Human cost of delayed reform

Swaminathan S. Anklesaria Aiyar presents a paper that assesses the impact on social indicators had India commenced economic reform one decade earlier,

with earlier reform, 14.5 million more children would have survived, 261 million more Indians would have become literate, and 109 million more people would have risen above the poverty line. The delay in economic reform represents an enormous social tragedy. It drives home the point that India's socialist era, which claimed it would deliver growth with social justice, delivered neither

TB HIV and Brazil

The objectives of this study from Brazil were to investigate the occurrence of TB, the prevalence of latent TB and the coverage of the skin test and subsequent isoniazid therapy, and to estimate the number of missed opportunities to prevent TB in patients with HIV/AIDS.

After the trial (which commenced in 2005) and following the analysis the researchers formed the opinion that by expanding the coverage of the skin test and subsequent isoniazid therapy to nearly 100% they could more than double the number of prevented cases of TB.

What is interesting from this study is that they found fault with the skin test

Until recently, the only test available to detect latent TB infection was the skin test. Although it is useful in clinical practice, it has limitations.

BCG vaccination, whilst endemic in Brazil, was ruled out as a limitation

We consider it reasonable to assume that BGC vaccination did not affect the response to the skin test in this study

Without being specific they imply that it is the application of the skin test is difficult

Given the difficulty of performing the skin test, especially in impoverished settings such as São Paulo City, new, more accurate tests, with high sensitivity and specificity for the diagnosis of LTBI are needed.

China and ESAT-6

ESAT-6 IGRA was used in the following groups;

1. 60 close tuberculosis contacts and 46 sputum culture confirmed active tuberculosis patients were compared with 55 healthy controls;

2. 68 children and 52 adolescent cases were compared with 45 seniors

Results In tuberculosis intimate contacts and active tuberculosis patients, ESAT-6 response was high sensitive; the results of ESAT-6 release assay in children and adolescents group were completely consistent with the following clinical diagnosis and prognosis

Conclusion In vitro IFN-γ release assay based on ESAT-6 antigen is helpful in the diagnosis of tuberculosis especially for children and adolescents.

Canada - slowly warming up

An Advisory Committee Statement (ACS) from the Committee to Advise on Tropical Medicine and Travel (CATMAT);

On IGRA;

Recently, a new approach to diagnosing latent tuberculosis infection has been developed—the interferon γ (gamma) release assays (IGRA). Two commercial tests using this principle are available—Quantiferon-TB Gold In Tube™ and T SPOT-TB™. These tests appear to be considerably more specific (to result in fewer false positives) than the TST since they are based on recombinant antigens found almost exclusively in M. tuberculosis. Reading is standardized in the laboratory and only a single visit is required. However, they appear to measure somewhat different biologic properties than does the TST. There is limited experience with their use in children, in immunocompromised hosts, and with serial testing. Their ability to predict risk of future TB activation is unknown, and they are more costly.

On BCG vacinated;

A frequently overestimated but nonetheless real concern in relation to BCG use has been that the vaccine would complicate interpretation of the tuberculin skin test and thus the diagnosis of latent tuberculosis infection. The increasing availability of interferon gamma release assays (IGRA) may reduce this concern since this test appears to avoid “false positive” results attributable to BCG exposure

EU - comparison of LTBI tests in HCWs

The aim of this study was to compare sensitivity and specificity of interferon gamma assays for latent tuberculosis infection by assessing the association of test results with tuberculosis occupational exposure and by using latent class analysis.

..A number of studies have evaluated IGRA, in comparison to TST, as a tool for screening latent tuberculosis infection among healthcare workers [14-19]. To our knowledge, however, no study has compared different IGRAs in this population group.

..We found that the diagnostic accuracy of the TST was significantly different from that of blood tests. This finding is not surprising if it is considered, in addition to the higher specificity of the antigens used, that the in vitro tests avoid a series of operational problems that may affect the accuracy of the TST, including variability in the intradermal injection of the antigen and in the reading of the response 

..the difference between the T-SPOT.TB and QFT-G was of borderline statistical significance

..In conclusion, when used in healthcare workers, in vitro assays may provide a significant increase of specificity for tuberculosis infection compared to TST, even among non vaccinated individuals, at the cost of some sensitivity.

CDC on global migration

Much of the medical literature, including the articles in this issue, still focus on defining populations and describing diseases and conditions associated with certain groups or activities.

Relatively few of these articles recommend or evaluate new interventions to keep globally mobile populations safer and healthier.

Investigators and public health authorities need to start making this shift towards scientific evaluation of interventions that can lead to using this evidence to begin shifting toward recommendations for efficient, cost-effective methods to prevent illness in refugees, immigrants, and travelers.

At the same time, all disease- or pathogen-specific guidelines from national and supranational bodies should explicitly address globally mobile populations.

