Baseline Estimates Research Articles

P1011 Correlations of clinical characteristics and serum proteins with drug levels: A multicentre cohort study of patients with inflammatory bowel disease starting biologics

Abstract Background Inter-individual differences in drug clearance are common in inflammatory bowel disease (IBD) patients treated with biologics. Associations between inflammatory markers, clinical features, and drug levels may indicate that the inflammatory immune response influences the pharmacokinetics of biologics. We assessed the impact of inflammatory and immunity-related proteins on drug levels in IBD. Methods Serum samples from 144 IBD patients initiating biologics in a prospective multicentre cohort were analysed using AFIAS-3 (Boditech Med Inc. Korea). The primary outcome was drug levels after the end of induction treatment (post-induction), analysed as continuous variables or categorised into high or low groups based on the median. Correlations were assessed using the Pearson’s correlation coefficients with false discovery rate (FDR) adjustment. Predictive capacity of clinical and protein data was evaluated with regularised linear regression models. Analyses were stratified by treatment (infliximab, adalimumab, vedolizumab) and diagnosis (Crohn’s disease (CD), ulcerative colitis (UC)). Results Patient demographics and clinical characteristics are provided in Table 1. Median (interquartile range, IQR) post-induction infliximab levels were 5.3 (2.2-9.5) µg/ml in patients with CD (n=34) and 3.8 (1.7-5.6) µg/ml in UC (n=33). The corresponding levels were 12.5 (7.0-16.1) µg/ml (n=36) and 8.8 (5.7-12.7) µg/ml (n=13) for adalimumab, 13.9 (6.4-24.4) µg/ml (n=19) and 17.7 (9.8-22.6) µg/ml (n=9) for vedolizumab. Principal component analyses revealed potential baseline protein profile differences between patients with high vs low post-induction levels for infliximab (p=0.09) and adalimumab (p=0.07) in CD, but no differences for vedolizumab (p=0.78) or UC. Individual protein analyses indicated that patients with higher drug levels post-induction seemed to display lower baseline estimates of inflammatory proteins compared to those with lower drug levels. However, statistical significance after correction for multiple comparisons was only observed for CDCP1 in adalimumab-treated CD patients (PFDR=0.04) (Figure 1). Additionally, baseline Flt31 (r=-0.57, PFDR=0.03) and Wisp1 (r=-0.61, PFDR=0.02) correlated with post-induction s-adalimumab levels in CD, while Mcp3 (r=-0.89, PFDR=0.04) and Frgamma (r=-0.87, PFDR=0.05) correlated in UC. Integrating baseline protein data in prediction models for post-induction drug levels did not improve their accuracy compared to models based on only clinical and biochemical variables. Conclusion Inflammatory protein levels may influence post-induction drug levels in IBD, particularly in adalimumab treated CD patients. This insight could aid in optimising personalised treatment.

Baseline Estimates for Companion Animals Living in Households in Hawai'i: Associated Socio-Demographic, and Select Health Variables, as Measured by a Household Survey.

Information on companion animals in Hawai'i is lacking. The Hawai'i Department of Health's Hawai'i Health Survey, collected data on adults and households by telephone interview. National estimates of companion animals range from 50-67%. However, the estimate from Hawai'i was lower with 39% of households in Hawai'i having a companion animal that spends part or all of the day indoors, including 29.5% of households with dogs and 14.7% with cats. There may be multiple reasons the count is lower for Hawai'i and possible factors are identified. There were significant differences in companion animals by ethnicity with Whites having the highest percentage of cats (25.8%) and Japanese the highest percentage of dogs (33.8%). Differences were observed between Asian ethnicities and Native Hawaiians. Specifically, individuals of Japanese ethnicity were more likely to have dogs, while Native Hawaiians were more likely to have cats compared to other Asian and Other Pacific Island ethnicities. Furthermore, companion animals were associated with counties other than Honolulu, lower poverty, ownership of a car or home, women, education, and middle-aged adults. Thus, many households in Hawai'i may not have the resources for a companion animal. Adults who rated their general health excellent had the highest association with having a cat(s). Asthma was higher for women living with dogs than women without cats or dogs. Asthma was lowest for men with cats compared to other groups for men and women. This study contributes to the understanding of complex interrelationships of humans, animals, and their environment which is gaining momentum under the umbrella of "One Health" by supporting increased collaboration and new data sources.

