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This study proposes a novel time-varying, endogenous fiscal reaction function, and investigates whether and how the US government responded to the rising debt to assess the sustainability of its debt over 1916 to 2022. The reaction function is estimated via a state space model using Bayesian methods by treating its coefficient as an unobservable stochastic process. Although there is evidence that the government considered long-term projections of the interest rate in its fiscal decisions, the response to debt was largely driven by unobservable non-economic factors and by large and persistent shocks. We find that the government was more proactive about constraining debt increases during the 20th century than previously thought (such as in Bohn, 1998), but it has become less aggressive ever since. The debt-GDP ratio was sustainable for almost the entire sample period, but its steady state value has been rising consistently in recent years. The government’s response to debt contributed 6.0 percentage points to the surplus-GDP ratio in the postwar 20th century, but only 3.6 percentage points afterward.
The blood-milk barrier (BMB) forms at parturition when the gland switches form a non-lactating state to one of copious milk production and becomes leaky again when milk removal ceases and mammary involution is initiated. In this review the importance of the BMB in milk production and, in particular, its hormonal regulation is explored. Tight junctions (TJ) between adjacent mammary epithelial cells form a barrier to the two-directional paracellular movement of small molecules between the blood and milk and are responsible for establishing and maintaining the BMB. They form part of the cell's junctional complex and consist of transmembrane proteins that are linked to the mammary cell's cytoskeleton. This means that when, during lactation, TJ become “leaky” the resulting perturbation of the cytoskeleton interferes with the cell's secretory function. As such, TJ are involved in regulating and maintaining milk production. Mammary TJ are under hormonal control, with progesterone, glucocorticoids, prolactin, parathyroid hormone-related peptide (PTHrP) and serotonin (5-HT) being the key hormones. Progesterone prevents closure of TJ and the immediate prepartum drop in its concentration is a prerequisite for TJ closure. A simultaneous increase in the levels of glucocorticoids and prolactin is necessary for full TJ closure and initiation and maintenance of lactation. Both PTHrP and 5-HT are important hormones in maintaining extracellular calcium concentrations, a requirement for maintaining TJ integrity. Whereas PTHrP reduces TJ permeability, necessary for establishing and maintaining milk production, 5-HT has an opening effect on TJ. The latter may help speed up mammary involution and facilitate the movement of immune factors into the gland, preventing intramammary infections. In summary, mammary TJ make up the BMB and play a role in establishing and maintaining milk production and are under hormonal control, with progesterone, glucocorticoids, PTHrP and 5-HT being key regulatory hormones and prolactin likely playing a supporting role.
To examine the knowledge, experience and attitudes of nurses working in nursing homes in relation to the administration of antipsychotic medications to individuals diagnosed with behavioural and psychological symptoms of dementia (BPSD).
Methods:
Questionnaires comprising 17 questions were distributed to 120 nurses working in nursing homes to evaluate their knowledge of and attitudes to the utilisation of antipsychotic medication for BPSD.
Results:
Of the 70 nurses who completed the study questionnaire, 68 (97.1%) were confident with their knowledge of managing BPSD symptoms in dementia patients; 49 (70.0%) stated that antipsychotic medications were associated with a noticeable improvement in BPSD symptoms (n = 49, 70.0%) and were mostly commenced at an appropriate stage of the patients illness (n = 47, 67.1%). Music therapy was the most commonly noted (58.6% of nurses) utilised alternative therapy, although only 46% nursing staff reported that there were sufficient alternative therapies available. Qualitative themes of note included the importance of communication between nursing staff, health professionals and family members and an ongoing requirement for training nursing staff regarding antipsychotic prescribing and dispensing in BPSD.
Conclusions:
Nurses working in nursing homes demonstrated confidence in their knowledge of treatment strategies in managing BPSD in dementia patients. However, concerns were expressed regarding the limited availability of non-pharmacological interventions.
This article examines the theology of Katherine Parr, sixth and surviving wife of Henry VIII, through a close reading of her mature work, The Lamentation of a Sinner. In particular, I treat Parr’s theological use of the epistle to the Romans to inform and structure her doctrine of the work of Christ within The Lamentation. I argue that Parr follows the structure of Romans in her opening lament over sin, her central discussion of the cross of Christ, and her application of this theology to the Christian lives of the people of England’s church. I also posit Parr’s use of several overlapping motifs for Christ’s work within The Lamentation’s treatment of the atonement and its relationship to the Protestant understanding of justification by faith.