Spain - MDR TB

In a recent letter to the CDC researchers from Spain warn of the fatal disease Multidrug-resistant Tuberculosis

To the Editor: Eleven years of molecular epidemiologic data allowed the Spanish Multidrug-resistant Tuberculosis (MDR TB) Surveillance Network to identify a specific MDR Mycobacterium tuberculosis strain that had been imported into Spain from Equatorial Guinea. Our study brings to light the potential dissemination of this strain (named MDR-TBEG) in Equatorial Guinea, a country where little is known about the extent and features of TB or MDR TB. It also highlights that MDR strains can spread across continents, and thus MDR TB's emergence in any country becomes a global problem. (cont'd) 

UK Thoracic Society gets nice with QFT

A circular recently sent out by the BTS to its stakeholders;

This advice note has been prepared to assist colleagues who are developing a business case for presentation to PCT commissioners for the provision of TB Services in their area. It has been prepared by Professor Peter Ormerod based on his experiences in the North West of England, and will be “a living document”.

----------

Although NICE recommends IGRA, it is apparent that many PCTs have indicated that they won’t pay for it. It is therefore important that Trusts demonstrate to the PCT(s) that their use is cost-effective. (See Gray M, Ormerod LP. An economic evaluation of the use of interferon gamma release assays in the screening of contacts and new entrants for latent TB. Thorax 2007:Vol 62 Suppl III: S49A pA22 BTS Winter Meeting 2007.)

PCTs can be given 2 options.

a) ALL persons up to age 35 with an inappropriately positive tuberculin test WILL be put on preventive TB treatment as per NICE recommendation, at a median cost per case of £450 (NICE 2006 economic data), OR

b) IGRA testing to be done on those potentially for treatment of LTBI, and only those with a positive IGRA test given treatment (see Gray and Ormerod above).

The author of this advice note was sufficiently confident that if the PCT agreed to option (b), the Trust would report the results after 12 months and change if not cost-effective. These results, reported at the 2007 BTS Winter meeting for this purpose, certainly for QFT showed very substantial cost savings (the year 2 data are even stronger). Essentially the ‘neutral’ cut off point is an 8% false positive tuberculin test rate, if more than 8% have a negative QFT then there is net saving which increases with the proportion of negative IGRA testing. The false positive rate with T-spot would have to be higher to be of economic benefit, because of the higher system cost per item.

----------

Spain, migration and infectious diseases

Via the CDC and their Journal of Emerging Infectious Disease®;

Migration to the European Union has increased exponentially during the past 2 decades, with 1.9 million new registered immigrants in 2008 alone. Of these, 700,000 arrived in Spain, currently the main recipient country in Europe.

..we analyzed health and demographic characteristics of 2,198 immigrants referred to the Tropical Medicine Unit of Ramón y Cajal Hospital over a 20-year period. The most frequent diagnoses were for latent tuberculosis (716 patients [32.6%])...

..Health screening of immigrant populations is needed to ensure early diagnosis and treatment of potentially transmissible infections.

..Screening policies for latent TB face several difficulties, and no consensus has been reached, the best screening method is under discussion..

Nevertheless with the implementation of new screening techniques (interferon gamma release assay) that are less affected by BCG vaccination and use of culturally adapted programs to improve adherence to treatment, screening for latent TB followed by appropriate treatment could be a successful strategy for global TB control in Western countries. Some studies support a better, cost-effective approach to TB using screening.

Future derailed

At a recent forum held at University of Nevada developers were presented with new concepts for a very fast train from Las Vegas to Los Angeles.

By taking the wheel off the vehicle and putting it into a support ring and taking the rail off the ground and putting it onto the train Tubular Rail Inc claim to have revolutionised transport systems.

More from Massachusetts

Whilst the following extracts are taken out of context the message is pretty clear..
1. IGRAs are more convenient,
2. of the available IGRAs QFT-GIT is the easiest to use,
3. TST is more labour intensive and requires a more qualified practitioner,
4. amongst HCWs QFT has gained a higher degree of confidence than the TST,
5. greater confidence in QFT translates to a higher degree of voluntary preventative treatment.

Is the QuantiFERON-TB Blood Assay a Good Replacement for the Tuberculin Skin Test in Tuberculosis Screening?

That was the question asked by Berkshire Medical Center.

We report a pilot study comparing the QFT-GIT and TST results for screening health care workers (HCWs) at Berkshire Medical Center (BMC; Pittsfield, MA), the second hospital in Massachusetts to use QFT-GIT.

And their conclusion?

..our results suggest that QFT-GIT has a superior specificity over TST and can be the test of choice in populations in which BCG vaccination status raises a concern of false-positive results in TB screening

Regulation of Advertising and Promotion of Pharmaceutical and Medical Devices

Recent changes to the Australian Trade Practices Act could provide regulators with increased powers and easier enforcement avenues. Those persons advocating an increase in the marketing of medical devices should first consider the following

The advertising and promotion of pharmaceutical and medical devices - both to medical practitioners as well as direct to consumer advertising in the case of OTC products and unbranded campaigns (which mention diseases and treatments without specifying any actual brand or company name) - are subject to the prohibition on misleading conduct and false representations in sections 52 and 53 of the Trade Practices Act 1974 (Cth) (TPA). In addition, under the TPA, the Australian Competition and Consumer Commission (ACCC) has the power to ban unsafe goods. As such, these reforms are of potential significance to the pharmaceutical and medical device industries.

