Research Note: Intergenerational Transmission Is Not Sufficient for Positive Long-Term Population Growth.

All leading long-term global population projections agree on continuing fertility decline, resulting in a rate of population size growth that will continue to decline toward zero and would eventually turn negative. However, scholarly and popular arguments have suggested that because fertility transmits intergenerationally (i.e., higher fertility parents tend to have higher fertility children) and is heterogeneous within a population, long-term population growth must eventually be positive, as high-fertility groups come to dominate the population. In this research note, we show that intergenerational transmission of fertility is not sufficient for positive long-term population growth, for empirical and theoretical reasons. First, because transmission is imperfect, the combination of transmission rates and fertility rates may be quantitatively insufficient for long-term population growth: higher fertility parents may nevertheless produce too few children who retain higher fertility preferences. Second, today even higher fertility subpopulations show declining fertility rates, which may eventually fall below replacement (and in some populations already are). Therefore, although different models of fertility transmission across generations reach different conclusions, depopulation is likely under any model if, in the future, even higher fertility subpopulations prefer and achieve below-replacement fertility. These results highlight the plausibility of long-term global depopulation and the importance of understanding the possible consequences of depopulation.

Disability Affirmative Action Requirements for the U.S. HHS and Academic Medical Centers.

Medical professionals exert enormous influence over the lives of persons with disabilities by providing medical care and by generating medical research and medical information about them that form the basis for policies and practices that affect their everyday lives. Yet persons with disabilities remain substantially underrepresented within the U.S. Department of Health and Human Services' workforce, among academic medical centers' employees, and in the health professions. The U.S. HHS and academic medical centers appear to be noncompliant with their obligations to engage in disability affirmative action under sections 501 and 503 of the Rehabilitation Act. This essay describes these requirements and contrasts them with medical leaders' "well-being" agendas. It also describes ongoing medical research on "burnout" being conducted on medical employees and further enabled through the Dr. Lorna Breen Health Care Provider Protection Act. The essay calls for a wholesale change in approaches to persons with disabilities within the health and medical professions.

Estimating consumer preferences for different beverages using the BLP approach.

The overconsumption of sugar is a significant problem in many jurisdictions, and one possible method to remedy this problem is the taxation of sugar-sweetened beverages (SSBs). To be able to implement an optimal tax, it is important to know the preferences and price sensitivity of consumers. This article therefore estimates the price elasticity of demand for different beverages in Quebec, using the Berry, Levinsohn and Pakes (BLP) random parameter logistic demand model, combined with Nielsen data from 2010 to 2016 and the 2016 Canadian Census. The results suggest that the average consumer prefers high-calorie beverages containing fruits and vegetables, and the estimated price elasticities are between -4.40 (energy drinks) and -1.59 (regular soft drinks). As a result, consumers of energy drinks appear to reduce their consumption the most in the face of rising prices, whereas consumers of soft drinks will decrease their consumption the least. However, at a general level, the implementation of a tax on SSBs in Quebec should generate a significant reduction in consumption.

Those who can't sort, steal: caste, occupational mobility, and rent-seeking in rural India.

Three important features of Indian labor markets enduringly coexist: rent-seeking, occupational immobility, and caste. These facts are puzzling, given theories that predict static, equilibrium social inequality without conflict. Our model explains these facts as an equilibrium outcome. Some people switch caste-associated occupations for an easier source of rents, rather than for productivity. This undermines trust between castes and shuts down occupational mobility, which further encourages rent-seeking due to an inability of workers to sort into occupations. We motivate our contribution with novel stylized facts exploiting a unique survey question on casteism in India, which we show is associated with rent-seeking.

Physician Burnout and the Americans with Disabilities Act.

The writer responds to the commentary "Physician Burnout Calls for Legal Intervention," by Sharona Hoffman, in the November-December 2019 issue of the Hastings Center Report.

How is "stigma" conceived within the biomedical literature on trainee wellness? A directed content analysis.

This article was migrated. The article was marked as recommended. Introduction: Institutional discrimination against trainees with suspected mental disorders has rarely been the focus of medical education research. This study explored whether such neglect might be related to the way in which stigma is conceived by academic medical researchers, and was informed by previous scholarship describing the disability models and stigma agendas believed to predominate within the medical field. The aim was to examine whether researchers might be focusing solely on the ways in which stigma prevents trainees from seeking mental health treatment, while neglecting to address mental health discrimination, as predicted by these scholars' descriptions. Methods: The authors searched PubMed and Medline for articles using combined terms wellness or wellbeing; medical student or resident or physician; and stigma and mental, published between September 12, 2011 and September 12, 2016. Directed content analysis of articles with a primary focus on mental health wellness provided counts of the words discrimination and treatment and evaluated authors' recommendations to either reduce discrimination or increase identification and mental health treatment. Results: Of the 25 articles meeting inclusion criteria, 23 used the word treatment (median = 7), while only 7 mentioned discrimination (median = 0). The authors of at least 20 articles recommended identification and treatment, but none provided any recommendations to reduce institutional discrimination. Three surveys also identified concerns about mental health discrimination that were not taken seriously by the authors of these studies. Conclusions: Current trainee wellness research appears to have largely ignored mental health discrimination as a negative influence. Such findings appear consistent with prior descriptions of a medical model of disability/services agenda to reducing stigma that has been criticized by proponents of a social model/rights agenda. Wellness researchers should take steps to reduce mental health discrimination against trainees and consider limitations of current conceptions of stigma within the medical field.

In-flight spatial disorientation induces roll reversal errors when using the attitude indicator.

