The comprehensive and expansionary Letter to Shareholders from the Chairman Edward S Lampert includes a warning against the current fervour for nationalisation;
"...I believe that the primary problem with the financial system has been a funding problem rather than a capital problem. What this means is that our banks went into this crisis with significant levels of capital and several have raised considerable levels of additional capital since. Nevertheless, their ability to fund their business on a day-to-day basis was compromised at times during 2008 due to dislocations in the capital markets. When Bear Stearns ran into funding problems in early 2008, the Federal Reserve and Treasury stepped in to arrange a merger with J.P. Morgan. Only a few days before this happened senior Bear Stearns officials were assuring nervous constituents that the bank had significant capital and liquidity and could weather the storm. However, when confidence in a financial institution is compromised, very few can survive without some form of assistance, especially when events unfold with such speed and are accompanied by rumors, speculation, and fear that only time can dispel.
...On September 7, 2008, in the largest nationalization in American history (executed expeditiously and without an obviously transparent process), the U.S. government announced that it was placing Fannie Mae and Freddie Mac into conservatorship. As part of the conservatorship, the government would provide capital support, if necessary, of up to $100 billion to each GSE through Preferred Stock Purchase Agreements. Although no cash changed hands, in consideration of this backstop, the U.S. government received 80% of the common stock plus $1 billion in preferred stock in each institution. This backstop has recently been increased to $200 billion as part of the Homeowner Affordability and Stability Plan. In the process, they suspended dividends on existing preferred stock of both Fannie Mae and Freddie Mac, eliminating approximately $36 billion in value, most of which was held by the major commercial banks in the United States.
Rather than help solve the housing and mortgage problem, the unintended consequences of this action were manifold. First, bank capital was depleted. Not only was $36 billion in GSE preferred wiped out, but the whole market for financial preferred securities went into a free fall, wiping out additional equity from financial institutions, including many large insurance companies. Second, despite the boards of directors of Fannie Mae and Freddie Mac consenting to conservatorship, neither company has ever given an explanation for its consent. For those who are sophisticated in finance, neither Fannie Mae nor Freddie Mac had a “funding” problem. Because each GSE’s balance sheet was comprised of highly liquid Mortgage Backed Securities (MBS) that pay off on a monthly basis, it should have been easy for either to pledge securities to raise money or to shrink their balance sheet and meet their financial obligations as they came due. The logical explanation for the boards of directors giving consent rests with the presumption that if they did not consent, there was some other threat that would have been even worse for those directors. As for the shareholders the directors represented, it is hard to imagine anything worse than having their investment effectively wiped out, and they had no vote on the matter.
..The two most important books that any student of current events should be reading in this environment are both by Friedrich Hayek, the esteemed Austrian economist. Based on events he witnessed beginning in the early part of the 20th century, Hayek wrote The Road to Serfdom as a warning to England and the United States against the damaging impact of socialist policies and The Fatal Conceit as a warning against heavy intervention in markets and society at large. Despite the almost universal belief today that more, but better, regulation is needed and that the role of the state needs to be not just temporarily larger, but permanently larger, Hayek’s writings and logic should give everybody pause as to the consequences of these actions.
As a country, we need to rebuild confidence and trust and to understand what happened. Whether by business or by government, the misdiagnosis of situations leads to poor prescriptions for rehabilitation and recovery. When the misdiagnosis is done at the federal government level and involves large parts of a national economy, the consequences can be swift and significant.
The unintended consequences are often swifter and even more significant. As the leaders in our nation continue to evaluate and evolve the policies and rules of the game, we would all be wise to heed the cautions raised by Friedrich Hayek. I appreciate that the free market can be a difficult master and that there is an important role for government and regulators, but I hope that as we move forward the rules of the game and the methodology for changing those rules will be more consistent and fair than they have been over the past year. Those who desire to protect civil liberties in times of war appreciate the importance of laws protecting individuals and institutions. In times of economic and financial distress we need to be similarly vigilant in protecting economic and contract rights so that we can continue to have a system that functions properly. Attempts to threaten or eliminate those rights will chase away the capital and investment that our country needs to restore prosperity and to thrive in the future..."
February 28, 2009
Skin test causes HCW angst
On the allnurses.com forum this cry for help was made;
Poster JennAudrey responded with commonsesnse
TB test positive... but may be neg?? Please advise...
I'm worried, i took the TB test required for my CNA course (which I already paid $900 for and is only 50% refundable), and they weren't sure whether it was pos. or neg. because the reaction was 5mm in diameter, which is right on the fence. Anything more than 5 is technically positive for sure. So they did a chest x-ray.... but I won't get the results back until the 12th and my class starts on the 16th.... which means I won't have time to postpone my start date or get my money back
The nurses said that I have most likely just been exposed but the TB is not active and I don't have any of the symptoms.... but my question is what are the chances that my test will come back negative?
PLEASE ADVISE, my livelyhood depends on this. I am planning on resigning from my job tomorrow in order to do this CNA program and eventually an RN!!!!!!
Poster JennAudrey responded with commonsesnse
Feb 26, 2009 05:58 PM - Couldn't they do the QuantiFERON®-TB Gold at your Dr's office and get the test results quicker? I had mine thru employee health at my facility and had a reaction to the test (not positive, but not normal) and they did the blood draw and had it back in a week. (Yeah for me... no more PPD... I hate that test!)
February 27, 2009
Quantiferon on dialysis patients
The value of QuantiFERON® TB-Gold in the diagnosis of tuberculosis among dialysis patients.
Source
Inoue T, Nakamura T, Katsuma A, Masumoto S, Minami E, Katagiri D, Hoshino T, Shibata M, Tada M, Hinoshita F.
Division of Nephrology, International Medical Center of Japan, Tokyo, Japan.
BACKGROUND: It is difficult to diagnose tuberculosis (TB) in dialysis patients because of the high rate of extrapulmonary TB in these patients compared with the general population. Recently, a new diagnostic test called QuantiFERON (QFT) has been developed and shown promise as a diagnostic tool for active TB diseases and latent TB infection.
METHODS: We examined 162 dialysis patients admitted to a single institute, including 8 patients with active TB, and evaluated the utility of this test in dialysis patients.
RESULTS: Among 162 dialysis patients, positive QFT results occurred in 28 (17.3%), negative QFT results occurred in 95 (58.6%) and indeterminate QFT results occurred in 39 (24.1%). All eight active TB patients had positive QFT results, and none of the 95 patients with negative results had active TB. Among 23 patients with a history of active TB, 10 (43.5%) had positive results. Although the indeterminate rate was relatively high, no patient with an indeterminate result had active TB. Factors such as shorter duration of dialysis, lower lymphocyte count and higher white blood cell count were associated with indeterminate results. Among 105 cases after excluding the patients with previous TB or indeterminate results, the sensitivity of the QFT is 100% (8 of 8) and the specificity is 89.7% (87 of 97 cases).
CONCLUSIONS: Our data suggest that the QFT test is a useful supplementary tool for the diagnosis of active TB even in dialysis patients. Negative and indeterminate results on this test may be used to exclude the presence of active TB.
Medical News Today
New Tuberculosis Blood Test Is Useful Tool, If Used With Care
Source
26 Feb 2009
The newly introduced Interferon-Y release assays (IGRA) is a new group of blood tests that offer many operational advantages over the conventional tuberculin skin tests (TST) -- particularly in the diagnosis of latent tuberculosis (TB).
An editorial published in Respirology by Wiley-Blackwell discusses the role of IGRA in the diagnosis of TB and brings attention to the potential caveats in the application of these new tests.
"IGRA offers many advantages over TST, such as completion of tests in one visit, availability of results within 24 hours, absence of inter and intra-divergence, ability to detect potential immonu-depression and the avoidance of the booster phenomenon. However, their current cost and the need for delivery of fresh blood limits the feasibility of large-scale application in most TB-endemic areas," said author Professor Chi Chiu Leung of the Tuberculosis and Chest Service, Department of Health, Hong Kong.
TB is an ancient disease that remains a major killer in many parts of the world. It is estimated that one out of ten infected immuno-competent individuals will develop the clinical disease in his or her lifetime.
The ultimate purpose of screening for TB infection is to prevent the onset of the disease. Unfortunately, none of the existing tests for TB infection can distinguish between latent infection and active disease.
"While it is generally difficult to interpret a positive test in TB-endemic areas, IGRA may still play an important adjunctive role for the diagnosis of active TB in children. The new tools offer significant advantages over TST, especially in setting with widespread BCG vaccinations after infancy or revaccinations." said Professor Leung.
He added, "With the various intrinsic limitations present in IGRA, added care should be exercised in the application and interpretation of the new tools. Further studies are required to provide definitive answers and allow these new tools to be applied more effectively."
The article abstract is available free of charge online http://www3.interscience.wiley.com/journal/121661805/abstract
About Respirology
Respirology is a journal of international standing, publishing peer-reviewed articles of scientific excellence in clinical and experimental respiratory biology and disease and its related fields of research including thoracic surgery, internal medicine, immunology, intensive and critical care, epidemiology, cell and molecular biology, pathology, pharmacology and physiology.
Source
26 Feb 2009
The newly introduced Interferon-Y release assays (IGRA) is a new group of blood tests that offer many operational advantages over the conventional tuberculin skin tests (TST) -- particularly in the diagnosis of latent tuberculosis (TB).
An editorial published in Respirology by Wiley-Blackwell discusses the role of IGRA in the diagnosis of TB and brings attention to the potential caveats in the application of these new tests.
"IGRA offers many advantages over TST, such as completion of tests in one visit, availability of results within 24 hours, absence of inter and intra-divergence, ability to detect potential immonu-depression and the avoidance of the booster phenomenon. However, their current cost and the need for delivery of fresh blood limits the feasibility of large-scale application in most TB-endemic areas," said author Professor Chi Chiu Leung of the Tuberculosis and Chest Service, Department of Health, Hong Kong.
TB is an ancient disease that remains a major killer in many parts of the world. It is estimated that one out of ten infected immuno-competent individuals will develop the clinical disease in his or her lifetime.
The ultimate purpose of screening for TB infection is to prevent the onset of the disease. Unfortunately, none of the existing tests for TB infection can distinguish between latent infection and active disease.
"While it is generally difficult to interpret a positive test in TB-endemic areas, IGRA may still play an important adjunctive role for the diagnosis of active TB in children. The new tools offer significant advantages over TST, especially in setting with widespread BCG vaccinations after infancy or revaccinations." said Professor Leung.
He added, "With the various intrinsic limitations present in IGRA, added care should be exercised in the application and interpretation of the new tools. Further studies are required to provide definitive answers and allow these new tools to be applied more effectively."
