Converting Retirement Savings into Income: Annuities and Periodic Withdrawals

To a worker contemplating retirement, there is perhaps no more important question than “How long will my money last?” Congress has a strong interest in the income security of older Americans because much of their income is either provided directly from public programs like Social Security, or in the case of pensions and retirement accounts, is subsidized through tax deductions and deferrals. Many retirees must decide how to convert retirement account balances into income and how to preserve the accounts in the face of several kinds of risk. * Longevity risk is the risk that the individual will exhaust his or her account before death and experience a substantial decline in income. * Investment risk is the risk that the assets in which the individual has invested his or her retirement account will decline in value. * Inflation risk is the risk that price increases will cause the individual’s retirement income to decline in purchasing power. * Unexpected events such as divorce, the death of a spouse, the cost of medical care, or a need for long-term care services are also risks. There are strategies for dealing with each of these risks, but no single strategy can deal effectively with all of them. For example, purchasing a life annuity insures against longevity risk and it shifts the investment risk to the insurer. However, purchasing an annuity depletes the purchaser’s available assets by the amount of the premium. These assets are no longer available to the retiree in the event of a catastrophic illness or other unexpected major expense. To date, the demand for annuities has been low. There are many reasons for the low demand for annuities, but one of the most important has been that many potential annuity purchasers do not value the longevity insurance provided by annuities at its market price. Retirees who choose not to purchase life annuities must decide how much to withdraw from their retirement accounts each year. Because they face uncertainty with respect to both life expectancy and the rate of return on investment, this decision carries its own risks. If withdrawals are too large, retirees risk spending down their savings too quickly, possibly leaving them impoverished. If withdrawals are too small, they might spend too little and leave substantial assets unspent when they die. An analysis conducted by CRS indicates that under specific conditions there is a 95% or greater probability that a man who retires at age 65 will not exhaust his retirement account before the earlier of death or age 95 if his initial withdrawal does not exceed 5% of the account balance and later withdrawals are the same in inflationadjusted dollars. Under the same conditions, there is a 95% or greater probability that a woman who retires at age 65 will not exhaust her retirement account before the earlier of death or age 95 if her initial withdrawal does not exceed 4.5% of the account balance and later withdrawals are the same in inflation-adjusted dollars

The spiritual reformation in Elizabethan books of public and private devotion

This dissertation argues that the Elizabethan settlement was a deliberate, self-conscious spiritual reformation, inaugurated and nurtured from above by Elizabeth I in public and private devotional works put forth by royal authority, and taken up and advanced from below in influential books of public prayer published by long-term English evangelicals. This spiritual reformation offered a balance of continuity and change, of tradition and reform, intentionally designed to provide for the devotional needs of English Christians of divergent spiritual identities and confessional commitments. Responding to longstanding historiographical debates over the English Reformation as either a political reformation “from above” or a popular reformation “from below,” and to recent expositions both of the vitality of late medieval Catholic devotion and the dissemination of sixteenth-century Evangelical piety, the dissertation explores the English Reformation as a spiritual phenomenon, using Elizabethan prayer literature, both public and private, as its central sources. It argues that the foundations and contours of Elizabeth Tudor’s evangelically ecumenist style of piety and spirituality were established in her childhood in the mid 1540s through the influence of her stepmother, Katherine Parr. After her accession to the throne, Elizabeth’s piety and spirituality were reflected in her Act of Supremacy, her Act of Uniformity, and her Book of Common Prayer (1559), and were modeled and transmitted from above by her official primer of 1559. Elizabeth’s model of piety was consciously and deliberately taken up and advanced in the works of printers John and Richard Daye, and Henry Bull; and, authors Elizabeth Tyrwhit and Anne Wheathill. These printers and authors were long-term, committed evangelicals of a hotter temper than their queen. Bull advanced Elizabeth’s spiritual reformation by publishing traditional and evangelical prayers side-by-side. The two Daye prayer books followed Bull’s lead. The 1569 Daye prayer book also published a series of foreign language prayers authored by Elizabeth. Tyrwhit and Wheathill advanced the queen’s spiritual reformation not only by offering traditional and evangelical prayers, but also by constantly echoing the language of her Book of Common Prayer. The dual movement of these two matrices created the broadly based spiritual reformation that was the Elizabethan Settlement