We hypothesized that an incorrect expectation due to spatial disorientation may induce roll reversal errors. To test this, an in-flight experiment was performed, in which forty non-pilots rolled wings level after receiving motion cues. A No-leans condition (subthreshold motion to a bank angle) was included, as well as a Leans-opposite condition (leans cues, opposite to the bank angle) and a Leans-level condition (leans cues, but level flight). The presence of leans cues led to an increase of the roll reversal error (RRE) rate by a factor of 2.6. There was no significant difference between the Leans-opposite and Leans-level condition. This suggests that the expectation strongly affects the occurrence of an RRE, and that people tend to base their responses on motion cues instead of on information on the AI. We conclude that expectation and spatial disorientation have a large effect on piloting errors and may cause hazardous aircraft upsets.

Optimal Population and Exhaustible Resource Constraints.

A large literature considers the optimal size and growth rate of the human population, trading off the utility value of additional people with the costs of a larger population. In this literature, an important parameter is the social weight placed on population size; a standard result is that a planner with a larger weight on population chooses larger population levels and growth rates. We demonstrate that this result is conditionally overturned when an exhaustible resource constraint is introduced: if the discount rate is small enough, the optimal population today decreases with the welfare weight on population size. That is, a more total-utilitarian social planner could prefer a smaller population today than a more average-utilitarian social planner. We also present a numerical illustration applied to the case of climate change, where we show that under plausible real-world parameter values, our result matters for the direction and magnitude of optimal population policy.

How broad are state physician health program descriptions of physician impairment?

BACKGROUND: Physician health program websites in 23 states provide many descriptions of possible physician impairment. This study sought to determine whether these descriptions are so broad that almost everyone might potentially be suspected of being impaired given these descriptions. METHODS: The authors randomly selected 25 descriptions of impairment and then presented them anonymously online to members of the general population in full-time employment through Amazon's Mechanical Turk (N = 199). Half of the respondents randomly received a narrowly worded version, and half received a broadly worded version of the survey questions. RESULTS: In the narrowly worded version of the survey, 70.9% of respondents endorsed at least one description of impairment, and 59.2% endorsed more than one. In the broadly phrased version, 96.9% endorsed at least one description, and 95.8% endorsed more than one. These respondents endorsed a median of 10 out of 25 (40%) descriptions. CONCLUSIONS: These findings call into question whether these descriptions really identify persons with poor performance or who pose a high risk of substantial, imminent harm to self or others in the workplace. They also demonstrate the extent to which these descriptions could potentially be misapplied and brand almost anyone as impaired.

Do state physician health programs encourage referrals that violate the Americans with Disabilities Act?

The websites of many physician health programs provide lists describing signs of impairment or indications to refer physician-employees for evaluation and possible treatment. This study aimed (1) to determine how many of these descriptions likely provide physicians' employers with sufficient evidence to legally request mental health examinations under the general regulations of the Americans with Disabilities Act (ADA); and (2) to find out who they described. The authors applied US Equal Employment Opportunity Commission guidance documents and sought expert legal advice to evaluate the descriptions for their consistency with the ADA. They used directed content analysis to review and code these descriptions into categories. Very few, if any, of the 571 descriptions appeared to provide sufficient evidence for employers to request an examination under the ADA. About 14%, however, could refer to physicians attempting to defend themselves, assert their ADA rights, or otherwise complain about the hospital; and 27% either described physicians who complain or else had discriminatory effects in one of several different ways. Leaders within the medical field should ensure that their policies and state laws pertaining to physician impairment comply with and incorporate the language of the ADA. They should also reevaluate the functions of these policies, laws, and physician health programs, and the implications for patient safety, physician wellness, suicide, and other important issues.

Among the Severely Mentally Ill, Who Responds to Ziprasidone?

So far, demographic variables have not consistently been found to predict clinical response to antipsychotics. This study examines some differences in response to ziprasidone, which has been shown to be effective, with a better metabolic side effect profile, but was little used in New York State Hospitals. The aim was to study state hospital patients switched to ziprasidone. The results led to questions about different responses in different groups. Subjects from state hospitals who needed a change of antipsychotic participated in this open-label, 8-week trial of up to 240-mg ziprasidone. Analyses included comparisons of the very different results from two sites. Of the 36 study subjects, 12 terminated early. The 17 outpatients from Buffalo, who were older and on lower doses of antipsychotics pre-study, improved significantly. The 19 inpatients from the Bronx, overall younger and on higher pre-study doses, barely changed. Improvements in PANSS total score were significantly associated with older age, greater baseline severity, and lower doses of antipsychotics pre-study. The subjects improved on metabolic parameters. The results suggest that ziprasidone may be just as effective as previous antipsychotics taken by these severely mentally ill patients, and with fewer metabolic side effects. Note: The study described here includes a dosage of ziprasidone that has not been approved by the U.S. Food and Drug Administration (FDA). The FDA has approved daily doses of ziprasidone no greater than 100 mg PO bid.

Digital particle image velocimetry measurements of the downwash distribution of a desert locust Schistocerca gregaria.

Actuator disc models of insect flight are concerned solely with the rate of momentum transfer to the air that passes through the disc. These simple models assume that an even pressure is applied across the disc, resulting in a uniform downwash distribution. However, a correction factor, k, is often included to correct for the difference in efficiency between the assumed even downwash distribution, and the real downwash distribution. In the absence of any empirical measurements of the downwash distribution behind a real insect, the values of k used in the literature have been necessarily speculative. Direct measurement of this efficiency factor is now possible, and could be used to compare the relative efficiencies of insect flight across the Class. Here, we use Digital Particle Image Velocimetry to measure the instantaneous downwash distribution, mid-downstroke, of a tethered desert locust (Schistocerca gregaria). By integrating the downwash distribution, we are thereby able to provide the first direct empirical measurement of k for an insect. The measured value of k = 1.12 corresponds reasonably well with that predicted by previous theoretical studies.