The article abstract is available free of charge online http://www3.interscience.wiley.com/journal/121661805/abstract
About Respirology
Respirology is a journal of international standing, publishing peer-reviewed articles of scientific excellence in clinical and experimental respiratory biology and disease and its related fields of research including thoracic surgery, internal medicine, immunology, intensive and critical care, epidemiology, cell and molecular biology, pathology, pharmacology and physiology.
February 25, 2009
Getting the message about Quantiferon - update
Last posted on in January, now further detail is emerging of the study into inflammatory bowel disease;
Should the TST be replaced by the IGRA for screening for latent TB in IBD patients?
The advantages of the QFT-G-IT include its high specificity for detecting M. tuberculosis, the lack of influence exerted by previous BCG vaccination, and its lower susceptibility for false negative results compared to TST in patients under immunosuppressive therapy.
The lack of false positive results omits unnecessary controls and therapies; furthermore, a second visit for reading the test result is not necessary. The cost-effectiveness of screening for latent infection with IGRA instead of TST has been demonstrated (43, 44).
The disadvantages of the QFT-G-IT are the requirements of a validated laboratory and a demanding logistic system for transport and storage.
Based on the abovementioned findings, we recommend performing an IGRA in every IBD patient, at least in those undergoing immunosuppressive therapy who will receive anti-TNFα treatment
Ron Paul 2002
Reference
Congressman Ron Paul
U.S. House of Representatives
July 16, 2002
Mr. Speaker, I rise to introduce the Free Housing Market Enhancement Act. This legislation restores a free market in housing by repealing special privileges for housing-related government sponsored enterprises (GSEs). These entities are the Federal National Mortgage Association (Fannie), the Federal Home Loan Mortgage Corporation (Freddie), and the National Home Loan Bank Board (HLBB). According to the Congressional Budget Office, the housing-related GSEs received $13.6 billion worth of indirect federal subsidies in fiscal year 2000 alone.
One of the major government privileges granted these GSEs is a line of credit to the United States Treasury. According to some estimates, the line of credit may be worth over $2 billion. This explicit promise by the Treasury to bail out these GSEs in times of economic difficulty helps them attract investors who are willing to settle for lower yields than they would demand in the absence of the subsidy. Thus, the line of credit distorts the allocation of capital. More importantly, the line of credit is a promise on behalf of the government to engage in a massive unconstitutional and immoral income transfer from working Americans to holders of GSE debt.
The Free Housing Market Enhancement Act also repeals the explicit grant of legal authority given to the Federal Reserve to purchase the debt of housing-related GSEs. GSEs are the only institutions besides the United States Treasury granted explicit statutory authority to monetize their debt through the Federal Reserve. This provision gives the GSEs a source of liquidity unavailable to their competitors.
Ironically, by transferring the risk of a widespread mortgage default, the government increases the likelihood of a painful crash in the housing market. This is because the special privileges of Fannie, Freddie, and HLBB have distorted the housing market by allowing them to attract capital they could not attract under pure market conditions. As a result, capital is diverted from its most productive use into housing. This reduces the efficacy of the entire market and thus reduces the standard of living of all Americans.
However, despite the long-term damage to the economy inflicted by the government’s interference in the housing market, the government’s policies of diverting capital to other uses creates a short-term boom in housing. Like all artificially-created bubbles, the boom in housing prices cannot last forever. When housing prices fall, homeowners will experience difficulty as their equity is wiped out. Furthermore, the holders of the mortgage debt will also have a loss. These losses will be greater than they would have otherwise been had government policy not actively encouraged over-investment in housing.
Perhaps the Federal Reserve can stave off the day of reckoning by purchasing GSE debt and pumping liquidity into the housing market, but this cannot hold off the inevitable drop in the housing market forever. In fact, postponing the necessary but painful market corrections will only deepen the inevitable fall. The more people invested in the market, the greater the effects across the economy when the bubble bursts.
No less an authority than Federal Reserve Chairman Alan Greenspan has expressed concern that government subsidies provided to the GSEs make investors underestimate the risk of investing in Fannie Mae and Freddie Mac.
Mr. Speaker, it is time for Congress to act to remove taxpayer support from the housing GSEs before the bubble bursts and taxpayers are once again forced to bail out investors misled by foolish government interference in the market. I therefore hope my colleagues will stand up for American taxpayers and investors by cosponsoring the Free Housing Market Enhancement Act.
Congressman Ron Paul
U.S. House of Representatives
July 16, 2002
Mr. Speaker, I rise to introduce the Free Housing Market Enhancement Act. This legislation restores a free market in housing by repealing special privileges for housing-related government sponsored enterprises (GSEs). These entities are the Federal National Mortgage Association (Fannie), the Federal Home Loan Mortgage Corporation (Freddie), and the National Home Loan Bank Board (HLBB). According to the Congressional Budget Office, the housing-related GSEs received $13.6 billion worth of indirect federal subsidies in fiscal year 2000 alone.
One of the major government privileges granted these GSEs is a line of credit to the United States Treasury. According to some estimates, the line of credit may be worth over $2 billion. This explicit promise by the Treasury to bail out these GSEs in times of economic difficulty helps them attract investors who are willing to settle for lower yields than they would demand in the absence of the subsidy. Thus, the line of credit distorts the allocation of capital. More importantly, the line of credit is a promise on behalf of the government to engage in a massive unconstitutional and immoral income transfer from working Americans to holders of GSE debt.
The Free Housing Market Enhancement Act also repeals the explicit grant of legal authority given to the Federal Reserve to purchase the debt of housing-related GSEs. GSEs are the only institutions besides the United States Treasury granted explicit statutory authority to monetize their debt through the Federal Reserve. This provision gives the GSEs a source of liquidity unavailable to their competitors.
Ironically, by transferring the risk of a widespread mortgage default, the government increases the likelihood of a painful crash in the housing market. This is because the special privileges of Fannie, Freddie, and HLBB have distorted the housing market by allowing them to attract capital they could not attract under pure market conditions. As a result, capital is diverted from its most productive use into housing. This reduces the efficacy of the entire market and thus reduces the standard of living of all Americans.
However, despite the long-term damage to the economy inflicted by the government’s interference in the housing market, the government’s policies of diverting capital to other uses creates a short-term boom in housing. Like all artificially-created bubbles, the boom in housing prices cannot last forever. When housing prices fall, homeowners will experience difficulty as their equity is wiped out. Furthermore, the holders of the mortgage debt will also have a loss. These losses will be greater than they would have otherwise been had government policy not actively encouraged over-investment in housing.
Perhaps the Federal Reserve can stave off the day of reckoning by purchasing GSE debt and pumping liquidity into the housing market, but this cannot hold off the inevitable drop in the housing market forever. In fact, postponing the necessary but painful market corrections will only deepen the inevitable fall. The more people invested in the market, the greater the effects across the economy when the bubble bursts.
No less an authority than Federal Reserve Chairman Alan Greenspan has expressed concern that government subsidies provided to the GSEs make investors underestimate the risk of investing in Fannie Mae and Freddie Mac.
Mr. Speaker, it is time for Congress to act to remove taxpayer support from the housing GSEs before the bubble bursts and taxpayers are once again forced to bail out investors misled by foolish government interference in the market. I therefore hope my colleagues will stand up for American taxpayers and investors by cosponsoring the Free Housing Market Enhancement Act.
Unintended consequences - Africa mines drug resistant TB
The problem, according to MSF doctor Kirill Kojemiakine, is that not all the miners treated for TB in Lesotho finish their six-month course of treatment before returning to work. "Many TB patients who are smear-positive, meaning they're still infectious, take one week of treatment and then default and go back to South Africa," he said.
######
MORIJA, 19 February 2009 (PlusNews) - Two years ago Mopeli Mofoka, 39, left his wife and child in Maseru, Lesotho's capital, and joined the more than 50,000 men pushed by poverty and unemployment in their home country to seek work on mines in neighbouring South Africa.
It was his second stint as a miner; the first had been 15 years earlier. This time he was hired as a sub-contractor, which meant that despite testing positive for HIV during his preliminary health screening he did not have access to the on-site health services available to mine employees.
When his health began deteriorating 18 months later, he went to a local public hospital but was turned away because he lacked a South African identity document.
His only option was to return home, where he is receiving treatment for tuberculosis (TB) at a government clinic run in partnership with international medical aid organisation Médecins Sans Frontières (MSF) in Morija, about 50km south of Maseru, the capital.
"[My employer] said they'll take me back when I'm better," Mofoka told IRIN/PlusNews. "I think I'll be good by April, when I finish the TB treatment."
The problem, according to MSF doctor Kirill Kojemiakine, is that not all the miners treated for TB in Lesotho finish their six-month course of treatment before returning to work. "Many TB patients who are smear-positive, meaning they're still infectious, take one week of treatment and then default and go back to South Africa," he said.
Interrupting treatment for either TB or HIV can lead to the development of drug resistance. Strains of TB that are resistant to first-line TB drugs, and thus more difficult to diagnose and treat, are becoming increasingly common among migrant miners and their families.
A 2008 study found that at least 25 percent of drug-resistant TB patients treated in Lesotho since August 2007 had worked in mines in South Africa. The full extent of Lesotho's multidrug-resistant (MDR) TB problem is unknown, said Kojemiakine, because the majority of such patients die before they are diagnosed or can start receiving appropriate treatment. International NGO, Partners in Health, which is partnering with Lesotho's Ministry of Health to provide treatment for MDR-TB patients has estimated that 950 new MDR-TB cases will be diagnosed in Lesotho every year.
Lack of coordination
The movement of mine workers between Lesotho and South Africa has had public health repercussions in both countries, but they have been most keenly felt in the tiny mountain kingdom of Lesotho, which has a population of just 1.8 million.
"You have a man leaving his family behind, and when they get across [the border], they develop other relationships," said Mojapela Majoro, regional manager for TEBA Ltd, a service organisation that recruits mineworkers for the South African mining industry.
An estimated 23 percent of Lesotho's population is now living with HIV, and the incidence of TB - a common HIV-related opportunistic infection - is the fourth highest in the world.
A lack of coordination between Lesotho and South Africa in developing TB and HIV policies, and the difficulty of tracking patients, many of them miners who move back and forth between the two countries, has contributed to Lesotho's growing incidence of MDR-TB.
Unlike South Africa, where MDR-TB patients are isolated in special facilities while they undergo treatment that can take up to two years, Lesotho has just one such facility in Maseru with 20 beds. Patients are only kept there for an initial one or two months, after which they are treated as out-patients, with community health workers making twice-daily visits to administer the necessary cocktail of drugs and injections.