Nitrogen limitation of phytoplankton growth in an oligotrophic lake

Blue Lake, Jefferson County, Oregon, has high summer surface phosphorus concentrations (ca. 30 ug/l) yet is oligotrophic (summer Secchi depth is 11 to 16 meters). Nutrient enrichment experiments done with 1000 1 polyethylene enclosures indicate nitrate limitation of phytoplankton growth. Basin morphology may be an important factor in nutrient cycling in this lake. The lake has a maximum depth of 95.7 meters with an average depth of 42.7 meters. The lake basin has steep sides with only 4% of the lake bottom less than 3.3 meters deep. of recent volcanic origin. In contrast, Suttle Lake, which is immediately downstream from Blue Lake, is moderately eutrophic (Secchi depth 1.7 meters) and supports much larger populations of phytoplankton, including nitrogen fixing cyanophytes. Suttle Lake is shallower and more subject to wind mixing

Patrick Mulvey, Oral History Interview, May 19, 2015

Major Topics Covered: Coming to MD Anderson The Office of Development under presidents Charles A. LeMaistre, John Mendelsohn, and Ronald DePinho Working with MD Anderson presidents The evolution of fundraising as a practice Changes in MD Anderson’s donor base MD Anderson’s capital campaigns Mechanisms for making appeals for donations The Moon Shots Program and fundraising The MD Anderson mission and culturehttps://openworks.mdanderson.org/mchv_interviewsessions/1178/thumbnail.jp

Patrick Mulvey, Oral History Interview, May 11, 2015

Major Topics Covered: Coming to MD Anderson The Office of Development under presidents Charles A. LeMaistre, John Mendelsohn, and Ronald DePinho Working with MD Anderson presidents The evolution of fundraising as a practice Changes in MD Anderson’s donor base MD Anderson’s capital campaigns Mechanisms for making appeals for donations The Moon Shots Program and fundraising The MD Anderson mission and culturehttps://openworks.mdanderson.org/mchv_interviewsessions/1177/thumbnail.jp

Global transmission of extended-spectrum cephalosporin resistance in Escherichia coli driven by epidemic plasmids

Background Extended-spectrum cephalosporins (ESCs) are third and fourth generation cephalosporin antimicrobials used in humans and animals to treat infections due to multidrug-resistant (MDR) bacteria. Resistance to ESCs (ESC-R) in Enterobacterales is predominantly due to the production of extended-spectrum β-lactamases (ESBLs) and plasmid-mediated AmpC β-lactamases (AmpCs). The dynamics of ESBLs and AmpCs are changing across countries and host species, the result of global transmission of ESC-R genes. Plasmids are known to play a key role in this dissemination, but the relative importance of different types of plasmids is not fully understood. Methods In this study, Escherichia coli with the major ESC-R genes blaCTX-M-1, blaCTX-M-15, blaCTX-M-14 (ESBLs) and blaCMY-2 (AmpC), were selected from diverse host species and other sources across Canada, France and Germany, collected between 2003 and 2017. To examine in detail the vehicles of transmission of the ESC-R genes, long- and short-read sequences were generated to obtain complete contiguous chromosome and plasmid sequences (n = 192 ESC-R E. coli). The types, gene composition and genetic relatedness of these plasmids were investigated, along with association with isolate year, source and geographical origin, and put in context with publicly available plasmid sequences. Findings We identified five epidemic resistance plasmid subtypes with distinct genetic properties that are associated with the global dissemination of ESC-R genes across multiple E. coli lineages and host species. The IncI1 pST3 blaCTX-M-1 plasmid subtype was found in more diverse sources than the other main plasmid subtypes, whereas IncI1 pST12 blaCMY-2 was more frequent in Canadian and German human and chicken isolates. Clonal expansion also contributed to the dissemination of the IncI1 pST12 blaCMY-2 plasmid in ST131 and ST117 E. coli harbouring this plasmid. The IncI1 pST2 blaCMY-2 subtype was predominant in isolates from humans in France, while the IncF F31:A4:B1 blaCTX-M-15 and F2:A-:B- blaCTX-M-14 plasmid subtypes were frequent in human and cattle isolates across multiple countries. Beyond their epidemic nature with respect to ESC-R genes, in our collection almost all IncI1 pST3 blaCTX-M-1 and IncF F31:A4:B1 blaCTX-M-15 epidemic plasmids also carried multiple antimicrobial resistance (AMR) genes conferring resistance to other antimicrobial classes. Finally, we found genetic signatures in the regions surrounding specific ESC-R genes, identifying the predominant mechanisms of ESC-R gene movement, and using publicly available databases, we identified these epidemic plasmids from widespread bacterial species, host species, countries and continents. Interpretation We provide evidence that epidemic resistance plasmid subtypes contribute to the global dissemination of ESC-R genes, and in addition, some of these epidemic plasmids confer resistance to multiple other antimicrobial classes. The success of these plasmids suggests that they may have a fitness advantage over other plasmid types and subtypes. Identification and understanding of the vehicles of AMR transmission are crucial to develop and target strategies and interventions to reduce the spread of AMR