Favourite gallops to second place

The latest figures shows that approval ratings for the US President are slipping and are doing so at record breaking speed;

 the 9-point drop in the most recent quarter is the largest Gallup has ever measured for an elected president between the second and third quarters of his term, dating back to 1953.

To maintain loyalty promises need to be followed up with action.

Comparison of an IGRA with TST in HCWs with a high rate of BCG vaccination.

Whilst the study used T-Spot TB as the IGRA (QuantiFERON or ELISpot-Plus are also IGRAs) the results were unequivocal;

The high rate of positive baseline TST results in our BCG-vaccinated healthcare workers renders the TST unsuitable as a surveillance tool in this tuberculosis risk group. Use of an IGRA has enabled the detection and treatment of latent tuberculosis in this group.

QFT false negatives

From Japan the following hypothesis was made

The result of QFT-TB test of patients were negative, however, we have to consider the possibility of false-negative.

The hypothesis was not supported by the evidence

So we followed up by monthly chest X-ray examination all hemodialysis patients for 2 years, and finally, it was found that secondary infection of multiple-drug-resistant tuberculosis among immunocompromised hosts did not occur.

Bradford Cornell on the recession

What makes Cornell's argument more compelling is that it appears in the Economist's Voice, a legitimate peer-reviewed journal started by economic heavyweights Joseph Stiglitz and Brad DeLong.

The best path for the government is to promote aggressive recognition of losses and a restructuring of the financial system...

..a general stimulus program will, in all likelihood, lead to highly inefficient allocations, effectively burning resources at a time when they are particularly scarce and particularly vital to restart and re-align our beleaguered economy.

In the beginning..

..of 2007 a recruitment of subjects for a comparitive study between QuantiFERON and TST was being made in Israel

We hypothesize that in spite of the cost of screening healthcare workers with Quantiferon-GOLD tests, the reduction in need for LTBI treatment and associated costs will render the test cost-effective.

Two years later the evidence supported the hypothesis

Screening HCWs with the QFT test compared to the TST resulted in fewer possible cases being identified, lower costs, and increased adherence to treatment. 

.

Is China a land of ruthless gamblers?

Analysis by *Michael Pettis in China Financial Markets points to stockpiling and inventory build up as the reason behind the recent "recovery" and warns that overcapacity is intensifying

From what I am being told, it seems that a number of wealthy Chinese investors have been speculating directly in commodities, and so some of this inventory buildup is occurring not at the company level but at the investor level.

Cost effective studies

Two studies on costs and effectiveness are out; one on contact investigations and the other on targetted screening using QuantiFERON.

XXXX woes

Kenneth Rogoff points to the vast reserves of $US that China is holding and tosses out a grenade;

When will China finally realize that it cannot accumulate dollars forever? It already has more than $2 trillion. Do the Chinese really want to be sitting on $4 trillion in another five to 10 years? With the United States government staring at the long-term costs of the financial bailout, as well as inexorably rising entitlement costs, shouldn’t the Chinese worry about a repeat of Europe’s experience from the 1970’s?

Clever sillies: Why high IQ people tend to be deficient in common sense

Bruce Charlton takes a shot at high IQ people claiming that

intelligent modern people (including scientists) decline to grow-up and instead remain in a state of perpetual novelty-seeking adolescence.

Bruce dryly notes that these brainy birds tend to stick together

The cognitively-stratified context of communicating almost exclusively with others of similar intelligence, generates opinions and behaviours among the highest IQ people which are not just lacking in common sense but perversely wrong. Hence the phenomenon of ‘political correctness’ (PC); whereby false and foolish ideas have come to dominate, and moralistically be enforced upon, the ruling elites of whole nations.

For Bruce this is a classic catch-22 situation

Speaka Italiano?

From an Italian Medical science usernet group, some chat re Quantiferon;

PPD - running on empty

Apparently in Italy the govt has advised of their policy on acquiring tuberculin. In response to the withdrawal of the Novartis product (Biocine Test PPD) the Deputy Secretary of Health, Ferruccio Fazio advised that PPD had been sourced from Statens Serum Institut and Sanofi Pasteur. However, due to recent shortages experienced by both of the suppliers efforts have been made by Italian authorities to secure future doses - some 15,000. It seems that efforts by the govt to "meet the market" has hit some governance hurdles;

Guidelines - Norway

Preceding note: some of the interpretation is loose eg what I have termed as "HCWs" reads as People who in the course of the last three years has stayed more than three months in countries with high incidence of tuberculosis, and that will occur or re-occur in positions in health and care service or other positions related to child care. The duty applies also for people under training or visiting

ditto with "Contacts", the Norwegian word is "smitteoppsporinger" which, in context, implies "contact" yet the Google translation is Other people it is medically suspect is or have been at risk of being infected with tuberculosis 

Therefore some guesstimation has been used.

However, it is without question that as from March 2009 the use of Quantiferon in Norway is mandatory.

Updated guidelines

From NICE;

Tuberculosis: interferon gamma tests for the diagnosis of latent tuberculosis

Status: In progress
Publication date: November 2009

Extrapulmonary Tuberculosis in the United States

Via the CDC;

EPTB epidemiology and risk factors differ from those of PTB, and the proportion of EPTB has increased from 1993 through 2006.