AIDS claimed an estimated 18,000 lives in Lesotho in 2007 It's a system that makes it difficult to keep track of patients who are determined to return to South Africa as soon as possible to earn an income to support their families.
The first time Daniel Thabiso, 41, was diagnosed with TB, he left the mine where he was working in South Africa and returned to Lesotho for treatment. He came back in 2002 to work as a sub-contractor but lost his job two years later because of ill health. He was diagnosed with MDR-TB and HIV in 2008 after a second bout of TB failed to respond to first-line treatment.
After a short stay at the MDR-TB facility in Maseru he was sent home and continued out-patient treatment for another four months, but the medication made him vomit and he was eager to join his wife and two children, who had recently moved to South Africa.
"I told the people at the MDR clinic I wanted to go to South Africa and they said they'd give me a referral letter, but I left before it arrived," he told IRIN/PlusNews.
He returned to Lesotho in December 2008 to attend his sister-in-law's funeral, but did not go back to the MDR clinic and, despite his gaunt appearance, is convinced that he no longer has TB after a sputum test he took in South Africa returned a negative result. Sputum tests often fail to detect TB in patients co-infected with HIV and only culture testing can diagnose MDR-TB.
"I'm feeling better, so the TB is gone," he told IRIN/PlusNews, adding that he planned to go back to South Africa in a few days.
For the estimated 90 percent of TB patients in Lesotho who are co-infected with HIV, movement back and forth across the border with South Africa makes treatment espcially complicated.
Even mine employees often have difficulty getting antiretroviral drugs (ARVs) from either mine clinics or government clinics in South Africa; most are sent back to Lesotho with a referral letter.
"We give them a [ARV] drug supply for a few months, but sometimes they come back late and this is one reason for defaulting," said Kojemiakine. "This gap between Lesotho workers and South African workers doesn't bring anything good because it creates [drug] resistance, and this resistance will spread from Lesotho back to South Africa."
Whose responsibility?
The AIDS and Rights Alliance for Southern Africa (ARASA) released a report in July 2008 urging mining companies and the South African and Lesotho governments to start working together to address the lack of cross-border health policies for migrant mine workers.
Noting the "unambiguous" relationship between Lesotho's TB incidence rate and the South African mining sector, the report accused mining companies of failing to take adequate responsibility for controlling TB among migrant Basotho miners, or for mitigating its impacts on their families and communities.
Dr Brian Brink, group medical consultant to Anglo American, one of South Africa's largest mining companies, agreed that the companies have a responsibility to ensure that all their employees have access to health care, but suggested that the root cause of Lesotho's drug-resistant TB crisis was a lack of coordination between health providers at the mine clinics and in the public sector on both sides of the border.
"If someone is too ill to work and is placed on early retirement, you have to make sure that continuity of care isn't broken," he told IRIN/PlusNews. "Whether it's asthma or TB or HIV, there has to be an arrangement made so you don't just drop someone and say, 'That's it.'"
A home-based care programme for Basotho mineworkers living with HIV, TB or other serious illnesses, run by the development arm of TEBA Ltd, the mineworker recruitment organisation, and funded mainly by mining companies, is one example of how such continuity of care can work.
Patients who are "repatriated" because of ill health by one of the participating mines in South Africa are referred to the programme in Lesotho, which partners with local health providers and non-governmental organisations to ensure that patients receive ongoing treatment and regular home visits from care-givers.
For a period of two years or until the patient recovers, the organisation takes care of all medical fees, monitors treatment and provides life-skills training for those unable or unwilling to return to the mines.
An alarming 47 of 409 patients currently on the programme have been diagnosed with MDR-TB, and stories like Thabiso's suggest that many more Basotho miners are falling undetected through the health care gap that spans the border between South Africa and Lesotho.
ks/he
February 24, 2009
Why not axe dividend imputation? Henry gets serious.
And how. The Review is taking shape.
Peter Martin
MILLIONS of Australian mum and dad investors face the loss of their imputation tax credits as part of what Treasury head Ken Henry says is shaping up to be the most comprehensive policy review ever undertaken in Australia.
Ramping up expectations of his Henry Tax Review, the Treasury boss told a Sydney conference it was considering axing the system of dividend imputation introduced by former Treasurer Paul Keating more than 20 years ago.
It has ensured that investors in Australian icons such as Telstra, BHP, CSR and Coles Myer paid no or little income tax on their dividends in those in years in which the companies paid the full rate of company tax.
It has also provided benefits to Australian superannuation funds.
Dr Henry told the conference it was "not surprising" that Australian investors and superannuation funds liked the tax-free dividends.
But he said it and other Australian tax provisions made little sense in a world of massive global capital flows...
By extending to Australian investors a concession not available to foreign investors, it made it harder for Australian companies to get access to funds - a process he referred to as "capital shallowing".
A cut in the company tax rate funded by axing dividend imputation would boost the
would also attract more foreign investment, increasing real wages and boosting share prices and Australia's gross domestic product.
The Melbourne consultancy Lateral Economics believes axing dividend imputation would free up $20 billion per year, enough to fund a cut in Australia's corporate tax rate from 30 per cent to 19 per cent.
The company tax rate could then be cut even lower if the new rate boosted the size of the Australian economy in the way expected.
Lateral Economics believes a cut in the headline corporate tax rate to 19 per cent would boost foreign direct investment in Australia by about one-quarter.
It says the resulting boost in share prices should more than compensate the Australian mum and dad investors who missed out on their imputation credits.
The UK and Ireland have already abolished their dividend imputation schemes leaving Australia and New Zealand as two of the only nations to retain them.
Dr Henry said he did not want to be interpreted as "arguing the case for doing away with imputation".
"Our system has some distinct advantages. For one thing as imputation credits are only provided for Australian tax paid Australian multinationals have fewer incentives to shift profits offshore."
The Treasury Secretary also raised the possibility of abandoning Australia's existing system of corporate taxation in favour of "more dramatic, far-reaching change".
One idea would be to tax by destination rather than origin so that imports would be taxed and exports would be tax free. Another would be to tax business spending rather than profits.
He said while such changes would involve significant costs, "sometimes change is necessary.
The Henry Review will report to the Treasurer in December. It is accepting submissions until May.
Peter Martin
MILLIONS of Australian mum and dad investors face the loss of their imputation tax credits as part of what Treasury head Ken Henry says is shaping up to be the most comprehensive policy review ever undertaken in Australia.
Ramping up expectations of his Henry Tax Review, the Treasury boss told a Sydney conference it was considering axing the system of dividend imputation introduced by former Treasurer Paul Keating more than 20 years ago.
It has ensured that investors in Australian icons such as Telstra, BHP, CSR and Coles Myer paid no or little income tax on their dividends in those in years in which the companies paid the full rate of company tax.
It has also provided benefits to Australian superannuation funds.
Dr Henry told the conference it was "not surprising" that Australian investors and superannuation funds liked the tax-free dividends.
But he said it and other Australian tax provisions made little sense in a world of massive global capital flows...
By extending to Australian investors a concession not available to foreign investors, it made it harder for Australian companies to get access to funds - a process he referred to as "capital shallowing".
A cut in the company tax rate funded by axing dividend imputation would boost the
would also attract more foreign investment, increasing real wages and boosting share prices and Australia's gross domestic product.
The Melbourne consultancy Lateral Economics believes axing dividend imputation would free up $20 billion per year, enough to fund a cut in Australia's corporate tax rate from 30 per cent to 19 per cent.
The company tax rate could then be cut even lower if the new rate boosted the size of the Australian economy in the way expected.
Lateral Economics believes a cut in the headline corporate tax rate to 19 per cent would boost foreign direct investment in Australia by about one-quarter.
It says the resulting boost in share prices should more than compensate the Australian mum and dad investors who missed out on their imputation credits.
The UK and Ireland have already abolished their dividend imputation schemes leaving Australia and New Zealand as two of the only nations to retain them.
Dr Henry said he did not want to be interpreted as "arguing the case for doing away with imputation".
"Our system has some distinct advantages. For one thing as imputation credits are only provided for Australian tax paid Australian multinationals have fewer incentives to shift profits offshore."
The Treasury Secretary also raised the possibility of abandoning Australia's existing system of corporate taxation in favour of "more dramatic, far-reaching change".
One idea would be to tax by destination rather than origin so that imports would be taxed and exports would be tax free. Another would be to tax business spending rather than profits.
He said while such changes would involve significant costs, "sometimes change is necessary.
The Henry Review will report to the Treasurer in December. It is accepting submissions until May.
Why the Obama Deficit-Spending Plan Will (Probably) Work
J. Bradford DeLong
University of California at Berkeley and NBER
brad.delong@gmail.com
http://delong.typepad.com
+1 925 708 0467
February 17, 2009
Article
Will the Obama deficit-spending plan work? Will throwing $800 billion—$500 billion in extra government spending, and $300 billion in tax cuts—at the economy produce a world in which production and employment are higher and unemployment lower than would otherwise have been the case?
The short answer is yes. The short reason is that spending works—eras when some group or other gets excited about future prospects and starts spending money like water are eras in which production and employment are high and unemployment low. And the government, in this respect, is just like any other group of starry-eyed optimists whose eagerness to spend pulls the economy into a high-employment high-pressure boom.
Between 2003 and 2005 the assembled investors of the world discovered the American housing market. Low interest rates produced by the Federal Reserve allowed them to borrow and leverage up cheaply—and the promise of financial engineering that would greatly help them diversify risk made them think investing in funding new construction and new homeowners’ moves in to new construction was a profit opportunity.
Spending on building houses rose. And the adult civilian employment to population ratio rose from 62% to 63.5% as the unemployment rate fell from 6.0% to 4.8%.
Between 1996 and 1998 the assembled investors of America discovered the internet. And the adult civilian employment to population ratio rose from 63% to nearly 65% as the unemployment rate fell 5.6% to 4.3%
In August of 1982 Paul Volcker’s Federal Reserve released the interest rate chokehold it was using to strangle the economy. Lower interest rates induced homebuilders to spend massively as for the first time in nearly half a decade they could obtain financing for construction. At the same time, the Reagan administration ramped up defense spending for the second cold war, and luxury spending rose as the Reagan tax cuts gave more of their own money back to America’s rich. The adult employment-to-population ratio rocketed up from 57.2% to 59.9% in the short order of two years as the unemployment rate fell from 10.8% to 7.3%
These are just three examples of a general principle: each major businesscycle expansion we have seen has been driven by a leading wave of spending—by some group that becomes enthusiastic about their prospects and decides to greatly up its spending. And that pulls employment and production up.