Right ventricular dysfunction is a common complication after surgical correction of tetralogy of Fallot. The assessment of right ventricular systolic function using cardiac magnetic resonance is the gold method. Our study aimed to compare the diagnostic accuracy of echocardiographic parameters in identifying right ventricular systolic dysfunction in comparison to cardiac magnetic resonance in children with repaired tetralogy of Fallot.
Patients and methods:
Fifty-six patients with corrected tetralogy of Fallot were included in the study. Right ventricular fractional area change, Tricuspid annular plane systolic excursion, right ventricular peak systolic tricuspid annular velocity, two-dimensional right ventricular global longitudinal strain, and two-dimensional right ventricular free wall strain were measured using echocardiography. Right ventricular ejection fraction and pulmonary regurgitant fraction were assessed using cardiac magnetic resonance.
Results:
Twenty (35.7%) patients showed right ventricular systolic dysfunction using cardiac magnetic resonance-derived right ventricular ejection fraction%, while 36 patients had normal right ventricular systolic function. Patients with right ventricular systolic dysfunction had significantly lower right ventricular fractional area change, tricuspid annular plane systolic excursion, right ventricular S’, 2D-right ventricular global longitudinal strain, 2D-right ventricular free wall strain compared to those with normal right ventricular systolic function. Right ventricular ejection fraction% was directly correlated to tricuspid annular plane systolic excursion, right ventricular fractional area change, right ventricular S’, 2D-right ventricular global longitudinal strain, and 2D-right ventricular free wall strain. Receiver operating characteristic curve revealed that 2D-right ventricular free wall strain and 2D-right ventricular global longitudinal strain had 70% sensitivity, 94.4% specificity, and 85% predictive accuracy, while right ventricular S’ and RV fractional area change had 100 % sensitivity in detection of right ventricular dysfunction, but they showed lower specificity, 30.6% and 52.8% respectively.
Conclusion:
2D-right ventricular global longitudinal strain and 2D-right ventricular FWL have good diagnostic value for right ventricular systolic dysfunction comparable to cardiac magnetic resonance in children with repaired tetralogy of Fallot.
The aim of this Research Communication was to develop new flow cytometric tools for the fine identification and characterization of milk somatic cells in water buffalo (Bubalus bubalis). Four multicolour panels of antibodies were designed to identify different subsets of live leukocytes and epithelial cells in bulk milk samples. Panel 1, including the CD18/CD172a/CD14/CD16 markers and Live/Dead vitality dye, allowed us to identify total lymphocytes, polymorphonuclear neutrophils (PMN) and monocyte/macrophage subsets. Panel 2 (CD18/CD4/CD8/δ chain/CD335 and Live/Dead dye) allowed us to identify T helper (CD4+), T cytotoxic (CD8+), γδ lymphocytes and NK cells. Panel 3 (CD18/CD79a/CD21 and Live/Dead dye) allowed us to identify total and CD21+ B lymphocytes. Finally, with Panel 4 (CD18/MHC-I/pan Cytokeratin and Live/Dead dye) the epithelial cells were distinguished from leukocytes. In conclusion, we propose a fine characterization of live milk somatic cell (live differential cell count (LDCC)) in buffalo species. In the future the determination of LDCC could used to identify new markers for detecting early inflammatory states of the mammary gland or for monitoring the technological properties of milks of different somatic cell composition.
On January 20, 2025, President Donald Trump issued a presidential memorandum that mandated all federal employees return to in-person work full time. Implementation guidance from the Office of Personnel Management (OPM) required rapid policy revisions. The order marks a sharp departure from prior federal telework policies, including longstanding efforts to expand flexible work as a tool for recruitment, retention, productivity, and inclusion. Contrary to claims that in-person work boosts efficiency, research shows remote work generally has no adverse impact on productivity and supports performance in both public and private sectors. The return-to-office mandate is likely to lead to turnover, particularly among highly skilled workers, creating risks of brain drain and diminished capacity to compete with the private sector for talent. It also threatens diversity, equity, and inclusion (DEI) efforts by disproportionately burdening women, caregivers, individuals with disabilities, workers of color, and LGBTQ+ employees. These changes, alongside parallel executive actions undermining DEI programs, reflect a broader return to traditional, centralized models of work built on outdated “ideal worker” norms. These changes have the potential to negatively reshape federal employment for years to come.
