Using a new measure of financial constraints based on firms' qualitative disclosures, we find that financially constrained firms—firms that use more negative words in their annual reports—pursue more ...aggressive tax planning strategies as evidenced by: (1) higher current and future unrecognized tax benefits, (2) lower short- and long-run current and future effective tax rates, (3) increase in tax haven usage for their material operations, and (4) higher proposed audit adjustments from the Internal Revenue Service. We exploit the unexpected closures of local banks as exogenous liquidity shocks to show that firms' external financial constraints affect their tax avoidance strategies. Overall, the linguistic cues in firms' qualitative disclosures provide incremental information beyond traditional accounting variables or commonly used effective tax rates to reveal and predict tax aggressiveness, both contemporaneously and in the future.
•We evaluate the effectiveness of household coping strategies in mitigating adverse weather shock impacts in rural Ethiopia.•Formal social safety nets mitigate the impact of adverse rainfall shocks ...on consumption, and significantly shape poverty dynamics.•Off-farm employment mitigates the impact of high-temperature shocks.•Social protection programs are needed to support existing household coping strategies and respond rapidly to weather shocks.
Rural households adopt a broad range of strategies to cope with adverse weather shocks. Previous studies have examined the effectiveness of individual coping strategies in mitigating the impact of adverse weather shocks, but no study to date has presented a comprehensive evaluation of alternative coping strategies. We employ household panel data spanning 15years to estimate the impact of weather shocks on consumption and poverty dynamics in rural Ethiopia, along with the effectiveness of household coping strategies in alleviating the impact of shocks. We find that rainfall increases are positively associated with per adult equivalent consumption, while high temperatures are negatively associated with consumption. In terms of household coping strategies, formal social safety net transfers mitigate the impact of adverse rainfall shocks on consumption and off-farm employment mitigates the impact of high-temperature shocks. Simulations suggest that rainfall shocks and formal social safety net transfers significantly influence household poverty dynamics. By contrast, high-temperature shocks and off-farm employment have less impact on poverty dynamics. The results highlight the need for social protection programs that support existing household coping strategies and that can rapidly respond to weather shocks.
Type 2 diabetes (T2D) has become epidemic in our modern lifestyle, likely due to calorie-rich diets overwhelming our adaptive metabolic pathways. One such pathway is mediated by nicotinamide ...phosphoribosyltransferase (NAMPT), the rate-limiting enzyme in mammalian NAD
+ biosynthesis, and the NAD
+-dependent protein deacetylase SIRT1. Here, we show that NAMPT-mediated NAD
+ biosynthesis is severely compromised in metabolic organs by high-fat diet (HFD). Strikingly, nicotinamide mononucleotide (NMN), a product of the NAMPT reaction and a key NAD
+ intermediate, ameliorates glucose intolerance by restoring NAD
+ levels in HFD-induced T2D mice. NMN also enhances hepatic insulin sensitivity and restores gene expression related to oxidative stress, inflammatory response, and circadian rhythm, partly through SIRT1 activation. Furthermore, NAD
+ and NAMPT levels show significant decreases in multiple organs during aging, and NMN improves glucose intolerance and lipid profiles in age-induced T2D mice. These findings provide critical insights into a potential nutriceutical intervention against diet- and age-induced T2D.
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► NAMPT-mediated NAD
+ biosynthesis is compromised in metabolic organs by HFD ► NMN ameliorates defects in NAD
+ biosynthesis and glucose metabolism in T2D mice ► NMN enhances hepatic insulin sensitivity by reversing gene expression caused by HFD ► NMN also ameliorates defects in glucose and lipid metabolism in age-induced T2D mice
Objective To estimate the frequency with which results of large randomized clinical trials registered with ClinicalTrials.gov are not available to the public.Design Cross sectional analysisSetting ...Trials with at least 500 participants that were prospectively registered with ClinicalTrials.gov and completed prior to January 2009.Data sources PubMed, Google Scholar, and Embase were searched to identify published manuscripts containing trial results. The final literature search occurred in November 2012. Registry entries for unpublished trials were reviewed to determine whether results for these studies were available in the ClinicalTrials.gov results database.Main outcome measures The frequency of non-publication of trial results and, among unpublished studies, the frequency with which results are unavailable in the ClinicalTrials.gov database.Results Of 585 registered trials, 171 (29%) remained unpublished. These 171 unpublished trials had an estimated total enrollment of 299 763 study participants. The median time between study completion and the final literature search was 60 months for unpublished trials. Non-publication was more common among trials that received industry funding (150/468, 32%) than those that did not (21/117, 18%), P=0.003. Of the 171 unpublished trials, 133 (78%) had no results available in ClinicalTrials.gov.Conclusions Among this group of large clinical trials, non-publication of results was common and the availability of results in the ClinicalTrials.gov database was limited. A substantial number of study participants were exposed to the risks of trial participation without the societal benefits that accompany the dissemination of trial results.