Now we are attempting to do the same thing once again—but this time with the government as the leading spender. A boost to spending by the government should have the same effects as the boosts to spending by luxury consumers and the defense department and homebuilders in the early 1980s, as the boost to spending by the high-tech sector in the late
1990s, and as the boost to spending by homebuilders in the mid-2000s.
The government’s money, after all, is as good as—is the same as—anybody else’s.
So there is little question as to the likely impact of the Obama deficit spending program: production and employment are going to be higher than they would have been otherwise. As George W. Bush’s then chief economic advisor Greg Mankiw said back in 1983: “There is nothing novel about this. It is very conventional short-run stabilization policy: You can find it in all of the leading textbooks.”
But there is a relevant remaining question: will there be some sort of a hangover after this Obama spending binge—and if there is a hangover how bad will it be? For that, you will have to wait until next time.
University of California at Berkeley and NBER
brad.delong@gmail.com
http://delong.typepad.com
+1 925 708 0467
February 17, 2009
Article
Will the Obama deficit-spending plan work? Will throwing $800 billion—$500 billion in extra government spending, and $300 billion in tax cuts—at the economy produce a world in which production and employment are higher and unemployment lower than would otherwise have been the case?
The short answer is yes. The short reason is that spending works—eras when some group or other gets excited about future prospects and starts spending money like water are eras in which production and employment are high and unemployment low. And the government, in this respect, is just like any other group of starry-eyed optimists whose eagerness to spend pulls the economy into a high-employment high-pressure boom.
Between 2003 and 2005 the assembled investors of the world discovered the American housing market. Low interest rates produced by the Federal Reserve allowed them to borrow and leverage up cheaply—and the promise of financial engineering that would greatly help them diversify risk made them think investing in funding new construction and new homeowners’ moves in to new construction was a profit opportunity.
Spending on building houses rose. And the adult civilian employment to population ratio rose from 62% to 63.5% as the unemployment rate fell from 6.0% to 4.8%.
Between 1996 and 1998 the assembled investors of America discovered the internet. And the adult civilian employment to population ratio rose from 63% to nearly 65% as the unemployment rate fell 5.6% to 4.3%
In August of 1982 Paul Volcker’s Federal Reserve released the interest rate chokehold it was using to strangle the economy. Lower interest rates induced homebuilders to spend massively as for the first time in nearly half a decade they could obtain financing for construction. At the same time, the Reagan administration ramped up defense spending for the second cold war, and luxury spending rose as the Reagan tax cuts gave more of their own money back to America’s rich. The adult employment-to-population ratio rocketed up from 57.2% to 59.9% in the short order of two years as the unemployment rate fell from 10.8% to 7.3%
These are just three examples of a general principle: each major businesscycle expansion we have seen has been driven by a leading wave of spending—by some group that becomes enthusiastic about their prospects and decides to greatly up its spending. And that pulls employment and production up.
Now we are attempting to do the same thing once again—but this time with the government as the leading spender. A boost to spending by the government should have the same effects as the boosts to spending by luxury consumers and the defense department and homebuilders in the early 1980s, as the boost to spending by the high-tech sector in the late
1990s, and as the boost to spending by homebuilders in the mid-2000s.
The government’s money, after all, is as good as—is the same as—anybody else’s.
So there is little question as to the likely impact of the Obama deficit spending program: production and employment are going to be higher than they would have been otherwise. As George W. Bush’s then chief economic advisor Greg Mankiw said back in 1983: “There is nothing novel about this. It is very conventional short-run stabilization policy: You can find it in all of the leading textbooks.”
But there is a relevant remaining question: will there be some sort of a hangover after this Obama spending binge—and if there is a hangover how bad will it be? For that, you will have to wait until next time.
Carolina wakes up to QFT
Source
Click on image for FULL SIZE
It is estimated that the Wake County Department of Human Services and Wake County Sheriff’s Office will annually order over 33,700 laboratory tests, with projected annual expenditures exceeding $1.5 million. Attachment A lists types of laboratory tests frequently ordered by these two Wake County departments.
Click on image for FULL SIZE
February 22, 2009
Dont believe what you read..
Ex Senator and Vice chairman of UBS Investment Bank Phil Gramm writes in WSJ.
Neither bankers or politicians have much to commend them.
.
As Mr. Greenspan testified last October at a hearing of the House Committee on Oversight and Government Reform, "It's instructive to go back to the early stages of the subprime market, which has essentially emerged out of CRA." It was not just that CRA and federal housing policy pressured lenders to make risky loans -- but that they gave lenders the excuse and the regulatory cover.Here is the actual transcript of the Dr. Alan Greenspan testimony before the Committee of Government Oversight and Reform;
What went wrong with global economic policies that had worked so effectively for nearly four decades? The breakdown has been most apparent in the securitization of home mortgages. The evidence strongly suggests that without the excess demand from securitizers, subprime mortgage originations (undeniably the original source of crisis) would have been far smaller and defaults accordingly far fewer. But subprime mortgages pooled and sold as securities became subject to explosive demand from investors around the world. These mortgage backed securities being “subprime” were originally offered at what appeared to be exceptionally high risk-adjusted market interest rates. But with U.S. home prices still rising, delinquency and foreclosure rates were deceptively modest. Losses were minimal. To the most sophisticated investors in the world, they were wrongly viewed as a “steal.”
The consequent surge in global demand for U.S. subprime securities by banks, hedge, and pension funds supported by unrealistically positive rating designations by credit agencies was, in my judgment, the core of the problem. Demand became so aggressive that too many securitizers and lenders believed they were able to create and sell mortgage backed securities so quickly that they never put their shareholders’ capital at risk and hence did not have the incentive to evaluate the credit quality of what they were selling. Pressures on lenders to supply more “paper” collapsed subprime underwriting standards from 2005 forward. Uncritical acceptance of credit ratings by purchasers of these toxic assets has led to huge losses.
It was the failure to properly price such risky assets that precipitated the crisis. In recent decades, a vast risk management and pricing system has evolved, combining the best insights of mathematicians and finance experts supported by major advances in computer and communications technology. A Nobel Prize was awarded for the discovery of the pricing model that underpins much of the advance in derivates markets. This modern risk management paradigm held sway for decades. The whole intellectual edifice, however, collapsed in the summer of last year because the data inputted into the risk management models generally covered only the past two decades, a period of euphoria.
Neither bankers or politicians have much to commend them.
.
How to stay healthy
Healthcare tipped to keep global ills at bay
Teresa Ooi | January 24, 2009
Article from: The Australian
IF you are looking for job security in this tough economic climate, stick to the healthcare sector, says research from IbisWorld.
Robert Bryant, general manager of independent research house IbisWorld, has picked biotechnology, online information, rail services, cosmetic and toiletry retailing, grain and livestock farming as among the industries best able to weather the financial storm.
Jobs in labour-intensive industries such as blood banks and health services were relatively "insensitive to economic conditions", he said.
Many health services were perceived as essential and with "many subsidised by government, such as blood banks, hearing, nursing and psychology services, and others covered under private health insurance, there would be solid growth of jobs in the health sector".
This trend would be helped by the ageing of Australia's population and the increase in chronic illnesses such as diabetes, Mr Bryant said.
IbisWorld also predicted that cosmetic sales would continue to thrive despite difficult economic times.
"History has shown that women continue to spend," he said. "However, they transfer spending from more expensive fashion items to cheaper alternatives which still deliver the feel-good factor.
"This means reduced spending on clothes, shoes and handbags in favour of lipsticks, skin creams, perfumes and other beauty products."
There was also a "manscaping trend", with men "becoming increasingly aware of skin care regimes and products", he said.
"The result will be openings for more cosmetics and toiletry sales people as well as laboratory technicians and those involved in the manufacturing side of the business," he said.
The economic downturn and global credit crunch would take their toll on the financial sector, he said.
The biggest losses and job cuts would be in the banking, tyre manufacturing, domestic airlines, boat building and real estate sectors, Mr Bryant said.
Teresa Ooi | January 24, 2009
Article from: The Australian
IF you are looking for job security in this tough economic climate, stick to the healthcare sector, says research from IbisWorld.
Robert Bryant, general manager of independent research house IbisWorld, has picked biotechnology, online information, rail services, cosmetic and toiletry retailing, grain and livestock farming as among the industries best able to weather the financial storm.
Jobs in labour-intensive industries such as blood banks and health services were relatively "insensitive to economic conditions", he said.
Many health services were perceived as essential and with "many subsidised by government, such as blood banks, hearing, nursing and psychology services, and others covered under private health insurance, there would be solid growth of jobs in the health sector".
This trend would be helped by the ageing of Australia's population and the increase in chronic illnesses such as diabetes, Mr Bryant said.
IbisWorld also predicted that cosmetic sales would continue to thrive despite difficult economic times.
"History has shown that women continue to spend," he said. "However, they transfer spending from more expensive fashion items to cheaper alternatives which still deliver the feel-good factor.
"This means reduced spending on clothes, shoes and handbags in favour of lipsticks, skin creams, perfumes and other beauty products."
There was also a "manscaping trend", with men "becoming increasingly aware of skin care regimes and products", he said.
"The result will be openings for more cosmetics and toiletry sales people as well as laboratory technicians and those involved in the manufacturing side of the business," he said.
The economic downturn and global credit crunch would take their toll on the financial sector, he said.
The biggest losses and job cuts would be in the banking, tyre manufacturing, domestic airlines, boat building and real estate sectors, Mr Bryant said.
February 20, 2009
RBA addresses CEDA
Full presentation here
There are reasons to expect that the Australian economy can continue to perform better than its international counterparts in the difficult period that lies ahead. Australia had more momentum than most comparable economies in the period leading into the crisis. As in other countries, substantial monetary and fiscal measures have been taken to support growth. But an important difference is that the Australian financial system remains in much better shape than its international counterparts. As a result of that, we have been able to gain much more traction from cuts in official interest rates. In the period since the RBA started cutting the cash rate in September, substantial rate cuts have been passed through to end borrowers, particularly for housing loans. This is in marked contrast to other countries, where banks have been more heavily affected by financial strains and the degree of pass-through has been much more limited. Another factor helping to insulate the domestic economy from events abroad is the depreciation of the exchange rate.
Having said all that, there’s no doubt that Australia will be operating in a difficult international environment this year. Official forecasts, including those of the IMF, imply that output in the major industrial economies will contract further in the first half of this year, but start to pick up later in the year and into 2010. The situation is still very uncertain but, for the reasons I’ve been outlining, that seems like a reasonable expectation.
