Bail-Out or Work-Out? Theoretical Considerations

In recent years, we appear to have entered an era of capital account crises. In response, a number of new crisis resolution ideas have been put forward, including the establishment of supranational institutions such as an international lender of last resort or an international bankruptcy court, temporary payments standstills and the inclusion of collective action clauses in debt contracts. This paper assesses these proposals using a theoretical model of crisis. The model underscores the importance of adapting policy interventions to the nature of the crisis at hand. For example, it finds that payments standstills and last-resort lending are an equally efficient means of dealing with liquidity crises, both ex-ante and ex-post, while creditor committees are second-best. It finds that debt-write-downs are a preferred means of dealing with solvency crises than subsidized IMF financing because of the negative moral hazard implications of the latter tool. And it finds that international bankruptcy court proposals may be superior to contractual approaches in securing such write-downscrisis resolution, international lender of last resort, standstills, IMF

Non-perturbative behavior of the quantum phase transition to a nematic Fermi fluid

We discuss shape (Pomeranchuk) instabilities of the Fermi surface of a two-dimensional Fermi system using bosonization. We consider in detail the quantum critical behavior of the transition of a two dimensional Fermi fluid to a nematic state which breaks spontaneously the rotational invariance of the Fermi liquid. We show that higher dimensional bosonization reproduces the quantum critical behavior expected from the Hertz-Millis analysis, and verify that this theory has dynamic critical exponent $z=3$. Going beyond this framework, we study the behavior of the fermion degrees of freedom directly, and show that at quantum criticality as well as in the the quantum nematic phase (except along a set of measure zero of symmetry-dictated directions) the quasi-particles of the normal Fermi liquid are generally wiped out. Instead, they exhibit short ranged spatial correlations that decay faster than any power-law, with the law $|x|^{-1} \exp(-\textrm{const.} |x|^{1/3})$ and we verify explicitely the vanishing of the fermion residue utilizing this expression. In contrast, the fermion auto-correlation function has the behavior $|t|^{-1} \exp(-{\rm const}. |t|^{-2/3})$. In this regime we also find that, at low frequency, the single-particle fermion density-of-states behaves as $N^*(\omega)=N^*(0)+ B \omega^{2/3} \log\omega +...$, where $N^*(0)$ is larger than the free Fermi value, N(0), and $B$ is a constant. These results confirm the non-Fermi liquid nature of both the quantum critical theory and of the nematic phase.Comment: 20 pages, 2 figures, 1 table; new version with minor changes; new subsection 3C2 added with an explicit calculation of the quasiparticle residue at the nematic transition; minor typos corrected, new references; general beautification of the text and figure

Non local Thirring model with backward and umklapp interactions

We extend a non local and non covariant version of the Thirring model in order to describe a many-body system with backward and umklapp scattering processes. We express the vacuum to vacuum functional in terms of a non trivial fermionic determinant. Using path-integral methods we find a bosonic representation for this determinant which allows us to obtain an effective action for the collective excitations of the system. By introducing a non local version of the self-consistent harmonic approximation, we get an expression for the gap of the charge-density excitations as functional of arbitrary electron-electron potentials. As an example we also consider the case of a non contact umklapp interaction.Comment: 19 pages, no figure

Developing integrated guidelines for health care workers in hospital and primary healthcare facilities in response to the COVID-19 pandemic in low- and middle- income countries (LMICs)

COVID-19 has placed an enormous burden on health systems globally. In response to the demands of the pandemic, there has been an urgent need to capacity build healthcare workers (HCWs) to reduce nosocomial transmission, strengthen triage systems, and rapidly identify cases to break chains of transmission in the community. The World Health Organization (WHO) has produced technical guidance documents for patient management, risk communication, infection control, etc. However, the guidance does not address health system challenges or implementation difficulties in resource-constrained settings such as LMICs. Further, while guidance provides valuable information for HCWs it must be complemented with training to ensure protocolization and uptake into practice. This is particularly important in the context of COVID-19, which has been hallmarked by waves of infections, resource scarcity, and growing stigma

Developing integrated guidelines for health care workers in hospital and primary healthcare facilities in response to the COVID-19 pandemic in low-and middle-income countries (LMICs)

COVID-19 has placed an enormous burden on health systems globally. In response to the demands of the pandemic, there has been an urgent need to capacity build HCWs (e.g., nurses, doctors, community health workers, and others) to reduce nosocomial transmission, strengthen triage systems, and rapidly identify cases to break chains of transmission in the community. The World Health Organization (WHO) has produced technical guidance documents for patient management, risk communication, infection control, etc. However, the guidance does not address health system challenges or implementation difficulties in resource-constrained settings such as LMICs. Further, while guidance provides valuable information for HCWs it must be complemented with training to ensure protocolization and uptake into practice. This is particularly important in the context of COVID-19, which has been hallmarked by waves of infections, resource scarcity, and growing stigma