In rodents, obesity and aging impair nicotinamide adenine dinucleotide (NAD
) biosynthesis, which contributes to metabolic dysfunction. Nicotinamide mononucleotide (NMN) availability is a ...rate-limiting factor in mammalian NAD
biosynthesis. We conducted a 10-week, randomized, placebo-controlled, double-blind trial to evaluate the effect of NMN supplementation on metabolic function in postmenopausal women with prediabetes who were overweight or obese. Insulin-stimulated glucose disposal, assessed by using the hyperinsulinemic-euglycemic clamp, and skeletal muscle insulin signaling phosphorylation of protein kinase AKT and mechanistic target of rapamycin (mTOR) increased after NMN supplementation but did not change after placebo treatment. NMN supplementation up-regulated the expression of platelet-derived growth factor receptor β and other genes related to muscle remodeling. These results demonstrate that NMN increases muscle insulin sensitivity, insulin signaling, and remodeling in women with prediabetes who are overweight or obese (clinicaltrial.gov NCT03151239).
NAD+ availability decreases with age and in certain disease conditions. Nicotinamide mononucleotide (NMN), a key NAD+ intermediate, has been shown to enhance NAD+ biosynthesis and ameliorate various ...pathologies in mouse disease models. In this study, we conducted a 12-month-long NMN administration to regular chow-fed wild-type C57BL/6N mice during their normal aging. Orally administered NMN was quickly utilized to synthesize NAD+ in tissues. Remarkably, NMN effectively mitigates age-associated physiological decline in mice. Without any obvious toxicity or deleterious effects, NMN suppressed age-associated body weight gain, enhanced energy metabolism, promoted physical activity, improved insulin sensitivity and plasma lipid profile, and ameliorated eye function and other pathophysiologies. Consistent with these phenotypes, NMN prevented age-associated gene expression changes in key metabolic organs and enhanced mitochondrial oxidative metabolism and mitonuclear protein imbalance in skeletal muscle. These effects of NMN highlight the preventive and therapeutic potential of NAD+ intermediates as effective anti-aging interventions in humans.
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•NMN suppresses age-associated body weight gain and enhances energy metabolism•NMN improves insulin sensitivity, eye function, and other features with no toxicity•NMN prevents age-associated gene expression changes in a tissue-specific manner•NMN is an effective anti-aging intervention that could be translated to humans
Mills et al. conducted a 12-month-long administration of nicotinamide mononucleotide (NMN), a key natural NAD+ intermediate, to normal wild-type mice, demonstrating that NMN effectively mitigates age-associated physiological decline in mice without any obvious toxicity. These results highlight the significant potential of NMN as an effective anti-aging intervention in humans.
Objectives
A significant proportion of geriatric patients experience suboptimal outcomes following episodes of emergency department (ED) care. Risk stratification screening instruments exist to ...distinguish vulnerable subsets, but their prognostic accuracy varies. This systematic review quantifies the prognostic accuracy of individual risk factors and ED‐validated screening instruments to distinguish patients more or less likely to experience short‐term adverse outcomes like unanticipated ED returns, hospital readmissions, functional decline, or death.
Methods
A medical librarian and two emergency physicians conducted a medical literature search of PubMed, EMBASE, SCOPUS, CENTRAL, and ClinicalTrials.gov using numerous combinations of search terms, including emergency medical services, risk stratification, geriatric, and multiple related MeSH terms in hundreds of combinations. Two authors hand‐searched relevant specialty society research s. Two physicians independently reviewed all s and used the revised Quality Assessment of Diagnostic Accuracy Studies instrument to assess individual study quality. When two or more qualitatively similar studies were identified, meta‐analysis was conducted using Meta‐DiSc software. Primary outcomes were sensitivity, specificity, positive likelihood ratio (LR+), and negative likelihood ratio (LR–) for predictors of adverse outcomes at 1 to 12 months after the ED encounters. A hypothetical test–treatment threshold analysis was constructed based on the meta‐analytic summary estimate of prognostic accuracy for one outcome.