Caries Impacts and Experiences and Dental Care Utilization for Saudi Schoolchildren: Caries Impacts and Experiences Questionnaire for Children – A Disease-Specific Measure

Introduction: The Caries Impacts and Experiences Questionnaire for Children (CARIES-QC) is a disease-specific questionnaire that assesses the impact of caries on the oral health-related quality of life of children. This study aimed to establish a baseline for caries-specific impact on schoolchildren in Saudi Arabia and to examine its association with dental care utilization. Methods: This cross-sectional study used random stratified cluster sampling among 4th–6th graders in Jeddah. Two surveys were administered: (1) a general parental survey and (2) CARIES-QC, a self-reported survey for children. Clinical examinations were conducted using the decayed, missing due to caries, and filled teeth (DMFT/dmft) index. Descriptive statistics provided CARIES-QC baseline estimates, and multilevel linear regression was performed to examine the relationships between CARIES-QC scores, DMFT/dmft index, and care utilization. Results: A total of 805 children aged 8–13 years participated. The overall median CARIES-QC score was six (interquartile range, 3–11). A higher DMFT/dmft index was associated with a higher CARIES-QC score (p < 0.05). Children who had never visited a dentist had lower CARIES-QC scores (β = −1.18, 95% confidence interval: −2.33; −0.02, p = 0.045) than those who had visited a dentist in the past 12 months. After adjusting for reasons for dental visits, the CARIES-QC scores were not associated with prior dental visits (p = 0.086). Conclusion: A higher DMFT/dmft index was associated with higher CARIES-QC scores, but prior dental care utilization was not significantly associated with improved CARIES-QC scores. Future research should explore other factors that influence the relationship between care utilization and caries-specific quality of life.

Estimating an Elephant Population Size Through Local Ecological Knowledge.

In planning and monitoring measures to protect wildlife in an area, it is important to have a reliable baseline estimate of population size and trends. There has been minimal published information on a small population of elephants, a keystone and endangered species, in a large area west of Etosha National Park in Namibia, known locally as the Northern Highlands. It is a highly remote, mountainous area in which it is difficult to count elephants. It is semi-desert, where the protection of wildlife is at increasing risk from climate change events, and research on the elephant population is a priority. We interviewed 34 community game guards in the Northern Highlands, focusing on the number of elephants and distinguishing features in known groups. Based on the collated knowledge, and analysis to reduce double counting of known groups, we estimate that there are between 78 and 212 elephants in the Northern Highlands, with a best estimate of 128. The wide range is an indication of the current uncertainties in the method. However, we conclude that this low-cost method, if adapted based on lessons from this pilot study, would be applicable for longer-term ecological monitoring in areas that have a low population density.

The effect of health on the marginal utility of consumption: Evidence based on household consumption expenditure

This study uses broad-based measures of household consumption and a utility proxy to estimate the effect of health on the marginal utility of consumption, utilizing data from the Russia Longitudinal Monitoring Survey (1994–2019). To do so, I estimate how an observed within-individual utility change associated with a health shock varies across individuals of different consumption levels. The results indicate that the marginal utility of consumption increases as health deteriorates. Specifically, the baseline estimates show that moving from a healthy state to a poor health state raises the marginal utility of consumption by approximately 4 percentage points. In relative terms, a one-standard-deviation increase in poor health is associated with a proportional increase of 22.7% to 29.4% in the marginal utility of consumption relative to the marginal utility in a healthy state. These findings are primarily driven by the increased marginal utility of luxuries rather than necessities, suggesting that certain types of goods offer greater utility in poor health and play a crucial role in mitigating the adverse impacts of health shocks.

Relationships between Patient-Reported Outcomes and Predictors of Second ACL Injuries during Unanticipated Jump Landings.

Reactive and external visual-cognitive demands are prevalent in sport and likely contribute to ACL injury scenarios. However, these demands are absent in common return-to-sport assessments. This disconnect leaves a blind spot for determining when an athlete can return to sport with mitigated re-injury risk. PurposeTo characterize relationships between patient-reported outcome measures (PROMs) and cognitive-task interference (i.e., cognitive demands exacerbating neuromuscular impairments) for biomechanical predictors of second ACL injuries during jump landings that involved rapid unanticipated decision making. MethodsThirty-six persons following primary ACLR (26F/10M, 19.8±1.8 years; 1.71±0.1 m; 69.6±12.8 kg, 1.5±0.6 years post ACLR; Tegner: 6.8±1.8) participated. PROMs of ACL-RSI, and the Forgotten Joint Score-12 Knee (FJS-12) were selected to assess altered psychological state (e.g., confidence, attention toward knee). Jumping tasks under anticipated and unanticipated secondary jump directions were performed. Biomechanical variables were dual-task changes (unanticipated - anticipated) in 1) uninvolved limb hip rotator impulse (DTC_Uni-HRot_Imp), 2) asymmetry of knee extensor moment at initial contact (DTC_KEM_Asym), and 3) range of involved knee abduction angle (DTC_KAbA_Range). Regression models tested for relationships between PROMs and the dual-task change in biomechanical variables. Results: ACL-RSI (DTC_Uni-HRot_Imp (p < 0.001)) and FJS-12 (DTC_KAbA_Range (p = 0.001)) had significant relationships with dual-task change in the opposite direction as expected (worse PROM ➔ less dual-task change). A follow-up analysis indicated that dual-task change was inversely correlated with the baseline estimates for kinetic biomechanical variables (less risky single-task biomechanics ➔ greater dual-task change for Uni-HRot_Imp and KEM_Asym).Conclusions: The collective results are consistent with higher functioning participants (better PROMs) who also demonstrate desirable biomechanics during single-task conditions being prone to demonstrating the greatest risk-associated DTC in unanticipated scenarios.