Determination of Genetic Variations of Toll-Like Receptor (TLR) 2, 4, and 6 with Next-Generation Sequencing in Native Cattle Breeds of Anatolia and Holstein Friesian

In recent years, the focus of disease resistance and susceptibility studies in cattle have been on determining patterns in the innate immune response of key proteins, such as Toll-like receptors (TLR). In the bovine genome, there are 10 TLR family members and, of these, TLR2, TLR4, and TLR6 are specialized in the recognition of bacterial ligands. Indigenous cattle breeds of Anatolia have been reported to show fewer signs of clinical bacterial infections, such as bovine tuberculosis and mastitis, and it is hypothesized that this might be due to a less stringent genetic selection during breeding. In contrast, Holstein-Friesian cattle have been under strong selection for milk production, which may have resulted in greater susceptibility to diseases. To test this hypothesis, we have compared the TLR2, TLR4, and TLR6 genes of Anatolian Black (AB), East Anatolian Red (EAR), South Anatolian Red (SAR), Turkish Grey (TG), and Holstein (HOL) cattle using next-generation sequencing. The SAR breed had the most variations overall, followed by EAR, AB, TG, and HOL. TG had the most variations for TLR2, whereas SAR had the most variations in TLR4 and TLR6. We compared these variants with those associated with disease and susceptibility traits. We used exon variants to construct haplotypes, investigated shared haplotypes within breeds, and proposed candidate haplotypes for a disease resistance phenotype in Anatolian cattle breeds

The social determinants of chronic disease management: perspectives of elderly patients with hypertension from low socio-economic background in Singapore

Background In Singapore, the burden of hypertension disproportionately falls on the elderly population of low socio-economic status. Despite availability of effective treatment, studies have shown high prevalence of sub-optimal blood pressure control in this group. Poor hypertension management can be attributed to a number of personal factors including awareness, management skills and overall adherence to treatment. However, these factors are also closely linked to a broader range of community and policy factors. This paper explores the perceived social and physical environments of low socio-economic status and elderly patients with hypertension; and how the interplay of factors within these environments influences their ability to mobilise resources for hypertension management. Methods In-depth interviews were conducted in English, Chinese, Chinese dialects and Malay with 20 hypertensive patients of various ethnic backgrounds. Purposive sampling was adopted for recruitment of participants from a previous community health screening campaign. Interviews were translated into English and transcribed verbatim. We deductively analysed leveraging on the Social Model of Health to identify key themes, while inductive analysis was used simultaneously to allow sub-themes to emerge. Results and discussion Our finding shows that financing is an overarching topic embedded in most themes. Despite the availability of multiple safety nets, some patients were left out and lacked capital to navigate systems effectively, which resulted in delayed treatment or debt. The built environment played a significant role in enabling patients to access care easily and lead a more active lifestyle. A closer look is needed to enhance the capacity of patients with mobility challenges to enjoy equitable access. Furthermore, the establishment of community based elderly centres has enabled patients to engage in meaningful and healthy social activities. In contrast, participants' descriptions showed that their communication with healthcare professionals remained brief, and that personalised and meaningful interactions that are context and culturally specific are essential to advocate for patients' overall treatment adherence and lifestyle modification. Conclusion Elderly patients with hypertension from lower socio-economic background have various unmet needs in managing their hypertension and other comorbidities. These needs are closely related to broader societal factors such as socio-demographic characteristics, support systems, urban planning and public policies, and health systems factors. Policy decisions to address these needs require an integrated multi-sectoral approach grounded in the principles of health equity.This research was supported by MOE TIER - 1 FUND R-608-000-133-112 and the National University Health System (NUHS) Singapore Population Health Improvement Centre (SPHERiC)

The impact of treatment adherence for patients with diabetes and hypertension on cardiovascular disease risk : a protocol for a retrospective cohort study, 2008-2018