The reasons why?

Interpreting interferon levels

From time to time you see lab results of IGRA tests in which subsequent IGRA tests have large unexplained variations. Some could be put down to lab error and others due to natural fluctuations in IFN-y levels, something that was not observed until the advent of IGRAs. From the CDC;

QFT in the Middle East

Dr Luca Richeldi speaking at the 1st Middle East Infectious Diseases Update for Physicians Conference, part of the Patient Safety Congress at the Abu Dhabi Medical Congress

..“Another concern for the UAE must now be the regular screening of its health care professionals who are at high risk of contracting TB. It is not enough for them to be screened once as latent TB can be reactivated and become full-blown TB at any time after initial screening. With countless new hospitals and healthcare facilities being built in the UAE, the concern for the safety of health care workers should be given serious consideration.”

Elinor Ostrom - Nobel prize for Economics

Paul Romer writes;

Most economists think that they are building cranes that suspend important theoretical structures from a base that is firmly grounded in first principles. In fact, they almost always invoke a skyhook, some unexplained result without which the entire structure collapses. Elinor Ostrom won the Nobel Prize in Economics because she works from the ground up, building a crane that can support the full range of economic behavior...

continued over the fold

Economists who have become addicted to skyhooks, who think that they are doing deep theory but are really just assuming their conclusions, find it hard to even understand what it would mean to make the rules that humans follow the object of scientific inquiry. If we fail to explore rules in greater depth, economists will have little to say about the most pressing issues facing humans today – how to improve the quality of bad rules that cause needless waste, harm, and suffering.

Cheers to the Nobel committee for recognizing work on one of the deepest issues in economics. Bravo to the political scientist who showed that she was a better economist than the economic imperialists who can’t tell the difference between assuming and understanding.

David Henderson in the WSJ

Yesterday's award of the Nobel Prize in economics to Elinor Ostrom and Oliver Williamson at first struck me as a good choice. Now I think it's a great choice. The reason is that mainstream economics has become highly mathematical and increasingly independent from reality. Many economists sit in their offices and derive proofs. Few go out and do the time-consuming work of examining the institutional structures that humans build to solve their own real-world problems. Among those few are Ms. Ostrom and Mr. Williamson...

Some have summarized their work by saying that institutions other than free markets often work well. But that statement can mislead you to conclude that government solutions are the answer. Free markets are only a subset of free institutions. A better way to sum up their work is that what Ms. Ostrom and Mr. Willamson really show is that voluntary associations work...

The following are a few extracts from Ostrom's considerable CV.

In Covenants With and Without a Sword: Self-Governance is Possible Ostrom argues that individuals can make proper choices;

Contemporary political theory often assumes that individuals cannot make credible commitments where substantial temptations exist to break them unless such commitments are enforced by an external agent. One such situation may occur in relation to common pool resources, which are natural or man-made resources whose yield is subtractable and whose exclusion is nontrivial (but not necessarily impossible). Examples include fisheries, forests, grazing ranges, irrigation systems, and groundwater basins. Empirical evidence, however, suggests that appropriators in common pool resources develop credible commitments in many cases without relying on external authorities. We present findings from a series of experiments exploring
(1) covenants alone (both one-shot and repeated communication opportunities);
(2) swords alone (repeated opportunities to sanction each other); and
(3) covenants combined with an internal sword (one-shot communication followed by repeated opportunities to sanction each other).

In Unlocking Public Entrepreneurship and Public Economies Ostrom argues that the private sector can enhance an individual's freedom;

Unlocking human potential requires a rich network of institutional arrangements in both private and public spheres. Opening the private sphere to entrepreneurship and complex market organization is well understood as a key to increasing the level and quality of private goods available to consumers. Opening the public sphere to entrepreneurship and innovation at local, regional, and international levels is also a key to increasing the level and quality of public goods – e.g., peace, safety, and health – available to citizens.

This paper reviews studies of urban service delivery that have repeatedly found communities of individuals who have self-organized to provide and co-produce surprisingly good local services. In addition to unlocking individual freedom, we need to unlock the public sector from rigid, top-down, hierarchical organization

Inflationary fears - equating apples with oranges

James Bullard, President and CEO of the Federal Reserve Bank of St. Louis, looks at the GFC and makes some observations;

* It has been popular to describe recent events in the economy as a collapse of a bubble in housing.
* A look at the housing data makes a convincing case.
* But when it comes to calculating traditional output gaps, there is no notion of a bubble.
* If part or most of the fall in output was a collapsed bubble, then today’s output gap would be smaller than it appears.
* This is mainly an issue for assessing medium term inflation risk.