RBA now feeling relaxed
Full Transcript
So there are reasonable grounds at this stage, I think, to believe that the Australian economy will come through this difficult episode not unscathed but well placed to benefit from a renewed expansion. Things will be difficult over the next year, but, as I have said before, the long-run prospects for Australia have not deteriorated by as much as we may all be feeling just now. China’s emergence, for example, has not finished. China has slowed a lot recently, but its emergence has years to run and Australia will benefit from that. So we should not lose sight of that or of the other positives that we have. We can have confidence in our long-run future and in our demonstrated capacity to adjust to changing circumstances. If we retain all that, there is no reason for any downturn to be a deep one.
The emperor with no clothes
Mario Rizzio, from the "Colloquium on Market Institutions and Economic Processes at the Department of Economics, New York University" looks at the Obama stimulus;
Morgan Stanley (Asia) chairman Dr Stephen Roach, who warned of past bubbles, has also spoken on the stimulus
Mario Rizzio also notes that the Obama argument that the stimulus "will save jobs that otherwise would have been lost" is counterfactual as does Greg Mankiw;
Obama is advised by a well regarded team which includes Central Banker Larry Summers, here he is in 1999
And so it goes, Larry is on the right.
- The central cause of the current economic state of affairs is bad monetary policy from 2002 through early 2006.
- Stimulus should not stimulate or reinforce the misallocation of resources.
- Stimulus should create economic value and not destroy it.
- The best stimulus consists of incentive-relevant tax reductions.
Morgan Stanley (Asia) chairman Dr Stephen Roach, who warned of past bubbles, has also spoken on the stimulus
Roach also said he doubted that the use of monetary policy to boost the economy could be as effective as before.Speaking of interest rate cuts Japan's economy has not only hit the wall, it has fallen off a cliff;
“One of the consequences of lowering interest rates is high inflation. But my utmost concern is what the exit strategy for this aggressive easing is? How do you wind down without tipping to deflation,” he said, citing the example of Japan, where the economy had not been stimulated even with near zero interest rates.
Roach said he preferred fiscal policies, especially those which focused more on investments rather than private consumption, as he felt businesses were better credit managers than individuals.
On the US financial crisis, Roach said he blamed it on the reckless consumption, politicians and the central bank.
Stung by collapsing exports, a surging Japanese yen, and ineffective government, Japan's Cabinet Office today announced that Japan's gross domestic product slumped at an astonishing annualized rate of 12.7% between October and December. The fall is more than most Tokyo economists expected and marked the biggest quarterly slump since 1974. "There's no doubt that the economy is in its worst state in the postwar period," Economic and Fiscal Policy Minister Kaoru Yosano said in Tokyo
Mario Rizzio also notes that the Obama argument that the stimulus "will save jobs that otherwise would have been lost" is counterfactual as does Greg Mankiw;
The expression "create or save," which has been used regularly by the President and his economic team, is an act of political genius. You can measure how many jobs are created between two points in time. But there is no way to measure how many jobs are saved. Even if things get much, much worse, the President can say that there would have been 4 million fewer jobs without the stimulus.
Obama is advised by a well regarded team which includes Central Banker Larry Summers, here he is in 1999
And awful as the Asian correction is, it was, in a sense, inevitable because those economies had trundled billions of dollars into useless real estate and industrial development. "In general," said Summers, 44, as he sat in the Frankfurt airport last September recovering from a hectic trip to Moscow, "we start with the idea that you can't repeal the laws of economics. Even if they are inconvenient."
And so it goes, Larry is on the right.
China - turnaround?
BCA research;The Chinese New Year effect is mainly to blame for China's extremely weak trade numbers in January.
Yesterday’s data release showed that Chinese exports tumbled by 17% in January and imports collapsed by 43% from a year ago. However, it is important to note that China’s macro data in the first two months of the year tend to be distorted by the Chinese New Year holidays. There is no question that January’s shocking trade data suggests that the economic environment remains highly challenging. Nonetheless, they are greatly exaggerated by fewer working days last month than January 2008. Adjusting for this factor, it is estimated that exports actually increased by 6% from a year ago, while imports dropped by 26%. The latter is also impacted by the tumble in commodity prices. The export sector performance is consistent with the most recent purchasing managers’ surveys, which show a slight improvement in both export orders and industrial production.
February 19, 2009
Another one of those weird blog things...
..this one calls itself Body Functions.
Not to worry, they ran a piece on TB which demonstrated that the QFT marketing is really kicking in;
Not to worry, they ran a piece on TB which demonstrated that the QFT marketing is really kicking in;
Mantoux skin test also known as a tuberculin skin test (TST): This test helps identify people infected with M. tuberculosis but who have no symptoms. A doctor must read the test.
The doctor will inject 5 units of purified protein derivative (PPD) into your skin. If a raised bump of more than 5 mm (0.2 in) appears at the site 48 hours later, the test may be positive.
This test can often indicate disease when there is none (false positive). Also, it can show no disease when you may in fact have TB (false negative).
QuantiFERON-TB Gold test: This is a blood test that is an aid in the diagnosis of TB. This test can help detect active and latent tuberculosis. The body responds to the presence of the tuberculosis bacteria. By special techniques, the patient's blood is incubated with proteins from TB bacteria.
If the bacteria is in the patient, the immune cells in the blood sample respond to these proteins with the production of a substance called interferon-gamma (IFN-gamma). This substance is detected by the test. If someone had a prior BCG vaccination (a vaccine against TB given in some countries but not the U.S.) and a positive skin test due to this, the QuantiFERON-TB Gold test will not detect any IFN-gamma.
Mark to madness
From letters in Wall St Journal;
Let me provide one example of the "irrationality" of mark-to-market. One year ago, an appraiser valued an old house on a half-acre of land close to the beach in Hawaii at $2 million. I tore down the house and built a nicer, bigger one at a cost of $850,000. Today, the bank appraisal comes in at $1.5 million. Why? Because the bank, to be "conservative," now only accepts appraisals done within the past three months. Nothing has sold on that beach for the past three months, so the closest comparable the appraiser can find is a similar property farther inland, where there is no beach premium. Now the bank must report a lower loan-to-value on its books for my loan, and I cannot sell the house for what it is worth.Golman Sachs CEO Lloyd Blankfein argues that to employ a mark-to-market methodology is a more true and realistic approach to finance;
So now the waiting game begins for the market to come back. The trouble is, if everyone waits, then the market will continue to spiral down like Japan's real estate market in the 1990s. Mark-to-market is indeed mark-to-madness.
Steven E. Connell
Honolulu
For Goldman Sachs, the daily marking of positions to current market prices was a key contributor to our decision to reduce risk relatively early in markets and in instruments that were deteriorating. This process can be difficult, and sometimes painful, but I believe it is a discipline that should define financial institutions.Our friend in Hawaii complains that the market will not validate his estimation of worth yet he accepted the assessed market value when borrowing from the bank for his new house. He needs to reassess his situation in light of current market conditions - he may buy cheaper elsewhere.
RBA - no more rate cuts?
RBA signal that as the "very significant" rate cuts "would take time to be effective" future rate cuts would be assessed in the medium term;
LINK
Minutes of the Monetary Policy Meeting of the Board - Sydney - 3 February 2009
Considerations for Monetary Policy
The recommendation to the Board was for a reduction in the cash rate of 100 basis points to 3.25 per cent.
The primary backdrop to members’ policy discussion this month was the marked deterioration in world economic conditions late in 2008. Members had noted at previous meetings that there had been an abrupt change to the outlook for global economic activity after September, following Lehman’s collapse and the resultant strains in financial markets and declines in asset values. This had caused a collapse of household and business confidence and a very sharp fall in global demand. The dependence of Asian economies on manufactured exports meant that they had been severely affected. Domestic demand in Asia had also weakened sharply. This included the Chinese economy, which, though still growing, had slowed markedly. These effects were becoming evident in the economic data that had recently been released. The weakness had in turn been reflected in a further significant downward revision to the IMF’s forecasts for growth in both developed and emerging economies in 2009, which was now expected to be the weakest in six decades.
Members noted that measures taken in developed economies to stabilise their financial systems had contributed to an improvement in the functioning of credit markets over the past few months. There had also been greater steadiness in commodity markets since November. The better functioning of markets plus the very significant monetary and fiscal stimulus that was being put in place in all regions would assist in promoting global recovery over time. Nonetheless, the near-term outlook was very weak.
Economic conditions in Australia were being affected by these global events, though, to date, the Australian economy had been more resilient than other industrial economies. Importantly, Australia’s financial system remained in a relatively strong condition. Among other things, this had allowed the significant monetary policy easing starting in September to flow through to large reductions in many lending rates. Nonetheless, the headwinds from the global economy were very strong and would continue to have a significant negative effect on the domestic economy in the near term.
Members noted that the package of fiscal measures to be announced by the Government later that day would result in a significant boost to demand during 2009. Even so, given the contractionary forces coming from abroad and the clear evidence that inflation was on a downward trend again, members judged that another substantial easing of monetary policy at this time was appropriate. They supported the recommendation for a cut of 100 basis points.
Members agreed that, together with earlier rate cuts, this would amount to a very significant easing of monetary policy. This had occurred relatively early in the business cycle and lending rates in many cases would soon be at generational lows.
Together with the fiscal measures, this meant that a very significant macroeconomic stimulus had been applied to the domestic economy. This stimulus would take time to be effective and could be expected to have only a modest effect on the near-term outlook in Australia. Given the speed at which the global contraction had occurred, short-term prospects were thus still for weakness in demand and output. Nonetheless, the substantial measures taken would help to cushion the economy from the contractionary forces coming from abroad and, over time, work to establish conditions conducive to stronger demand later in the year. Assessments of those medium-term prospects, as well as the course of the short-term data, would be important to future policy decisions.
LINK
Minutes of the Monetary Policy Meeting of the Board - Sydney - 3 February 2009
Considerations for Monetary Policy
The recommendation to the Board was for a reduction in the cash rate of 100 basis points to 3.25 per cent.
The primary backdrop to members’ policy discussion this month was the marked deterioration in world economic conditions late in 2008. Members had noted at previous meetings that there had been an abrupt change to the outlook for global economic activity after September, following Lehman’s collapse and the resultant strains in financial markets and declines in asset values. This had caused a collapse of household and business confidence and a very sharp fall in global demand. The dependence of Asian economies on manufactured exports meant that they had been severely affected. Domestic demand in Asia had also weakened sharply. This included the Chinese economy, which, though still growing, had slowed markedly. These effects were becoming evident in the economic data that had recently been released. The weakness had in turn been reflected in a further significant downward revision to the IMF’s forecasts for growth in both developed and emerging economies in 2009, which was now expected to be the weakest in six decades.