On what basis may the International Criminal Court (“ICC”) exercise its jurisdiction over States that have withdrawn from the Rome Statute? Is it enough that the alleged crimes occurred before the State withdrew from the treaty? When acting proprio motu, does the Prosecutor have to seek authorization from a Pre-Trial Chamber before they are allowed to proceed with the criminal investigation post-State withdrawal? This issue has received only cursory attention from the ICC and the academic community but the lack of clarity around the Court’s post-withdrawal jurisdiction is a serious concern, and not only for States that have withdrawn their membership (such as the Philippines). It is important because, as things stand, and given what the Court has said so far, States parties cannot be sure of the parameters of the Court’s temporal jurisdiction, nor of the legal effects of a State’s withdrawal.
Although unconditional cash transfers (UCTs) were an important government intervention during the COVID-19 crisis worldwide, research covering UCTs’ impact on compliance with public health recommendations, at an individual level, remains limited to low-income countries. This study assesses the association between UCTs’ reception and compliance with public health recommendations in the United States. Longitudinal data from the Understanding Coronavirus in America panel are applied to difference-in-differences models to estimate how Economic Impact Payments’ reception, associated with the CARES Act 2020, impacted a variety of pandemic health behaviours. UCTs’ reception was associated with increased uptake of explicitly costly health behaviours, such as facemasks, but not with increased compliance amongst behaviours more generally. Moreover, results document stronger effects amongst poorer households. These findings have theoretical implications for how government transfers impact individual behaviour during periods of crisis and for the direction of future research.
Consistent uptake and implementation of evidence-based CBT (EB-CBT) in clinical practice remains challenging. Understanding key barriers and facilitators experienced by CBT therapists is essential for developing effective implementation strategies to enhance adoption of EB-CBT practices. This study applies the Capability, Opportunity, Motivation-Behaviour (COM-B) and Theoretical Domains Framework (TDF) to provide a theoretically driven exploration of perceived barriers and facilitators to implementing EB-CBT reported by CBT therapists. A cross-sectional survey design incorporating qualitative open-ended questions was used to gather in-depth insights from 228 UK-based CBT therapists. Data were analysed using reflexive thematic analysis. Inductive analysis identified ten barriers and eight facilitators, which were deductively mapped onto the COM-B and TDF to identify key determinants affecting practice at the individual therapist or broader organisational level. At the therapist level, barriers identified were understanding of evidence-based decision making, scepticism about EB-CBT as being rigid, based on flawed evidence, and lacking client centredness, and a preference for intuitive eclecticism. Therapist facilitators included skills in research literacy and formulation, guided self-reflection as a behaviour regulation strategy, and reinforcement through positive outcomes. Organisational barriers were limited or complex research/guidelines, difficulty accessing knowledge, lack of training/supervision, and service constraints. Organisational facilitators consisted of external monitoring as a behavioural regulation strategy, fostering communities of practice, gaining knowledge through resources, and access to training/supervision. Key perceptions as well as misconceptions around using EB-CBT in practice were identified, highlighting the need for multi-level strategies addressing both individual and organisational factors to enhance therapists’ capability, motivation, and opportunity to adopt EB-CBT practices.
Key learning aims
As a result of reading this paper, readers should:
(1) Understand the key barriers UK therapists perceive as hindering the implementation of evidence-based CBT practices.
(2) Understand the key factors UK therapists perceive as facilitating and enhancing the implementation evidence-based CBT practices.
(3) Be able to use the COM-B and TDF model to map key determinants affecting adoption of evidence-based CBT practice at both the individual therapist and broader organisational level.
(4) Consider theoretically driven implementation interventions which could be used to target identified individual and organisational factors to improve sustained adoption of EB-CBT.
This study longitudinally examined associations between parent and peer relationships, childhood maltreatment, and adolescents’ psychopathology. We expected lower perceived parental relationship quality to predict greater symptomatology and higher perceived friendship quality to buffer this association, with greater buffering effects for maltreated participants. We assessed 545 participants (295 maltreated, 250 non-maltreated; 60.2% male; 52.8% Black, 27.5% White, 12.8% Bi-racial, 13.4% Latin@) across two timepoints (Wave 1, Mage = 13.8 years, Wave 2,Mage = 16.2 years). Department of Human Services records indicated maltreatment status prior to Wave 1. Adolescents self-reported Wave 1 parental relationship and friendship quality and Wave 2 internalizing/externalizing symptoms. Parental relationship quality did not predict psychopathology, and this association did not differ by maltreatment status. We found a significant three-way interaction between maternal relationship quality, maltreatment, and friendship quality on internalizing (β = .10, p = .037) and externalizing (β = .12, p = .010) symptoms. For non-maltreated adolescents, parental relationships and friendship quality differentially predicted symptomatology. Maltreated adolescents with low maternal relationship and friendship quality exhibited the most symptoms, whereas those with low maternal relationship quality and high friendship quality exhibited the least. Findings invite inquiry into parent and peer relationships’ differential roles in adolescents’ psychopathology.