Dynamics of extended-spectrum cephalosporin resistance genes in Escherichia coli from Europe and North America

Extended-spectrum cephalosporins (ESCs) are critically important antimicrobial agents for human and veterinary medicine. ESC resistance (ESC-R) genes have spread worldwide through plasmids and clonal expansion, yet the distribution and dynamics of ESC-R genes in different ecological compartments are poorly understood. Here we use whole genome sequence data of Enterobacterales isolates of human and animal origin from Europe and North America and identify contrasting temporal dynamics. AmpC β-lactamases were initially more dominant in North America in humans and farm animals, only later emerging in Europe. In contrast, specific extended-spectrum β-lactamases (ESBLs) were initially common in animals from Europe and later emerged in North America. This study identifies differences in the relative importance of plasmids and clonal expansion across different compartments for the spread of different ESC-R genes. Understanding the mechanisms of transmission will be critical in the design of interventions to reduce the spread of antimicrobial resistance

A bipartite transcription factor module controlling expression in the bundle sheath of Arabidopsis thaliana.

C4 photosynthesis evolved repeatedly from the ancestral C3 state, improving photosynthetic efficiency by ~50%. In most C4 lineages, photosynthesis is compartmented between mesophyll and bundle sheath cells, but how gene expression is restricted to these cell types is poorly understood. Using the C3 model Arabidopsis thaliana, we identified cis-elements and transcription factors driving expression in bundle sheath strands. Upstream of the bundle sheath preferentially expressed MYB76 gene, we identified a region necessary and sufficient for expression containing two cis-elements associated with the MYC and MYB families of transcription factors. MYB76 expression is reduced in mutant alleles for these transcription factors. Moreover, downregulated genes shared by both mutants are preferentially expressed in the bundle sheath. Our findings are broadly relevant for understanding the spatial patterning of gene expression, provide specific insights into mechanisms associated with the evolution of C4 photosynthesis and identify a short tuneable sequence for manipulating gene expression in the bundle sheath.ERC BBSR

Diversity of blaCTX-M-1-carrying plasmids recovered from Escherichia coli isolated from Canadian domestic animals

Conserved IncI1 and IncHI1 plasmids carrying blaCTX-M-1 have been found circulating in chickens and horses from continental Europe, respectively. In Canada, blaCTX-M-1 is overwhelmingly the most common blaCTX-M variant found in Escherichia coli from chicken and horses and can be recovered at lower frequencies in swine, cattle, and dogs. Wholegenome sequencing has identified a large genetic diversity of isolates carrying this variant, warranting further investigations into the plasmids carrying this gene. Therefore, the objective of this study was to describe the genetic profiles of blaCTX-M-1 plasmids circulating in E. coli from Canadian domestic animals and compare them to those recovered in animals in Europe. Fifty-one blaCTX-M-1 positive E. coli isolates from chicken (n = 14), horses (racetrack horses n = 11; community horses n = 3), swine (n = 7), turkey (n = 6), dogs (n = 5), beef cattle (n = 3), and dairy cattle (n = 2) were selected for plasmid characterization. Sequences were obtained through both Illumina and Oxford Nanopore technologies. Genomes were assembled using either Unicycler hybrid assembly or Flye with polishing performed using Pilon. blaCTX-M-1 was found residing on a plasmid in 45 isolates and chromosomally located in six isolates. A conserved IncI1/ST3 plasmid was identified among chicken (n = 12), turkey (n = 4), swine (n = 6), dog (n = 2), and beef cattle (n = 2) isolates. When compared against publicly available data, these plasmids showed a high degree of similarity to those identified in isolates from poultry and swine in Europe. These results suggest that an epidemic IncI1/ ST3 plasmid similar to the one found in Europe is contributing to the spread of blaCTX-M-1 in Canada. A conserved IncHI1/FIA(HI1)/ST2 plasmid was also recovered from nearly all racetrack horse isolates (n = 10). Although IncHI1/ST2 plasmids have been reported among European horse isolates, IncHI1/ST9 plasmids appear to be more widespread. Further studies are necessary to understand the factors contributing to these plasmids' success in their respective populations