DUS Topp-Leone-G Family of Distributions: Baseline Extension, Properties, Estimation, Simulation and Useful Applications.

This study introduces the DUS Topp-Leone family of distributions, a novel extension of the Topp-Leone distribution enhanced by the DUS transformer. We derive the cumulative distribution function (CDF) and probability density function (PDF), demonstrating the distribution's flexibility in modeling various lifetime phenomena. The DUS-TL exponential distribution was studied as a sub-model, with analytical and graphical evidence revealing that it exhibits a unique unimodal shape, along with fat-tail characteristics, making it suitable for time-to-event data analysis. We evaluate parameter estimation methods, revealing that non-Bayesian approaches, particularly Maximum Likelihood and Least Squares, outperform Bayesian techniques in terms of bias and root mean square error. Additionally, the distribution effectively models datasets with varying skewness and kurtosis values, as illustrated by its application to total factor productivity data across African countries and the mortality rate of people who injected drugs. Overall, the DUS Topp-Leone family represents a significant advancement in statistical modeling, offering robust tools for researchers in diverse fields.

Comparison of seven models for the progression patterns of multiple chronic conditions in longitudinal studies

IntroductionStudies investigating the relationship between patterns of multimorbidity and risk of a new condition have typically defined the patterns at a baseline time and used Kaplan-Meier (KM) or Cox proportional...

Ankle brachial index,a non invasive tool predicts cardiovascular events after acute myocardial infarction:a 3 year follow -up study

Abstract Background / Introduction The ankle-brachial index (ABI) is a non-invasive tool that was initially used for the diagnosis of lower-extremity peripheral artery disease (PAD). It has been proven that ABI is a marker of atherosclerosis in other vascular sites and can therefore be used to predict cardiovascular events regardless the presence or not of PAD symptoms. Purpose This study aims to examine the prognostic value of ABI in the setting of acute myocardial infarction (MI), as up till now there is not enough relevant evidence. Method We followed up 441 patients [79% male;mean age 62 years;67% hypertnesive; 30% with diabetes mellitus (DM); 52% current smokers] who were hospitalized because of MI for a period of three years. All patients underwent baseline estimation of clinical and laboratory parameters during theri hospitalization.The ABI was measured according to established methodology using a certified automated device and abnormal ABI defined as a value ≤ 0.9. The primary endpoint was a composite of all-cause and cardiovascular death, as well as major cardiovascular events including decompensated heart failure, new acute coronary syndrome, cerebrovascular event, malignant arrhythmia, PAD event and new onset renal dysfunction. All events were assessed both in-hospital and within 3 years of follow-up. Results Our study population had a mean ABI of 1.1 (IQR: 1.00 to 1.18). With the use of reduced multivariate regression models ABI was proven to be a prognostic indicator for the in-hospital composite endpoint. Patients with an abnormal ABI had a threefold risk of in-hospital events [HR 2.93, 95% CI: 1.48-5.81, p=0.002]. After conducting multivariate analysis ABI maintained its predictive power of all-cause mortality [HR 2.88, 95% CI: 1.53 – 5.42, p=0.001], regardless of hypertension DM, LDL levels and smoking status of the study population in 3 years follow-up. Conclusion An impaired ABI is associated with greater risk of in-hospital events in patients with acute MI. Moreover, ABI emerges as an independent predictor of long-term all-cause mortality in those patients.The findings of this study suggest that subclinical and clinical PAD are associated with poor outcomes among patients with acute MI; thus, routine ABI tests enhance risk stratification and might carry important prognostic significance in these patients regardless of PAD symptoms.

Morbidity and Mortality Following Surgery for Pancreatic Cancer in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis.