Members noted that measures taken in developed economies to stabilise their financial systems had contributed to an improvement in the functioning of credit markets over the past few months. There had also been greater steadiness in commodity markets since November. The better functioning of markets plus the very significant monetary and fiscal stimulus that was being put in place in all regions would assist in promoting global recovery over time. Nonetheless, the near-term outlook was very weak.
Economic conditions in Australia were being affected by these global events, though, to date, the Australian economy had been more resilient than other industrial economies. Importantly, Australia’s financial system remained in a relatively strong condition. Among other things, this had allowed the significant monetary policy easing starting in September to flow through to large reductions in many lending rates. Nonetheless, the headwinds from the global economy were very strong and would continue to have a significant negative effect on the domestic economy in the near term.
Members noted that the package of fiscal measures to be announced by the Government later that day would result in a significant boost to demand during 2009. Even so, given the contractionary forces coming from abroad and the clear evidence that inflation was on a downward trend again, members judged that another substantial easing of monetary policy at this time was appropriate. They supported the recommendation for a cut of 100 basis points.
Members agreed that, together with earlier rate cuts, this would amount to a very significant easing of monetary policy. This had occurred relatively early in the business cycle and lending rates in many cases would soon be at generational lows.
Together with the fiscal measures, this meant that a very significant macroeconomic stimulus had been applied to the domestic economy. This stimulus would take time to be effective and could be expected to have only a modest effect on the near-term outlook in Australia. Given the speed at which the global contraction had occurred, short-term prospects were thus still for weakness in demand and output. Nonetheless, the substantial measures taken would help to cushion the economy from the contractionary forces coming from abroad and, over time, work to establish conditions conducive to stronger demand later in the year. Assessments of those medium-term prospects, as well as the course of the short-term data, would be important to future policy decisions.
In the beginning there was Wikipedia..
..now there was Medpedia,
Quantiferon gets a mention under Tuberculosis;
About The Medpedia Project
The Medpedia Project is a long-term, worldwide project to evolve a new model for sharing and advancing knowledge about health, medicine and the body among medical professionals and the general public. This model is founded on providing a free online technology platform that is collaborative, interdisciplinary and transparent. Read more about the model.
Users of the platform include physicians, consumers, medical and scientific journals, medical schools, research institutes, medical associations, hospitals, for-profit and non-profit organizations, expert patients, policy makers, students, non-professionals taking care of loved ones, individual medical professionals, scientists, etc.
As Medpedia grows over the next few years, it will become a repository of up-to-date unbiased medical information, contributed and maintained by health experts around the world, and freely available to everyone. The information in this clearinghouse will be easy to discover and navigate, and the technology platform will expand as the community invents more uses for it.
In association with Harvard Medical School, Stanford School of Medicine, Berkeley School of Public Health, University of Michigan Medical School and other leading global health organizations, Medpedia will be a commons for the gathering of the information and people critical to health care. Many organizations have united to support The Medpedia Project. See the Record of Merit.
Quantiferon gets a mention under Tuberculosis;
Latent tuberculosis diagnosis in the United States usually consists of a tuberculosis skin test and/or chest X-ray. A new test the QuantiFERON Gold blood test is also used to diagnose latent tuberculosis infection. Many other countries, for example Mexico, do not test for latent tuberculosis infection as much of the population will be positive, either due to high tuberculosis incidence and/or use of the BCG vaccine. The tuberculosis skin test (TST), also called the tuberculin test or Mantoux test, detects an immune response to tuberculosis antigens. The test involves injecting a small amount of tuberculosis bacterial antigens (called PPD for purified protein derivative) under the skin and waiting several days to observe any reaction. The TST test is known to have several problems:The QuantiFERON Gold blood test was approved by the FDA in 2005 and does not suffer from many of the problems of the tuberculosis skin test.
- There are many false positives (that is people who have not been exposed to tuberculosis who test positive). Sometimes this is due to BCG vaccination, which can have cause people to have positive TST tests.
- The test requires trained personnel to evaluate whether it is positive or not.
- It requires two visits by the patient to a healthcare provider. This results in both inconvenience and many lost tests as patients may not return.
February 18, 2009
February 17, 2009
Morgan Stanley tackle fear mongers head on
Morgan Stanley's Chief Global Fixed Income Economist Joachim Fels writes
As the global recession deepens and broadens, comparisons between the current downturn and the Great Depression of the 1930s are becoming ever more popular. This was certainly the case at Morgan Stanley’s 2009 Global Macro Conference in New York last week, where we hosted a small group of US real-money and hedge-fund clients. The consensus view was that the US economy would, at best, go through something similar to Japan’s lost decade, and some thought things might turn out to be as bad as, or even worse than, the Great Depression
We don’t think so. As we have explained before and did again at the conference, we disagree. Yes, things are bad, but by far not as bad as in the Great Depression, because policymakers have learned their lesson and have started to throw massive monetary and fiscal stimulus at the economy. Our base case remains that policy action will find traction in the course of this year, leading to a (probably anaemic) recovery sometime during 2H09.
....The key lesson from the Great Depression is that policy, and especially monetary policy, matters a lot. Central bankers around the world have learned that lesson and have not only cut rates early and aggressively, but have also engaged in quantitative easing and are, together with governments, stabilising the banking system. Thus, money supply is expanding rather than contracting. This, together with the coming fiscal expansion, is the reason why we think that the widespread Depression angst is just that – angst.
February 15, 2009
New Iraq Emerges from Tyranny and War
Friday, January 09, 2009
posted by Omar
Iraq has started to reap the benefits of the status of forces agreement with the United States. The United Nations Security Council voted to set the ground for relieving Iraq from the restrictions of Chapter Seven of the UN Charter.
In fact, the remaining effects of previous resolutions will from now on serve only to protect Iraq’s assets from claims by other parties, not to impose anything on the people of Iraq. Sovereignty, which was lost two decades ago under Saddam Hussein’s capricious and belligerent reign, is being restored to the nation.
The Security Council resolution 1859 states, among other things, that Iraq is no longer a threat to its neighbors, region, or the world. The United States has succeeded in transforming a bellicose, autocratic state into a friendly one that is making steady progress towards becoming a self-sustaining democracy — the international community is finally coming to recognize this transformation.
This resolution is bound to make a positive impact on the domestic and regional levels. First and foremost it is a testimony to the United States’ true desire to help Iraq get on its feet and relieve it from restrictions that belong to a past era — the United States is indisputably a friendly protector of Iraq, not an occupier as many like to claim.
However, this achievement did not receive as much attention in the Arab media as did the shoes of a disturbed young journalist — not surprisingly, since the resolution strengthens the credibility of the United States, which the dictators in the region always love to attack.
The headlines, as expected, were reserved for the resignation of the speaker of Iraq’s parliament. It was an attempt to highlight political contests in Iraq that ironically ignores two important facts. First is the fact that pluralistic parliaments tend to look “messy”; second, that other parliaments in the region enjoy fake stability only because they exist under the rule of one man, one party, or one family.
Domestically, the resolution is a blow dealt to all those nostalgic for the totalitarian past. Those people had exhausted their lungs screaming and rallying against a security agreement with the United States. The voice that prevailed at the end was that of Iraq’s elected parliament in choosing to open a new era of cooperation and mutual respect between Iraq and the nation that liberated it from tyranny, and continues to protect its interests as we speak.
Whereas Arab nationalists and Islamist extremists ended up with a pair of shoes, Iraqis ended up with their sovereignty, democracy, and friendship with the United States. Those hypocrites did not lift a finger to help Iraq at a time of hardship. On the contrary, they used all the means they could muster to bring democratization in Iraq and the Middle East to a halt. But despite the vicious attacks, Iraq and the United States moved hand in hand to overcome the countless obstacles and present the model of reform and democracy that is taking shape with every dispute Iraqis resolve in the parliament and every new brick they lay in a new building.
The headlines for those cynics do not go beyond the throw of a shoe, whereas my headlines look into the future and speak of a new Iraq. My headlines speak of agreements with our friends in American industries who will help us have 24 hours of electricity and equip a strong army dedicated to serving and protecting the Iraqi nation. This is a future where Iraq’s billions are used in transparent contracts to build the country and improve economic ties with our true allies and friends, not in shady deals for building palaces, supporting terrorists, and procuring tools of aggression.
My headlines speak of symbols of sovereignty returned to Iraqi hands, of France forgiving Iraqi debts, and of the first Christmas festival ever in downtown Baghdad. Iraqis gathered on the beautiful street of Abu Nawas to celebrate Christmas and to honor Iraqi Christians who stood with their brethren courageously against the forces of evil.
My headlines look up to new elections in which many incumbent and new parties will compete for Iraqi’s votes. Whether those parties are qualified or not is something for the Iraqi voters to decide. What popular participation in elections by both voters and parties indicates is that everyone knows their part in building the country, through ballots not bullets — more and more people are adhering to the model of the future and moving away from the shadows of a dark past.
My headlines speak of universities, airports, businesses, and parks that we build with patience and hope.
My headlines say that coup rumors were, well, rumors and that all officers arrested have been released with dignity. Today in Iraq the state does not execute people on mere suspicions, as was the case in the past. Today in Iraq power is transferred by means other than coups.
When hypocrites and extremists sober up from their shoe hangover they will see a new Iraq which will not be easy for them to recognize. Even harder for them will be to contain the tides of freedom and democracy which are bound to reach their shores and shake the foundations of dictatorships and extremism.
posted by Omar
Iraq has started to reap the benefits of the status of forces agreement with the United States. The United Nations Security Council voted to set the ground for relieving Iraq from the restrictions of Chapter Seven of the UN Charter.
In fact, the remaining effects of previous resolutions will from now on serve only to protect Iraq’s assets from claims by other parties, not to impose anything on the people of Iraq. Sovereignty, which was lost two decades ago under Saddam Hussein’s capricious and belligerent reign, is being restored to the nation.
The Security Council resolution 1859 states, among other things, that Iraq is no longer a threat to its neighbors, region, or the world. The United States has succeeded in transforming a bellicose, autocratic state into a friendly one that is making steady progress towards becoming a self-sustaining democracy — the international community is finally coming to recognize this transformation.
This resolution is bound to make a positive impact on the domestic and regional levels. First and foremost it is a testimony to the United States’ true desire to help Iraq get on its feet and relieve it from restrictions that belong to a past era — the United States is indisputably a friendly protector of Iraq, not an occupier as many like to claim.
However, this achievement did not receive as much attention in the Arab media as did the shoes of a disturbed young journalist — not surprisingly, since the resolution strengthens the credibility of the United States, which the dictators in the region always love to attack.