Output gap is the difference between potential GDP and actual GDP with potential GDP (or natural gross domestic product NGDP) being defined as the optimal production capacity of a country's economy given its practical and regulatory constraints. The concept of GDP was devised by economist Keynes and has become known as the Keynesian formula;

In scientific notation, the Keynesian Formula consists of the following make-up:
C + I + G + X − M = Y(GDP) which means:
Consumption + Investment + Government Spending + Exports − Imports = Gross Domestic Product

NGDP is the natural rate of GDP growth (in Australia since 1992 NGDP has never fallen below 4%) and  the theory goes that if actual GDP exceeds its natural level, inflation will accelerate as suppliers increase their prices. If actual GDP falls below its natural level, inflation will decelerate as suppliers attempt to fill excess capacity - hence the term output gap.

Back to Bullard;

I am concerned about a popular narrative in use today. The narrative is that the output gap must be large since the recession is severe ..and so any medium term inflation threat is negligible..even in the face of an extraordinarily accommodative monetary policy.

I think this narrative overplays the output gap story for understanding medium term risks.

* Gap-based theories of inflation were badly discredited in the 1970s.
* Athanasios Orphanides has argued that much of the run-up in 70s inflation can be attributed to a misreading of the output gap.
* There are three main issues:
 1. Measurement of the gap itself is difficult - there are both theoretical and practical issues.
 2. Even accepting a particular measure, the empirical relationship with inflation is not robust.
 3. Traditional output gaps have no concept of a collapsing bubble.

Bullard then concludes by saying

The output gap argument is overemphasized with respect to assessing medium term inflation risk.

Arnold Kling picks up on this and warns

if a post-bubble economy were to behave more like a supply shock than a demand shock, we could be in for a rude awakening. The monetary and fiscal expansion may have little or no effect on unemployment, and after a bit of a lag we could see inflation come back with a vengeance.

Down and out in Qatar

Need a peice of advice!!!

My friend is declared by MEDICAL COMMISSION as UNFIT TO WORK after they sent her to Rumaila Hospital (based on the findings, she has a pulmonary nodules,positive on PPD test but negative on 3X smear culture test). They sent her to HAMAD HOSPITAL for QUANTIFERON, after almost 1 month, they declared her as UNFIT TO WORK.

Is there anyway for her to stay in Qatar?can she undergo a medication instead of sending her to her country? She needs a work.and aside from that, she dont have such history..she dont have any symptoms of having that desease.

By soulzytravlyrz07

Military marches to a slow beat

Whilst sales of QFT to the US military have been excruciatingly slow for some its comforting to think that detainees at Gitmo are getting a better deal than the troops elsewhere;

Tuberculosis (TB) screening conducted via Quantiferon testing – the most accurate TB testing method available

Stimulus not very stimulating

NYU economist Mario Rizzo points to Greg Mankiw's original and updated graphs and says

Greg Mankiw continues to trace the unemployment rate as predicted by the original calculations of the effect of  the fiscal stimulus as against no-stimulus. My advanced “eye-ball” extrapolations suggest that we are following the same path as the no-stimulus projection BUT at a higher level of unemployment throughout.

Dare I suggest (ever so tentatively and with all scientific humility given the nature of the data) that the stimulus has done harm?

These figures need to be taken seriously. As reported in the Australian

THE doyen of Labor economics advisers, Ross Garnaut, has warned that Kevin Rudd’s attacks on neo-liberalism risk an expansion of government that could damage the economy and even erode Australia’s democratic values.

And he warns that, by further fuelling excess spending, the Rudd government’s budget stimulus will have to be followed by “hard times” and lower living standards that the government has “barely begun to contemplate”. His sharp critique of the Rudd government’s response to the global financial crisis is contained in his new book, The Great Crash of 2008.

..“Sustainable full employment will require reduction of average incomes and living standards below those to which Australians became accustomed before the crash. The Australian government, community and business leadership has barely begun to contemplate the adjustment that is required.”

Finally! the penny drops

Commenting in the Australian TB Review on the Swedish study Use of a T cell interferon gamma release assay in the investigation for suspected active tuberculosis in a low prevalence area "JT" says

In other words we should be looking to QFT-G to help diagnose TB infection, but not disease.

Yes! Unlike other disease you can be infected with TB yet not have the disease - it is in a state of inactivity and there are no symptoms. Only when TB becomes clinically active does it show symptoms of the disease.

Treating disease is required however until infection is diagnosed and treated the risk of disease will always be present. The task for epidemiologists is to identify an infection that has no symptoms and treat it before it becomes active.

Begging belief

Last May the WSJ blew the whistle on Rudd's cash splash

Australia entered the global financial crisis with one of the soundest fiscal positions among developed nations. Now, thanks to the Labor government of Kevin Rudd, that's no longer the case.

Treasurer Wayne Swan announced Tuesday a 32.1 billion Australian dollar ($24.3 billion) fiscal deficit this year and forecast that it would rise to A$57.6 billion in 2009-10 -- the largest in the country's history. Canberra plans to borrow money to fund the shortfall. Outstanding debt will rise to A$300.8 billion over the next four years from around A$111.9 billion.

Today George Megalogenis picks the nits out of the budget;

Even if Kevin Rudd stopped his spending dead, it would still leave the budget facing a deficit of $30bn in this financial year, peaking at $40bn in 2010-11.

How does an economy that avoids a technical recession wind up with deficits of this order?

The dry accounting explanation is that GDP measures production while the budget deals in cash and Australia is already in an income recession.

