No abstract

Interest rates in many advanced economies have been low for almost a decade now and are often expected to remain so. This creates challenges for banks. Using a sample of 3,385 banks from 47 countries from 2005 to 2013, we find that a one percentage point interest rate drop implies an 8 basis points lower net interest margin, with this effect greater (20 basis points) at low rates. Low rates also adversely affect bank profitability, but with more variation. And for each additional year of "low for long", margins and profitability fall by another 9 and 6 basis points, respectively.

ObjectiveTo evaluate the clinical effectiveness of two modes of cognitive–behavioural therapy (CBT) for IBS compared with treatment as usual (TAU) in refractory IBS.DesignA three-arm randomised controlled trial assessing telephone-delivered CBT (TCBT), web-based CBT (WCBT) with minimal therapist support, and TAU. Blinding participants and therapists was not possible. Chief investigator, assessors and statisticians were blinded. Participants were adults with refractory IBS (clinically significant symptoms for ≥12 months despite first-line therapies), recruited by letter and opportunistically from 74 general practices and three gastroenterology centres in London and South of England between May 2014 to March 2016. Co-primary outcomes were IBS Symptom Severity Score (IBS-SSS) and Work and Social Adjustment Scale (WSAS) at 12 months.Results558/1452 (38.4%) patients screened for eligibility were randomised: 76% female: 91% white: mean age 43 years. (391/558) 70.1% completed 12 months of follow-up. Primary outcomes: Compared with TAU (IBS-SSS 205.6 at 12 months), IBS-SSS was 61.6 (95% CI 33.8 to 89.5) points lower (p<0.001) in TCBT and 35.2 (95% CI 12.6 to 57.8) points lower (p=0.002) in WCBT at 12 months. Compared with TAU (WSAS score 10.8 at 12 months) WSAS was 3.5 (95% CI 1.9 to 5.1) points lower (p<0.001) in TCBT and 3.0 (95% CI 1.3 to 4.6) points lower (p=0.001) in WCBT. All secondary outcomes showed significantly greater improvement (p≤0.002) in CBT arms compared with TAU. There were no serious adverse reactions to treatment.ConclusionBoth CBT interventions were superior to TAU up to 12 months of follow-up.Trial registration numberISRCTN44427879.

The uropathogenic bacterium Proteus mirabilis displays a form of multicellular behavior called swarming, in which typical vegetative rods differentiate into long hyperflagellate swarm cells that undergo rapid and coordinated population migration across surfaces. Such behavior might inherently assist ascending colonization of the urinary tract, and it has also been shown that swarming differentiation in vitro is central to the expression of conventional virulence factors. This study provides support for a role of swarming in vivo. Mortality rates of mice inoculated intravenously with 2.5 x 10(8) vegetative cells were lower than rates for those inoculated with wild type strains in the case of motile transposon mutants either completely unable to swarm (< 1%) or able to undergo only aberrant swarming migration (< 40%, P < .001). Histologic analysis of renal tissues from mice infected by wild type Proteus strains showed that long differentiated cells were the major cell type, whereas the extracellular inflammatory exudate contained primarily short vegetative cells. Following intravesical (bladder) inoculation with 2.0 x 10(7) vegetative cells, kidney infection was not established by any of the three motile swarm-defective mutants; indeed, the nonswarming mutant was not retained in the bladder. In contrast, the wild type strain and a normally swarming but nonhemolytic mutant achieved a high incidence of ascending infection to the kidney.