The headlines, as expected, were reserved for the resignation of the speaker of Iraq’s parliament. It was an attempt to highlight political contests in Iraq that ironically ignores two important facts. First is the fact that pluralistic parliaments tend to look “messy”; second, that other parliaments in the region enjoy fake stability only because they exist under the rule of one man, one party, or one family.
Domestically, the resolution is a blow dealt to all those nostalgic for the totalitarian past. Those people had exhausted their lungs screaming and rallying against a security agreement with the United States. The voice that prevailed at the end was that of Iraq’s elected parliament in choosing to open a new era of cooperation and mutual respect between Iraq and the nation that liberated it from tyranny, and continues to protect its interests as we speak.
Whereas Arab nationalists and Islamist extremists ended up with a pair of shoes, Iraqis ended up with their sovereignty, democracy, and friendship with the United States. Those hypocrites did not lift a finger to help Iraq at a time of hardship. On the contrary, they used all the means they could muster to bring democratization in Iraq and the Middle East to a halt. But despite the vicious attacks, Iraq and the United States moved hand in hand to overcome the countless obstacles and present the model of reform and democracy that is taking shape with every dispute Iraqis resolve in the parliament and every new brick they lay in a new building.
The headlines for those cynics do not go beyond the throw of a shoe, whereas my headlines look into the future and speak of a new Iraq. My headlines speak of agreements with our friends in American industries who will help us have 24 hours of electricity and equip a strong army dedicated to serving and protecting the Iraqi nation. This is a future where Iraq’s billions are used in transparent contracts to build the country and improve economic ties with our true allies and friends, not in shady deals for building palaces, supporting terrorists, and procuring tools of aggression.
My headlines speak of symbols of sovereignty returned to Iraqi hands, of France forgiving Iraqi debts, and of the first Christmas festival ever in downtown Baghdad. Iraqis gathered on the beautiful street of Abu Nawas to celebrate Christmas and to honor Iraqi Christians who stood with their brethren courageously against the forces of evil.
My headlines look up to new elections in which many incumbent and new parties will compete for Iraqi’s votes. Whether those parties are qualified or not is something for the Iraqi voters to decide. What popular participation in elections by both voters and parties indicates is that everyone knows their part in building the country, through ballots not bullets — more and more people are adhering to the model of the future and moving away from the shadows of a dark past.
My headlines speak of universities, airports, businesses, and parks that we build with patience and hope.
My headlines say that coup rumors were, well, rumors and that all officers arrested have been released with dignity. Today in Iraq the state does not execute people on mere suspicions, as was the case in the past. Today in Iraq power is transferred by means other than coups.
When hypocrites and extremists sober up from their shoe hangover they will see a new Iraq which will not be easy for them to recognize. Even harder for them will be to contain the tides of freedom and democracy which are bound to reach their shores and shake the foundations of dictatorships and extremism.
Why You Should Invest in Private Equity
From Brad de Long;
Dear investors,
If you believe that you have the self-discipline to "buy and hold" a portfolio of "mid cap value stocks" for ten years, despite the fact that during that time many of them will deliver heartbreakingly awful newsflow and earnings, then go for it.
Love,
The private equity industry.
PS: The evidence of the entire history of investing is that you don't.
Posted by: dsquared | January 17, 2007 at 12:23 AM
HCW TB survey
Members of an Occupational Health list were asked the following questions on TB testing;
Presently 50% are using QFT (either wholly or in part) with 50% using TST only. One responder noted that distance was a decision factor, perhaps they are not yet using QFT-GIT.
Facility size ranged from 350 to 7,500 HCWs and 25 to 704 beds.
The facility with 7,500 HCWs made the following observations;
- Is everyone requiring two-step testing on hire?
- Is anyone using Quantiferon testing?
- Do you test all employees on an ongoing schedule or only post exposure?
- How big is your organization and what is your TB risk (how many TB patients are seen in your facility per year)?
Presently 50% are using QFT (either wholly or in part) with 50% using TST only. One responder noted that distance was a decision factor, perhaps they are not yet using QFT-GIT.
Facility size ranged from 350 to 7,500 HCWs and 25 to 704 beds.
The facility with 7,500 HCWs made the following observations;
"We do Quantiferon Gold on all new hires...We do annual testing on staff and providers that work at other Hospitals in order for our staff to get privileges. We have been working to get these facilities to also follow CDC. We know from other hospitals in our State that have stopped doing annual testing that if CDC evaluations are done, most, if not all, would be very low risk."
"We follow CDC TB guidelines and are a low risk system, so we have eliminated annual TB testing. We also switched to Quantiferon Gold Blood Testing for TB. This has made it a lot easier to get new hires done and also some of our providers that still need annual testing for privileges at other facilities."
February 14, 2009
There's a hole in the bucket, dear Liza, dear Liza...
Plan to Combat Extensively Drug-Resistant Tuberculosis
Recommendations of the Federal Tuberculosis Task Force
The reason for all this activity is, apparently, the risk of losing money;
The emergence of XDR TB raises concerns about the possibility of epidemics of virtually untreatable TB. Such epidemics could result in excessive mortality and substantial financial and infrastructure burden for public health and TB control programs. XDR TB is much more expensive to treat, with hospitalization costs in the United States estimated to average $483,000 per case. A major outbreak of XDR TB in the United States would constitute a substantial drain on public health resources and could quickly deplete the existing state and local TB budgets and have a negative impact on progress toward TB elimination
There are problems with XDR-TB, how do you differentiate between TB and drug resistant TB and in particular drug resistant TB in its latent form? (drug resistant TB is defined as TB that is unresponsive to treatment)
Problem 13
The role of public and private TB laboratories in the diagnosis of persons latently infected with XDR M. tuberculosis has not been defined clearly
Objective 13.1
Develop laboratory services to identify persons with drug-resistant latent M. tuberculosis infection (DR LTBI) (domestic).
No sooner do you identify one problem others arise
Problem 15Fundamentally its the same TB story with a new twist, drug resistant TB has the potential to return the world to the pre antibiotics era.
Limited capacity exists for the evaluation of new TB diagnostic tests
The emergence of drug-resistant TB illustrates the pressing need .....to prevent development of active disease among persons who are infected latently with drug-resistant M. tuberculosisThis document is a wake up call to decision makers; falling rates of TB is no reason to drop funding to TB programs
There is concern that progress in TB prevention and control is waning as manifested by the decrease in the rate of decline in TB incidence since 2000. The United States responded successfully to the MDR TB problem in the 1990s and is capable of preventing and controlling XDR TB; however, this will require a united commitment and effort similar to that which occurred in 1992...The Federal TB Task Force Plan and the Global Action Plan will require a renewed commitment by all public health workers as well as new resources from both the public and private sectors.
February 13, 2009
Trade deficits
Editor, The Wall Street Journal
200 Liberty Street
New York, NY 10281
To the Editor:
Peter Morici asserts that America's trade deficit with China causes "a huge drain on the demand for U.S.-made goods and services. The absence of reciprocal free trade is an important reason the U.S. economy is in its current mess," (Letters, Feb. 11).
Untrue. Dollars the Chinese do not spend on U.S.-made goods and services are invested in dollar-denominated assets. These investments raise demand for U.S. output just as would more direct expenditures on goods and services.
Consider what happens, for example, if the Chinese buy shares of Microsoft, thus raising America's trade deficit with China. First, the American sellers of these shares get more dollars to spend on U.S.-made goods and services. It's economically irrelevant if the persons buying these outputs are from Seattle or from Shanghai. Second, Microsoft's cost of capital falls, making that company more likely to expand operations, or at least less likely to contract them.
Concerns about the U.S. trade deficit are unwarranted.
Sincerely,
Donald J. Boudreaux
Don Boudreaux is the Chairman of the Department of Economics at George Mason University and a Business & Media Institute adviser.
200 Liberty Street
New York, NY 10281
To the Editor:
Peter Morici asserts that America's trade deficit with China causes "a huge drain on the demand for U.S.-made goods and services. The absence of reciprocal free trade is an important reason the U.S. economy is in its current mess," (Letters, Feb. 11).
Untrue. Dollars the Chinese do not spend on U.S.-made goods and services are invested in dollar-denominated assets. These investments raise demand for U.S. output just as would more direct expenditures on goods and services.
Consider what happens, for example, if the Chinese buy shares of Microsoft, thus raising America's trade deficit with China. First, the American sellers of these shares get more dollars to spend on U.S.-made goods and services. It's economically irrelevant if the persons buying these outputs are from Seattle or from Shanghai. Second, Microsoft's cost of capital falls, making that company more likely to expand operations, or at least less likely to contract them.
Concerns about the U.S. trade deficit are unwarranted.
Sincerely,
Donald J. Boudreaux
Don Boudreaux is the Chairman of the Department of Economics at George Mason University and a Business & Media Institute adviser.
Quest and QuantiFERON - update #2
Following on from October 2008 and January 2009 another lab has been added; Pittsburgh Pennsylvania
Of the 33 listed labs (some are mentioned twice) 18 now perform Quantiferon, an increase of +60% in 3.5 months.
Quest labs listed are;
Of the 33 listed labs (some are mentioned twice) 18 now perform Quantiferon, an increase of +60% in 3.5 months.
Quest labs listed are;
- VA - Chantilly
- TX - Irving
- TX - Houston
- TN - Nashville
- PA - Pittsburgh
- PA - Horsham
- OH - Daytona
- NY - Syosset
- NJ - Teterboro
- MO - Maryland
- MA - Cambridge
- KS - Lenexa
- IN - Indianapolis
- IL - Wood Dale
- CT - Wallingford
- CO - Denver
- CA - San Jose
- CA - Sacramento
February 11, 2009
More on HCW IGRA report
From the World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians Journal Watch;
We can expect interferon TB testing to become more routine, especially for health care workers.
We can expect interferon TB testing to become more routine, especially for health care workers.
Tuberculosis and illicit drug use: review and update.
Clinical Infectious Diseases
© 2008 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2009/4801-0011$15.00
DOI: 10.1086/594126
REVIEW ARTICLE
University of California, San Diego, and Department of Family and Preventive Medicine, Division of International Health and Cross‐Cultural Medicine, La Jolla, California
Illicit drug users continue to be a group at high risk for tuberculosis (TB). Here, we present an updated review of the relationship between TB and illicit drug use, and we summarize more than a decade of new research. Drug users, and injection drug users in particular, have driven TB epidemics in a number of countries. The successful identification and treatment of TB among illicit drug users remain important components of a comprehensive TB strategy, but illicit drug users present a unique set of challenges for TB diagnosis and control. New diagnostic modalities, including interferon‐γ–release assays, offer potential for improved diagnosis and surveillance among this group, along with proven treatment strategies that incorporate the use of directly observed therapy with treatment for drug abuse. Special considerations, including coinfection with viral hepatitis and the rifampin‐methadone drug interaction, warrant clinical attention and are also updated here.