The study received partial in-kind funding from Diabetes Action Canada (503854).Background: Cardiovascular disease (CVD) is the leading cause of death globally and in Canada. Diabetes and hypertension are major risk factors for CVD events. Despite the increasing availability of effective treatments, the majority of diabetic and hypertensive patients do not have adequate blood pressure and glycemic control. One of the major contributors is poor treatment adherence. Objective: This study aims to evaluate the impact of treatment adherence for patients with both diabetes and hypertension on acute severe CVD events and intermediate clinical outcomes in Canadian primary care settings. Methods: We will conduct a population-based retrospective cohort study of patients living with both diabetes and hypertension in Ontario, Canada, between January 1, 2008, and March 31, 2018. The Social Cognitive Theory will be used as a conceptual framework by which to frame the reciprocal relationship between treatment adherence, personal factors, and environmental determinants and how this interplay impacts CVD events and clinical outcomes. Data will be derived from the Diabetes Action Canada National Data Repository. A time-varying Cox proportional hazards model will be used to estimate the impacts of treatment adherence on CVD morbidity and mortality. Multivariable linear regression models and hierarchical regression models will be used to estimate the associations between treatment adherence of different medication categories and intermediate clinical outcomes. Our primary outcome is the association between treatment adherence and the risk of acute severe CVD events, including CVD mortality. The secondary outcome is the association between treatment adherence and intermediate clinical outcomes including diastolic and systolic blood pressures, glycated hemoglobin, low-density lipoprotein cholesterol, and total cholesterol. Owing to data limitation, we use medication prescriptions as a proxy to estimate treatment adherence. We assume that a patient adhered to medications if she or he had any prescription record in the 4 preceding quarters and 1 quarter after each quarter of interest. Acute severe CVD events are defined based on the World Health Organization’s Monitoring Trends and Determinants in Cardiovascular Disease Project, including acute coronary heart disease, stroke, and heart failure. As causes of death are not available, the number of CVD deaths will be computed using the most recent systolic blood pressure distributions and the population attributable risks related to systolic blood pressure level. Results: The project was funded by Diabetes Action Canada (reference number: 503854) and approved by the University of Toronto Research Ethics Board (reference number: 36065). The project started in June 2018 and is expected to be finished by September 2019. Conclusions: The findings will be helpful in identifying the challenges of treatment adherence for diabetic and hypertensive patients in primary care settings. This will also help to develop intervention strategies to promote treatment adherence for patients with multi-morbidities.Publisher PDFPeer reviewe

Integrating cardiovascular diseases, hypertension, and diabetes with HIV services: a systematic review.

Non-communicable diseases (NCDs), including cardiovascular diseases (CVD), hypertension and diabetes together with HIV infection are among the major public health concerns worldwide. Health services for HIV and NCDs require health systems that provide for people's chronic care needs, which present an opportunity to coordinate efforts and create synergies between programs to benefit people living with HIV and/or AIDS and NCDs. This review included studies that reported service integration for HIV and/or AIDS with coronary heart diseases, chronic CVD, cerebrovascular diseases (stroke), hypertension or diabetes. We searched multiple databases from inception until October 2015. Articles were screened independently by two reviewers and assessed for risk of bias. 11,057 records were identified with 7,616 after duplicate removal. After screening titles and abstracts, 14 papers addressing 17 distinct interventions met the inclusion criteria. We categorized integration models by diseases (HIV with diabetes, HIV with hypertension and diabetes, HIV with CVD and finally HIV with hypertension and CVD and diabetes). Models also looked at integration from micro (patient focused integration) to macro (system level integrations). Most reported integration of hypertension and diabetes with HIV and AIDS services and described multidisciplinary collaboration, shared protocols, and incorporating screening activities into community campaigns. Integration took place exclusively at the meso-level, with no micro- or macro-level integrations described. Most were descriptive studies, with one cohort study reporting evaluative outcomes. Several innovative initiatives were identified and studies showed that CVD and HIV service integration is feasible. Integration should build on existing protocols and use the community as a locus for advocacy and health services, while promoting multidisciplinary teams, including greater involvement of pharmacists. There is a need for robust and well-designed studies at all levels - particularly macro-level studies, research looking at long-term outcomes of integration, and research in a more diverse range of countries

Perspectives on decision making amongst older people with end‐stage renal disease and caregivers in Singapore: a qualitative study

Background End‐stage renal disease (ESRD) is increasing both globally and in Asia. Singapore has the fifth highest incidence of ESRD worldwide, a trend that is predicted to rise. Older patients with ESRD are faced with a choice of haemodialysis, peritoneal dialysis or conservative management, all of which have their risks and benefits. Objective This study seeks to explore perspectives on decision making amongst older (≥70) Singaporean ESRD patients and their caregivers to undergo (or not to undergo) dialysis. Design Qualitative study design using semi‐structured interviews. Setting and participants Twenty‐three participants were recruited from the largest tertiary hospital in Singapore: seven peritoneal dialysis patients, five haemodialysis patients, four patients on conservative management and seven caregivers. Results While some patients believed that they had made an independent treatment decision, others reported feeling like they had no choice in the matter or that they were strongly persuaded by their doctors and/or family members to undergo dialysis. Patients reported decision‐making factors including loss of autonomy in daily life, financial burden (on themselves or on their families), caregiving burden, alternative medicine, symptoms and disease progression. Caregivers also reported concerns about financial and caregiving burden. Discussion and conclusion This study has identified several factors that should be considered in the design and implementation of decision aids to help older ESRD patients in Singapore make informed treatment decisions, including patients' and caregivers' decision‐making factors as well as the relational dynamics between patients, caregivers and doctors.This research was supported by the National Medical Research Council of Singapore (Grant Number: NMRC/HSRG/0080/2017), the Lien Centre for Palliative Care at Duke NUS Medical School and the National University Health System (NUHS) Singapore Population Health Improvement Centre (SPHERiC)(Grant Number: NMRC/CG/C026/2017_NUHS)