Treasurer Swan gave reassurance that fiscal policy would remain expansionary;

Well, the economy is beginning to grow, but the economy still requires support which it is continuing to receive. It is continuing to receive that support from the Government's fiscal stimulus, but that fiscal stimulus is being gradually withdrawn as we move through next year.

A city of two tales

Whilst treasurer Wayne Swan defends the governments fiscal policy

We must keep the stimulus in place. It supports employment across the board, it supports confidence in the economy as we move forward,"

the RBA claims that it is their monetary policy that has rescued the economy

Unemployment has not risen as far as had been expected....it is now prudent to begin gradually lessening the stimulus provided by monetary policy

Caught in the middle is the poor befuddled taxpayer. In an effort to make some sense of all these global contradictions macroeconomist Greg Mankiw recommends this piece by David Brooks

I’d like to introduce you to two friends of mine, Mr. Bentham and Mr. Hume.

Mr. Bentham knows everything. He went to Stanford, then to the Kennedy school before getting a business degree. He’s got multivariate regressions coming out of his ears, and he sprinkles C.B.O. reports on his corn flakes for added fiber.

Mr. Hume is very smart, too, but he doesn’t seem to make much use of his intelligence. He worked on Wall Street for a little while, but he never could accurately predict how the market was going to move tomorrow or the day after that.

Mr. Bentham is a great lunch partner. If you ask him to recommend a bottle of wine, he’ll reel off the six best vintages on the wine list, in ranked preference. Mr. Hume can’t even tell you which entree to order because he doesn’t know what you like.

If you put Mr. Bentham in charge of the government, he’d proceed with confidence. If you told him to solve a complicated issue like the global-warming problem, he’d gather the smartest people in the country and he’d figure out how to expand wind, biomass, solar and geothermal sources to reduce CO2 emissions. He’d require utilities to contribute $1 billion a year to a Carbon Storage Research Consortium. He’d draw up regulations determining how much power plants would be allowed to pollute.

He’d know about battery efficiency and building retrofit programs, and he’d give you a long string of dazzling proposals. So then you’d ask him to solve the health care mess.

He’d say we have to cover the uninsured without bankrupting the country. He’d design a set of insurance policy regulations to make sure everybody gets uniform care. He’d get out his magnifying glass and help pay for expanded coverage by identifying waste in Medicare.

Then, he’d say, we’ve got change the way government reimburses providers. He’d set up a $1 billion-a-year Innovation Center within the Department of Health and Human Services. He’d organize a superempowered Medicare commission to rewrite regulations and hold down costs. He’d set up comparative effectiveness research centers with teams of experts who would determine what treatments work best. He’d encourage doctors to merge their practices into efficient teams because he’d seen successful pilot programs along that line.

Mr. Hume, I’m afraid, wouldn’t be so impressive. If you asked him to take on global warming, he’d pile up reports on the problem. But if you walked into his office after a few days, you’d find papers strewn in great piles on the floor and him at his desk with his head in his hands.

“I don’t know the best way to generate clean energy,” he’d whine, “and I don’t know how technology will advance in the next 20 years. Why don’t we just raise the price on carbon and let everybody else figure out how to innovate our way toward a solution? Or at worst, why don’t we just set up a simple cap-and-trade system — with no special-interest favorites — and let entrepreneurs figure out how to bring down emissions?”

On health care, he’d be much the same. He’d spend a few days reading reports. Then one day you’d find him in the fetal position, weeping. He’d confess that he doesn’t know enough to reorganize a fifth of the economy. He can’t figure out which health care delivery system is the most efficient. “Why don’t we just set up insurance exchanges with, say, 12 different competing policies? We’ll let everybody choose a policy, and we’ll let people keep any money they save. That way they can set off a decentralized cascade of reform, instead of putting all the responsibility on us here.” And then Mr. Hume would beg you to leave him alone.

I’ve introduced you to my friends Mr. Bentham and Mr. Hume because they represent the choices we face on issue after issue. This country is about to have a big debate on the role of government. The polarizers on cable TV think it’s going to be a debate between socialism and free-market purism. But it’s really going to be a debate about how to promote innovation.

The people on Mr. Bentham’s side believe that government can get actively involved in organizing innovation. (I’ve taken his proposals from the Waxman-Markey energy bill and the Baucus health care bill.)

The people on Mr. Hume’s side believe government should actively tilt the playing field to promote social goods and set off decentralized networks of reform, but they don’t think government knows enough to intimately organize dynamic innovation.

So let’s have the debate. But before we do, let’s understand that Mr. Bentham is going to win. The lobbyists love Bentham’s intricacies and his stacks of spending proposals, which they need in order to advance their agendas. If you want to pass anything through Congress, Bentham’s your man.

Reasons for Holding onto a Security

Under "Portfolio Changes – 2 October 2009" Bioshares said

Cellestis and Biota Holdings have both made strong gains this year. We will take some profits and remove them from the portfolio.