Results
A total of 7,940 unique citations were identified yielding 34 studies for inclusion in this systematic review. Studies were significantly heterogeneous in terms of country, outcomes assessed, and the timing of post‐ED outcome assessments. All studies occurred in ED settings and none used published clinical decision rule derivation methodology. Individual risk factors assessed included dementia, delirium, age, dependency, malnutrition, pressure sore risk, and self‐rated health. None of these risk factors significantly increased the risk of adverse outcome (LR+ range = 0.78 to 2.84). The absence of dependency reduces the risk of 1‐year mortality (LR– = 0.27) and nursing home placement (LR– = 0.27). Five constructs of frailty were evaluated, but none increased or decreased the risk of adverse outcome. Three instruments were evaluated in the meta‐analysis: Identification of Seniors at Risk, Triage Risk Screening Tool, and Variables Indicative of Placement Risk. None of these instruments significantly increased (LR+ range for various outcomes = 0.98 to 1.40) or decreased (LR– range = 0.53 to 1.11) the risk of adverse outcomes. The test threshold for 3‐month functional decline based on the most accurate instrument was 42%, and the treatment threshold was 61%.
Conclusions
Risk stratification of geriatric adults following ED care is limited by the lack of pragmatic, accurate, and reliable instruments. Although absence of dependency reduces the risk of 1‐year mortality, no individual risk factor, frailty construct, or risk assessment instrument accurately predicts risk of adverse outcomes in older ED patients. Existing instruments designed to risk stratify older ED patients do not accurately distinguish high‐ or low‐risk subsets. Clinicians, educators, and policy‐makers should not use these instruments as valid predictors of post‐ED adverse outcomes. Future research to derive and validate feasible ED instruments to distinguish vulnerable elders should employ published decision instrument methods and examine the contributions of alternative variables, such as health literacy and dementia, which often remain clinically occult.
•We provide a method for generating theoretical clear sky performance for photovoltaic arrays using available models.•Using the ratio of actual power output to clear sky power output, we formulate a ...new clear-sky index.•This clear-sky index then allows for the power output from one site to be used to estimate another nearby site.
The rapidly growing installed base of distributed solar photovoltaic (PV) systems is causing increased interest in forecasting their power output. A key step towards this is accurately estimating the output from a PV system based on the known output from a nearby PV system. However, each PV system is unique with its own hardware configuration, orientation, shading, etc. Thus, the process of using the power output from one system to estimate the power output of another nearby system is not necessarily straightforward. In order to address these challenges, a modified clear-sky index for photovoltaics is proposed. This index is the ratio of the instantaneous PV power output to the instantaneous theoretical clear-sky power output derived from a clear-sky radiation model and PV system simulation routine. This definition performs better than previous clear-sky indices when both PV systems’ characteristics are known and the two PV systems have similar orientations. Through this index, the performance of a nearby PV system can be predicted quite accurately. This is demonstrated through the analysis of power output data from five residential PV systems in Canberra, Australia.
ABSTRACT
Background
Malnutrition is a potentially remediable condition that when untreated contributes to poor health and economic outcomes. While assessment of malnutrition risk is improving, its ...identification rate and economic burden in emergency departments (EDs) is largely unknown. We sought to determine prevalence and economic burden of diagnosed malnutrition among patients presenting to U.S. EDs.
Methods
This is a retrospective analysis of Healthcare Cost and Utilization Project Nationwide Emergency Department Sample data. Malnutrition prevalence was confirmed via International Classification of Diseases, 9th Edition, diagnosis codes. The economic burden was assessed by comparing probability of hospitalization and the average total charges between propensity‐score matched visits with and without a malnutrition diagnosis.
Results
Data from 238 million ED visits between 2006 and 2014 were analyzed. Over this period, the prevalence of diagnosed malnutrition increased for all demographic categories assessed. For older adults (≥65 years), the prevalence increased from 2.5% (2006) to 3.6% (2014). Older age, high‐income community residence, Western region, urban areas, and Medicare coverage were associated with higher diagnosis prevalence. Malnutrition diagnosis was associated with a 4.23 (95% confidence interval CI = 3.93 to 4.55) times higher odds of hospitalization and $21,892 higher mean total charges (95% CI = $19,593 to $24,192).
Conclusions
While malnutrition is currently diagnosed at a low rate in U.S. EDs, the economic burden of malnutrition is substantial in this care setting. Given the potential for systematic malnutrition screening and treatment protocols to alleviate this burden, future research is warranted.
The most widely used standard for mass-casualty triage, START, relies on a fixed-priority ordering among different classes of patients, and does not explicitly consider resource limitations or the ...changes in survival probabilities with respect to time. We construct a fluid model of patient triage in a mass-casualty incident that incorporates these factors and characterize its optimal policy. We use this characterization to obtain useful insights about the type of simple policies that have a good chance to perform well in practice, and we demonstrate how one could develop such a policy. Using a realistic simulation model and data from emergency medicine literature, we show that the policy we developed based on our fluid formulation outperforms START in all scenarios considered, sometimes substantially.
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