Annals of Rheumatic Diseases Journal
A peer review journal for health professionals and researchers in the rheumatic diseases.
Ann Rheum Dis. Published Online First: 28 January 2009. doi:10.1136/ard.2008.101857
Copyright © 2009 BMJ Publishing Group Ltd & European League Against Rheumatism
Source
Extended Report
Comparison of interferon-{gamma}-release assays and conventional screening tests before tumour necrosis factor-{alpha} blockade in patients with inflammatory arthritis
Ann Rheum Dis. Published Online First: 28 January 2009. doi:10.1136/ard.2008.101857
Copyright © 2009 BMJ Publishing Group Ltd & European League Against Rheumatism
Source
Extended Report
Comparison of interferon-{gamma}-release assays and conventional screening tests before tumour necrosis factor-{alpha} blockade in patients with inflammatory arthritis
1 St Vincent's University Hospital, Republic of Ireland
2 St James' Hospital, Republic of Ireland
3 University College Dublin, Republic of Ireland
* To whom correspondence should be addressed. E-mail: barry.bresnihan@gmail.com.
Accepted 11 January 2009
Abstract
Background: This study compared the performance of 2 interferon-
release assays (IGRAs) and conventional screening tests in patients with inflammatory arthritis undergoing screening for latent tuberculosis infection (LTBI) before treatment with anti-TNF
compounds.
Methods: Successive patients were subjected to conventional LTBI screening, including a tuberculin skin test (TST). The T-SPOT.TB test was performed on all patients and the QuantiFERON-TB Gold test was performed on a large subset. The results of the IGRAs were compared to the results of conventional screening tests.
Results: A total 150 patients were evaluated. The majority (57.9%) had rheumatoid arthritis (RA). Previous vaccination with Bacille Calmette-Guerin was confirmed in 82% of patients. No patient had received prior anti-TB treatment. A total 57 patients (38.0%) had at least one positive conventional risk factor. In contrast, an unequivocally positive T-SPOT.TB test was observed in only 14 (9.8%). There was 98.2% agreement between the two IGRAs. Statistically significant associations were observed between each of the IGRAs and both TST and risk history, but not CXR. A positive IGRA result was significantly associated with increased age. No patient developed reactivation of TB during the follow-up period.
Interpretation: This study provides compelling evidence to suggest that IGRAs may have utility when screening for LTBI before anti-TNF therapy in patients with immune-mediated inflammatory diseases. The observations reported here also highlight the inadequate performance of CXR as a marker of LTBI.
Ground hog day comes to Minnesota
Important Bulletins on TB Screening for Health Care Providers Released
February 9, 2009
The Minnesota Department of Health has taken an important step to bring Tuberculosis screening requirements for various types of licensed health care providers up-to-date and into conformity with current guidelines from the Centers for Disease Control.
MDH has issued four separate information bulletins--for nursing homes, boarding care homes, home care and supervised living facilities--that grant "blanket" waivers to the specific TB screening requirements in rule for all of these providers.
This action was the result of work the MDH Compliance Monitoring Division initiated with the MDH TB Prevention and Control Program staff and OSHA staff to develop a more consistent approach to TB screening based on the most current evidence-based research from CDC. Aging Services of Minnesota and other provider groups have been urging MDH for several years to update the TB requirements, particularly as physicians have voiced more and more reluctance to order multiple x-rays for staff with positive Mantoux. Aging Services appreciates the efforts of MDH staff to resolve this long-standing issue.
The new MDH bulletins link to a detailed list of waiver conditions that has been developed for each type of licensed provider. As long as the provider follows the applicable waiver conditions, the provider does not need to submit to MDH an individual request to waive the obsolete TB screening requirements in the applicable licensing rules.
The waiver provisions will remain in effect indefinitely, although MDH staff has told Aging Services that MDH might be interested in working with provider groups sometime in the future to make statutory changes to permanently delete the obsolete rules.
The waiver conditions for all types of providers require that all paid and unpaid health care workers (HCW, as defined in the CDC Guidelines) must receive baseline TB screening. This screening must include a written assessment of the HCW's risk factors for TB and any current TB symptoms, and a two-step tuberculin skin test (TST) or single interferon gamma release assay (IGRA) for M.tuberculosis (e.g., QuantiFERONR TB Gold or TB Gold- InTube, T-SPOTR.TB). This may be a change for many home care agencies, as the home care rules do not require a two-step Mantoux.
Having an alternative screening method to the Mantoux will be helpful for workers who know they would have a positive Mantoux.
The bulletins and the waiver conditions are found at the following links:
- Nursing Homes, bulletin 09-02, NH-135,
http://www.health.state.mn.us/divs/fpc/profinfo/ib09_2.html - Boarding Care Homes, bulletin 09-03, BC-45,
http://www.health.state.mn.us/divs/fpc/profinfo/ib09_3.html - Home Care, bulletin 09-04, HC-26,
http://www.health.state.mn.us/divs/fpc/profinfo/ib09_4.html - Supervised Living Facilities, bulletin 09-05, SLF-17,
http://www.health.state.mn.us/divs/fpc/profinfo/ib09_5.html
Aging Services will be evaluating the need for additional member training related to the waiver conditions.
Providers may purchase the 143-page 2005 CDC TB Guidelines in a handy binder format from Aging Services of Minnesota for $50.(Item number REG5025; go to www.agingservicesmn.org and click on "store" or call Alecia Crumpler at 651-645-4545 or 800-462-5368.)
For Further Information:Contact Mary Youle at myoule@agingservicesmn.org, Darrell Shreve at dshreve@agingservicesmn.org or Liz Sether at lsether@agingservicesmn.org.
Interferon gamma release assays superior and cost-effective compared with TST
By MedWire Reporters
09 February 2009
Arch Intern Med 2009; 169: 179-187
MedWire News: Two assays used to detect active tuberculosis (TB) and latent TB infections (LTBI) are more effective and less costly than tuberculin skin tests (TSTs), US research shows.
"Our findings are robust and insensitive to changes across a wide range of probabilities, costs, and utility estimates," write Marie de Perio (University of Cincinnati College of Medicine, OH) and colleagues in the Archives of Internal Medicine.
The analysis, modelled in health care workers because of their increased risk of TB infection, compared the cost-effectiveness of two approved interferon gamma release assays (IGRAs), the QuantiFERON-TB Gold test (QFT-G) and the QuantiFERON-TB Gold in Tube test (GFT-GIT).
In this theoretical model, researchers assessed the effectiveness of the IGRAs and TST in a hypothetical 35-year-old female registered nurse working in a US hospital.
The TST strategy was more costly and less effective than either QFT strategy across a wide range of values, including the prevalence of LTBI and the probability of developing active TB, report de Perio and colleagues.
A sensitivity analysis showed that the IGRA strategies were "clinically and economically worthwhile" among low- and high-prevalence populations.
The incremental cost-effectiveness ratio of the QFT-G compared with the QFT-GIT was $14 092/quality-adjusted life-years (QALY) for non–BCG-vaccinated health care workers and $103 047/QALY for BCG-vaccinated health care workers.
TB control in health care settings typically involves screening health care workers for LTBI using the TST, but recent guidelines say the GFT-G can be used in any instance the TST is used.
An advantage of IGRAs over the TST is that they require only a single patient visit, results are available in 24 hours, and the findings are not subject to reader bias.
The study's findings, say the researchers, support the Centers for Disease Control recommendation for using QFT-G when screening health care workers for TB.
MedWire is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009
Free Abstract
Article Source
.
09 February 2009
Arch Intern Med 2009; 169: 179-187
MedWire News: Two assays used to detect active tuberculosis (TB) and latent TB infections (LTBI) are more effective and less costly than tuberculin skin tests (TSTs), US research shows.
"Our findings are robust and insensitive to changes across a wide range of probabilities, costs, and utility estimates," write Marie de Perio (University of Cincinnati College of Medicine, OH) and colleagues in the Archives of Internal Medicine.
The analysis, modelled in health care workers because of their increased risk of TB infection, compared the cost-effectiveness of two approved interferon gamma release assays (IGRAs), the QuantiFERON-TB Gold test (QFT-G) and the QuantiFERON-TB Gold in Tube test (GFT-GIT).
In this theoretical model, researchers assessed the effectiveness of the IGRAs and TST in a hypothetical 35-year-old female registered nurse working in a US hospital.
The TST strategy was more costly and less effective than either QFT strategy across a wide range of values, including the prevalence of LTBI and the probability of developing active TB, report de Perio and colleagues.
A sensitivity analysis showed that the IGRA strategies were "clinically and economically worthwhile" among low- and high-prevalence populations.
The incremental cost-effectiveness ratio of the QFT-G compared with the QFT-GIT was $14 092/quality-adjusted life-years (QALY) for non–BCG-vaccinated health care workers and $103 047/QALY for BCG-vaccinated health care workers.
TB control in health care settings typically involves screening health care workers for LTBI using the TST, but recent guidelines say the GFT-G can be used in any instance the TST is used.
An advantage of IGRAs over the TST is that they require only a single patient visit, results are available in 24 hours, and the findings are not subject to reader bias.
The study's findings, say the researchers, support the Centers for Disease Control recommendation for using QFT-G when screening health care workers for TB.
MedWire is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009
Free Abstract
Article Source
.
February 10, 2009
How Government Created the Financial Crisis
writes John Taylor, a professor of economics at Stanford and a senior fellow at the Hoover Institution.
...On Friday, Sept. 19, the Treasury announced a rescue package, though not its size or the details. Over the weekend the package was put together, and on Tuesday, Sept. 23, Fed Chairman Ben Bernanke and Treasury Secretary Henry Paulson testified before the Senate Banking Committee. They introduced the Troubled Asset Relief Program (TARP), saying that it would be $700 billion in size. A short draft of legislation was provided, with no mention of oversight and few restrictions on the use of the funds.
The two men were questioned intensely and the reaction was quite negative, judging by the large volume of critical mail received by many members of Congress. It was following this testimony that one really begins to see the crisis deepening and interest rate spreads widening.
The realization by the public that the government's intervention plan had not been fully thought through, and the official story that the economy was tanking, likely led to the panic seen in the next few weeks. And this was likely amplified by the ad hoc decisions to support some financial institutions and not others and unclear, seemingly fear-based explanations of programs to address the crisis. What was the rationale for intervening with Bear Stearns, then not with Lehman, and then again with AIG? What would guide the operations of the TARP?
Subscribe to:
Posts (Atom)