Use of digital measurement of medication adherence and lung function to guide the management of uncontrolled asthma (INCA Sun):a multicentre, single-blinded, randomised clinical trial

BACKGROUND: The clinical value of using digital tools to assess adherence and lung function in uncontrolled asthma is not known. We aimed to compare treatment decisions guided by digitally acquired data on adherence, inhaler technique, and peak flow with existing methods.METHODS: A 32-week prospective, multicentre, single-blinded, parallel, randomly controlled trial was done in ten severe asthma clinics across Ireland, Northern Ireland, and England. Participants were 18 years or older, had uncontrolled asthma, asthma control test (ACT) score of 19 or less, despite treatment with high-dose inhaled corticosteroids, and had at least one severe exacerbation in the past year despite high-dose inhaled corticosteroids. Patients were randomly assigned in a 1:1 ratio to the active group or the control group, by means of a computer-generated randomisation sequence of permuted blocks of varying sizes (2, 4, and 6) stratified by fractional exhaled nitric oxide (FeNO) concentration and recruitment site. In the control group, participants were masked to their adherence and errors in inhaler technique data. A statistician masked to study allocation did the statistical analysis. After a 1-week run-in period, both groups attended three nurse-led education visits over 8 weeks (day 7, week 4, and week 8) and three physician-led treatment adjustment visits at weeks 8, 20, and 32. In the active group, treatment adjustments during the physician visits were informed by digital data on inhaler adherence, twice daily digital peak expiratory flow (ePEF), patient-reported asthma control, and exacerbation history. Treatment was adjusted in the control group on the basis of pharmacy refill rates (a measure of adherence), asthma control by ACT questionnaire, and history of exacerbations and visual management of inhaler technique. Both groups used a digitally enabled Inhaler Compliance Assessment (INCA) and PEF. The primary outcomes were asthma medication burden measured as proportion of patients who required a net increase in treatment at the end of 32 weeks and adherence rate measured in the last 12 weeks by area under the curve in the intention-to-treat population. The safety analyses included all patients who consented for the trial. The trial is registered with ClinicalTrials.gov, NCT02307669 and is complete.FINDINGS: Between Oct 25, 2015, and Jan 26, 2020, of 425 patients assessed for eligibility, 220 consented to participate in the study, 213 were randomly assigned (n=108 in the active group; n=105 in the control group) and 200 completed the study (n=102 in the active group; n=98 in the control group). In the intention-to-treat analysis at week 32, 14 (14%) active and 31 (32%) control patients had a net increase in treatment compared with baseline (odds ratio [OR] 0·31 [95% CI 0·15-0·64], p=0·0015) and 11 (11%) active and 21 (21%) controls required add-on biological therapy (0·42 [0·19-0·95], p=0·038) adjusted for study site, age, sex, and baseline FeNO. Three (16%) of 19 active and 11 (44%) of 25 control patients increased their medication from fluticasone propionate 500 μg daily to 1000 μg daily (500 μg twice a day; adjusted OR 0·23 [0·06-0·87], p=0·026). 26 (31%) of 83 active and 13 (18%) of 73 controls reduced their medication from fluticasone propionate 1000 μg once daily to 500 μg once daily (adjusted OR 2·43 [1·13-5·20], p=0·022. Week 20-32 actual mean adherence was 64·9% (SD 23·5) in the active group and 55·5% (26·8) in the control group (between-group difference 11·1% [95% CI 4·4-17·9], p=0·0012). A total of 29 serious adverse events were recorded (16 [55%] in the active group, and 13 [45%] in the control group), 11 of which were confirmed as respiratory. None of the adverse events reported were causally linked to the study intervention, to the use of salmeterol-fluticasone inhalers, or the use of the digital PEF or INCA.INTERPRETATION: Evidence-based care informed by digital data led to a modest improvement in medication adherence and a significantly lower treatment burden.FUNDING: Health Research Board of Ireland, Medical Research Council, INTEREG Europe, and an investigator-initiated project grant from GlaxoSmithKline.</p