado integral as crianças com HIV/AIDS, que contemple o acompanhamento de seu crescimento e desenvolvimento e de sua condição de saúde

Philopatry and regional connectivity of the great hammerhead shark, Sphyrna mokarran in the U.S. and Bahamas

A thorough understanding of movement patterns of a species is critical for designing effective conservation and management initiatives. However, generating such information for large marine vertebrates is challenging, as they typically move over long distances, live in concealing environments, are logistically difficult to capture and, as upper-trophic predators, are naturally low in abundance. Large-bodied, broadly distributed tropical shark typically restricted to coastal and shelf habitats, the great hammerhead shark Sphyrna mokarran epitomizes such challenges. Highly valued for its fins (in target and incidental fisheries), it suffers high bycatch mortality coupled with fecundity conservative life history, and as a result, is vulnerable to over-exploitation and population depletion. Although there are very little species-specific data available, the absence of recent catch records give cause to suspect substantial declines across its range. Here, we used biotelemetry techniques (acoustic and satellite), conventional tagging, laser-photogrammetry, and photo-identification to investigate the level of site fidelity/residency for great hammerheads to coastal areas in the Bahamas and U.S., and the extent of movements and connectivity of great hammerheads between the U.S. and Bahamas. Results revealed large-scale return migrations (3030 km), seasonal residency to local areas (some for 5 months), site fidelity (annual return to Bimini and Jupiter for many individuals) and numerous international movements. These findings enhance the understanding of movement ecology in great hammerhead sharks and have potential to contribute to improved cons

Global burden of chronic respiratory diseases and risk factors, 1990–2019: an update from the Global Burden of Disease Study 2019

Background: Updated data on chronic respiratory diseases (CRDs) are vital in their prevention, control, and treatment in the path to achieving the third UN Sustainable Development Goals (SDGs), a one-third reduction in premature mortality from non-communicable diseases by 2030. We provided global, regional, and national estimates of the burden of CRDs and their attributable risks from 1990 to 2019. Methods: Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we estimated mortality, years lived with disability, years of life lost, disability-adjusted life years (DALYs), prevalence, and incidence of CRDs, i.e. chronic obstructive pulmonary disease (COPD), asthma, pneumoconiosis, interstitial lung disease and pulmonary sarcoidosis, and other CRDs, from 1990 to 2019 by sex, age, region, and Socio-demographic Index (SDI) in 204 countries and territories. Deaths and DALYs from CRDs attributable to each risk factor were estimated according to relative risks, risk exposure, and the theoretical minimum risk exposure level input. Findings: In 2019, CRDs were the third leading cause of death responsible for 4.0 million deaths (95% uncertainty interval 3.6–4.3) with a prevalence of 454.6 million cases (417.4–499.1) globally. While the total deaths and prevalence of CRDs have increased by 28.5% and 39.8%, the age-standardised rates have dropped by 41.7% and 16.9% from 1990 to 2019, respectively. COPD, with 212.3 million (200.4–225.1) prevalent cases, was the primary cause of deaths from CRDs, accounting for 3.3 million (2.9–3.6) deaths. With 262.4 million (224.1–309.5) prevalent cases, asthma had the highest prevalence among CRDs. The age-standardised rates of all burden measures of COPD, asthma, and pneumoconiosis have reduced globally from 1990 to 2019. Nevertheless, the age-standardised rates of incidence and prevalence of interstitial lung disease and pulmonary sarcoidosis have increased throughout this period. Low- and low-middle SDI countries had the highest age-standardised death and DALYs rates while the high SDI quintile had the highest prevalence rate of CRDs. The highest deaths and DALYs from CRDs were attributed to smoking globally, followed by air pollution and occupational risks. Non-optimal temperature and high body-mass index were additional risk factors for COPD and asthma, respectively. Interpretation: Albeit the age-standardised prevalence, death, and DALYs rates of CRDs have decreased, they still cause a substantial burden and deaths worldwide. The high death and DALYs rates in low and low-middle SDI countries highlights the urgent need for improved preventive, diagnostic, and therapeutic measures. Global strategies for tobacco control, enhancing air quality, reducing occupational hazards, and fostering clean cooking fuels are crucial steps in reducing the burden of CRDs, especially in low- and lower-middle income countries

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to <90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], >300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of <15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years