This appears to be counterintuitive, why would you sell what you consider to be a good investment? In June 2009 of Cellestis Bioshares said

We place a Hold recommendation on this stock and maintain a very favourable long term outlook for this company. Look for price weaknesses to acquire

Obviously Bioshares are speculators not investors; this is their justification for another recent purchase;

Biodiem appears well undervalued at present with a capitalisation of only $11 million. With major milestones due to be reached in the year ahead, it makes an appealing speculative investment at its current price.

Warren Buffett could see no sense in profit taking for the sake of making a profit

We do not sell holdings just because they have appreciated or because we have held them for a long time. (Of Wall Street maxims the most foolish may be "You can't go broke taking a profit.") We are quite content to hold any security indefinitely, so long as the prospective return on equity capital of the underlying business is satisfactory, management is competent and honest, and the market does not overvalue the business.

Whilst Buffett can be controversial he has the track record to back his opinions

Word of mouth

One of the best places for medical chat is amongst HCW forums, tap in "quantiferon" and see what is on their minds;

Sunnysweetpea

 ..I want to get the blood test, Quantiferon TB Gold, but my primary physician refuses to order it because she doesn't feel it's necessary and the doctor that read my test is no help either. Has anyone heard of this test or do you have any advice? I would accept a blood test if it said I was positive and take the potentially liver damaging meds for 9 months, but I don't trust my skin test especially because it was red, not raised...

Tessamae

..I know this might not work out for everyone but there is also a TB blood test quantiFERON-gold as an option to see if the result was a false positive. The CDC website has lots of good info about this.

 J_Audrey

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!)

 Tessamae

Maybe the newer TB blood test would be something that would work for you?? Its called Quantiferon Gold. I would also call a Tb clinic. I had a positive ppd once that I was sure was from an error in the placement and I was against getting chest x-rays for ever so I called my local tb clinic and they helped me find this blood test so I do not have to get the chest x-ray. I recently read an article that this new blood test might even replace the skin test...
You can find more on the CDC website too
http://www.cdc.gov/TB/pubs/tbfactsheets/QFT.htm

agr8rn

Just remember for the future, NEVER TAKE THE PPD TEST AGAIN

There will be people who try to make you take it, but don't do it. The reactions get worse every time, and you can get serious scarring and tissue damage.

Know your Gnowee

From Wikipedia;

In Australian aboriginal mythology, Gnowee is a solar goddess who lived on Earth before there was a sun. People had to carry torches or other light sources to see. Gnowee's baby son wandered off while she was gathering yams, and she began searching for him, carrying a large torch. She continues to do so, and her torch is the sun.

According to legend Gnowee's torch brings light into the darkness.

Centres of Learning

Oxford Immunotec have introduced a learning zone, once you sign up (it's free) you can learn all about TB. There is also this simple diagram to help you on your way

To get a grip on the enormous amount of information on QuantiFERON Cellestis have introduced gnowee, a net based reference guide.

Since the advent of IGRAs and the first mention of early IGRAs in the literature in the late 1990s, nearly 400 peer-reviewed, published articles have mentioned QuantiFERON®-TB Gold technology.

The number of QFT™-related publications has risen dramatically between 2004 and today. In fact,the TB world is on track for a record of 133 QFT-related articles published this year (based on PubMed keyword search, 20 Aug 2009). Such a large knowledge base can be incredibly advantageous to those who strive to eradicate TB and its morbidity and mortality.

With so much information so readily available, searching, sorting, saving, remembering, collating and incorporating all of these articles into your clinical or research practice is increasingly more difficult.

Enter..

Gnowee is like your one-stop-shop for all of your QuantiFERON information needs. 

Gnowee (pronounced nō-ē) is a comprehensive resource for information relating to QuantiFERON. A new tool developed by Cellestis for customers and QFT users, Gnowee brings together a whole library full of references, documents, presentations, images, and more.

First and foremost, Gnowee is a comprehensive collection of peer-reviewed QFT-related publications and abstracts for QFT customers and prospective customers. Because articles are so frequently published, Gnowee has continuous updates so you can be confident you have latest evidence at hand.

You’ll be able to tell when new content is available through QFT News—the  icon next to a news item will indicate that related information has been updated in Gnowee online (see below for more details on updating content). QFT News will complement Gnowee by providing in-depth coverage of the latest publications as well as Cellestis commentary on major issues in the TB space.

Here’s a snapshot of what else you can find in Gnowee:

-The Guidelines section provides updated TB and QFT-related guidelines, position statements, and recommendations from around the world.

-Several Presentations are also available to help you tailor your own presentations. You can reproduce or adapt these slides without permission under a few copyright conditions that you can find in the ‘Help’ section.

-The Technical Support section provides detailed technical answers to frequently asked questions and advice on QFT procedures and products. You can automatically request that a Cellestis Technical Service representative contact you with the click of a button.

-Copyright-free Images have also been collated so that you can embellish your presentations.

-Last but not least, the QuantiFERON Information section contains product information, analysis software, instructional videos, and the QFT News archive.


Gnowee is like your one-stop-shop for all of your QuantiFERON information needs.