This study examined three neurocognitive patterns or “clinical pearls” historically viewed as evidence for executive dysfunction in Parkinson disease (PD): 1) letter < category fluency; 2) word list < story delayed recall; 3) word list delayed recall < recognition. The association between intraindividual magnitudes of each neuropsychological pattern and individual performance on traditional executive function tests was examined.
Methods:
A clinical sample of 772 individuals with PD underwent neuropsychological testing including tests of verbal fluency, word list/story recall, recognition memory, and executive function. Raw scores were demographically normed (Heaton) and converted to z-scores for group-level analyses.
Results:
Letter fluency performance was worse than category fluency (d = −0.12), with 28% of participants showing a discrepancy of ≥ −1.0 SD. Delayed recall of a list was markedly poorer than story recall (d = −0.86), with 52% of the sample exhibiting ≥ −1.0 SD deficits. Lastly, delayed free recall was worse than recognition memory (d = −0.25), with 24% showing a discrepancy of ≥ −1.0 SD. These patterns did not consistently correlate with executive function scores. The word list < story recall pattern was more common in earlier than later PD stages and durations.
Conclusion:
Among the three pearls, the most pronounced was stronger memory performance on story recall than word lists, observed in more than half the sample. Only ¼ the participants exhibited all three neurocognitive patterns simultaneously. The variability in patterns across individuals highlights the heterogeneity of cognitive impairment in PD and suggests that intra-individual comparisons may offer a more nuanced insight into cognitive functioning.
Our aim is to illuminate the persistent problem of evidence in cases of sexual violence in conflict zones by investigating the relationship between archival practices and processes of legal redress. This special issue consists of six essays, with contributors drawn from the disciplines of history and law. In temporal terms, the cases range from the seventeenth century to the late twentieth century; spatially, they address conflicts in Africa, Asia, Europe, and the United States. The case studies each offer an overview of “their archive,” explain its creation and limitations, and address its political logic and uses. As we interrogate archives, where evidence of sexual violence is located, it is critical that we note three things. First, to understand the nature and political construction of the archive. Second, to use this insight to interpret and assess the nexus of power relations within which historical and contemporary actors operate. Finally, to remember the inescapable limits of the evidence that shape the pursuit of justice, past or present.
Despite recent attention to the increased risk of cognitive impairment in older adults with essential tremor (ET), there are only limited data on the trajectories of cognitive change in ET or the demographic and motor predictors of such change.
Method:
This study included 148 cognitively normal individuals with ET (mean age = 76.7 ± 9.7 years) at baseline and had at least one follow-up evaluation (mean years of observation = 5.2 ± 1.6). Generalized Estimating Equations examined rates of change in six composite cognitive outcomes as a function of time, as well as demographic (age, sex, and education) and motor predictors (tremor severity, age of tremor onset, presence of rest tremor, cranial tremor, intention tremor, tandem gait) of rates of change. Demographics, medication use, and mood symptoms at baseline were covariates for all models.
Results:
Participants evidenced a decline in global cognition, executive function, and attention (prange = <0.001–0.044) over time. Older age predicted faster decline in all cognitive outcomes except attention (prange=<0.001–0.025). Tremor severity predicted faster decline in executive function (p = 0.011). Rest tremor predicted faster decline in executive function and attention (p = 0.033, 0.017). Tandem gait missteps predicted faster decline in memory and visuospatial ability (p = 0.026, 0.028).
Conclusions:
Results point to a dissociation in the predictive value of different motor features for specific aspects of cognitive decline. These results shed light on the earliest manifestations of cognitive impairment in older adults with ET and implicate different pathways by which heterogeneous cognitive changes emerge.
We report a rare case of a 3-month-old male infant with Down syndrome, severe pulmonary arterial hypertension (a large patent ductus arteriosus, an atrial septal defect, and a giant hepatic arteriovenous malformation). Initial treatment involved hepatic arteriovenous malformation embolisation using 17 Azur® CX Peripheral Coils, resulting in clinical improvement. However, persistent pulmonary arterial hypertension led to patent ductus arteriosus closure using an 8-mm Lifetech Cera™ vascular plug after a successful balloon occlusion test. Post-intervention, the patient showed symptomatic relief, reduced right ventricular overload, and atrial septal defect shunting shifted to left to right. This is the first reported paediatric case combining these features successfully managed through a multidisciplinary and stepwise treatment approach, eliminating the need for liver transplantation.