Obama loses, the people of Chicago win

News of the win by Rio for the 2016 Olympics should bring a sigh of relief to taxpayers in Chicago; by any reasonable cost benefit analysis hosting an Olympics is a non-zero-sum game

When combined with the substantial upside risks inherent in costs of public works projects48, the expected overall net benefit of hosting an Olympic Games is substantially negative

This was also the conclusion arrived at by  the Canadian Centre for Policy Alternatives who found that the Olympics cannot be justified by economic grounds;

“The Olympics have too often been pitched as having miraculous economic powers,” says Klein “They do not. Like all public policy choices, they come with benefits and costs, and will require trade-offs.”

WHO Policy on TB Infection Control in Health-Care Facilities, Congregate Settings and Households

Nothing new here however it does set the global standard for HCW's

Conduct surveillance of TB disease among health workers, and conduct assessment at all levels of the health system and in congregate settings

HPA follows the guidelines.

First there was an outbreak

The Health Protection Agency has revealed that it has been told of three cases of Tuberculosis connected with Kingswood Secondary School in Corby.

All three people affected are responding well to treatment.

The East Midlands South Health Protection Unit has been working with NHS Northamptonshire, Northamptonshire Provider Services and Kettering General Hospital following the outbreak.

An investigation is now underway to identify those who had prolonged contact with the infectious individuals and more than 200 people have been screened as a precaution. 

Then the contact investigation

"Following the screening of more than 200 people associated with the school, we have had positive blood test results for 57 people which means that they have been exposed to the TB germ.

All in line with HPA guideline:

TST (Mantoux) should generally be used as the first line test for LTBI in contacts of infectious cases and others considered to be at increased risk of LTBI. Those with positive TST results (based on the criteria in the ‘Green Book’(8)) should then be considered for IGRA testing, if available.

How savings saved Australia

In an address to the Australian Conference of Economists Business Symposium Treasury Secretary Ken Henry acknowledges the role savings played in the GFC;

One piece of anecdotal evidence that has captured my attention in the immediate aftermath of the global financial crisis is the role played by Australian superannuation funds in financing, through equity purchases, a large-scale de-leveraging of corporate Australia.  It is not at all clear that such a large structural change in corporate financing could have been achieved without our very substantial pool of superannuation savings.

He then signals that savings may receive a more benevolent treatment from the ATO;

Personal capital income taxes are taxes on saving.  They affect how consumption is distributed over a person's lifetime and, in turn, the national level of saving. Further, the personal capital income tax settings have other effects. Taxing savings reduces the gains from working, where some of those gains are saved. It affects the allocation of a household's savings among various assets as well as having important implications for equity.

Well blow me down, this is the first time that I have heard a tax man applying a cost benefit analysis to taxation. 

We have a system for taxing personal capital income that has evolved into something that is, to put it mildly, far from the originally intended ideal.

Further, the case for staying true to that original ideal now appears weak; while the case for moving to the other conceptual ideal is not strong either.

Meanwhile, we have a tax system for household saving that has not been calibrated to address the challenges of population ageing and the financing of unprecedented levels of business investment and infrastructure.

Tax agents - an endangered species

Treasury Secretary Ken Henry puts the heat under those ubiquitous double dipping freeloaders - the tax agents;

"Seventy five per cent or more of individual taxpayers feel the need ... to go to an agent to look after their tax - that is by far the highest rate of agent assisted tax returns of anywhere in the developed world," he said.

"A lot of people, because they get advice from an agent, they automatically trust that advice.

"We are looking at some quite adventurous proposals for individual taxpayers that would ... in some years time make their experience with the tax and transfer system very simple."

Oh happy days indeed

Economist takes a walk

Back In November 2008 Macquarie Banks Rory Robertson told of his wager with economist Steve Keen

On the maybe 1% chance that he is right, and capital-city home prices do indeed fall by 40% within the next five years – starting from Q2 2008, and as measured by the ABS – I will walk from Canberra to the top of Mt Kosciusko (that’s maybe 200km followed by a 2228-metre incline). If Dr Keen turns out to be less than half right, as I expect, and home prices drop by (much) less than 20%, he will take that long walk. Moreover, the loser must wear a tee-shirt saying: “I was hopelessly wrong on home prices! Ask me how.”

Well latest data confirms that Steve Keen will be enjoying his alpine ramble

However he is not so keen to be alone

After the last four years, I doubt that anyone has any confidence in the ability of economists to fine tune anything.

Tony Richards from the RBA looks at housing in Australia and comments

...it is clear there have been problems in recent years in land zoning, and in the development and building approvals processes. An extreme example was perhaps on the fringes of Sydney, where in the middle of this decade, proposed infrastructure contributions in some new developments would have come to as much as $100,000 per lot

Factors that boost the cost of new land on the fringe and reduce new supply must inevitably impact on the broader cost of housing in our cities.

Over the past five years, our incomes have grown, with per capita real GDP 9 per cent higher on average than over the preceding five years....Yet the number of dwellings we have built has not risen

I think it is becoming well understood that supply side factors, in addition to the well known demand side ones have contributed to the relatively high level of housing prices in Australia.

This is bad news for 1st home buyers and good news for speculators and NIMBY's - excessive regulation and zoning laws has contributed to maintaining real estate values above levels of affordability