Measuring postoperative outcomes after complex cancer operations such as pancreatectomy is vital to improve cancer surgery in low- and middle-income countries (LMICs); however, such data is often limited. This study aimed to review existing research and obtain baseline estimates for postoperative mortality and morbidity after pancreatic cancer surgery in LMICs. PubMed, Embase, Web of Science Core Collection, and Global Index Medicus were systematically searched for original articles published between January 2005 and May 2022. LMICs based studies reporting postoperative mortality, morbidity, and/or length of stay of patients with primary pancreatic tumors undergoing pancreaticoduodenectomy and/or distal pancreatectomy were included. Of 18 344 unique titles and abstracts retrieved, 114 studies met the inclusion criteria. Of these, 51 "good" quality studies comprising 7528 patients were included in the meta-analyses. Pooled estimates for pancreatic fistula were 16.6% (95% CI 14.0-19.7, p < 0.001); 16.0% (95% CI 11.1-22.5, p < 0.001) for Clavien-Dindo grade 3 and 4 complications; 13.4% (95% CI 9.8-17.9, p < 0.001) for wound infection; and 4.4% (95% CI 3.3-5.7, p < 0.001) for postoperative mortality. This is the first systematic review and meta-analysis examining surgical complications after pancreatic surgery in LMICs. We highlight a lack of data and the need to further evaluate surgical outcomes in LMICs.

Governance, institutional quality and economic complexity in selected African countries

AbstractNew economic thinking speculates that the diversification and sophistication of economic capabilities/structures is key in explaining why African countries lag in development behind the rest of the world. We question the extent to which non-traditional growth factors such as governance and institutional quality are related to economic complexity for 35 African countries. We estimate panel GMM regressions using 8 different measures of governance/institutional quality for both linear and kinked regressions using annual data collected between 1996 and 2021. The baseline estimates reveal a positive linear relationship between most measures of governance and institutional quality and economic complexity. Our sensitivity analysis further show that institutions/governance have stronger relationship with economic complexity in the post-global financial crisis era. Moreover, nonlinear or kinked relationships emerge once the data is segregated into different income and resource abundant groups. Altogether, our findings of a nonlinear relationship between institutions/governance and economic complexity are novel to the literature and offer unique insights on how African policymakers can use governance/institutions for improving the complexity of production processes.

Housing instability increases for stimulant-involved overdose deaths after linking surveillance data to electronic health records in Kentucky

BackgroundAccording to the U.S. Centers for Disease Control and Prevention, approximately 10.2 % of fatal overdoses in 2022 were among people experiencing homelessness or housing instability. In the United States, the majority of all drug overdoses now involve stimulants. MethodsWe linked stimulant-involved fatal overdose records occurring between 2017 and 2021 from Kentucky’s Drug Overdose Fatality Surveillance System to the electronic health records (EHR) of the state’s largest safety-net hospital network. We used State Unintentional Drug Overdose Reporting System (SUDORS) definitions of homelessness or housing instability to establish baseline estimates before linking decedents to medical records. After linkage, we augmented SUDORS data with structured administrative billing codes, semi-structured address data, and unstructured clinical notes identifying homelessness from the EHR. ResultsThere were 313 individuals with stimulant-involved fatal overdoses linked to at least one medical encounter in the EHR (2017–2021). Thirty-three individuals (10.5 %) were identified as having unstable housing according to SUDORS. After linkage, 130 individuals (41.5 %) had evidence of housing instability. For this period, these 313 individuals represent 8.0 % of stimulant-involved overdoses in KY or 38.5 % of stimulant-involved overdoses from residents of the primary and secondary catchment area of our healthcare network. ConclusionsThe single-site increase in observed housing instability in stimulant-involved fatal overdoses suggests that increased data linkage between state medicolegal death investigation system and EHRs would significantly improve the public health surveillance of overdoses.

Estimates of life-history and growth parameters of exploited fish species in lakes Edward and George: Implications on exploitation status, population dynamics, management, and conservation of native species.

Adequate knowledge is essential for responsible inland fisheries. However, many inland fisheries lack monitoring, and therefore, decision-making for fisheries management is not reliable. In this paper, we used data from surveys and literature to estimate the life-history and growth parameters of 16 exploited fish stocks in the Ugandan part of Lake Edward and Lake George (East Africa). The estimated parameters are pivotal indicators of fish stock status, particularly in data-poor fisheries. The estimated parameters included maximum length (Lmax) and mean length (Lmean) as indicators of size structure in experimental and commercial catches, coefficients of length-weight relationships, length at 50% maturity (Lm50), fecundity, von Bertalanffy parameters, total mortality (Z), and natural mortality (M). These parameters were estimated using empirical formulae, statistical methods, and analyses of length frequencies. Only two stocks of semutundu Bagrus docmak exhibited significant and increasing trends in Lmax (Lake Edward) and Lmean (Lake George). The estimates for the remaining parameters were consistent with those in FishBase and other literature resources, either for the same species or related species. This consistency indicates their reliability for application in decision-making and further assessments. Some parameters showed evidence of unsustainable fishing. For example, estimates of Lm50 for four of the assessed stocks belonging to two species (Nile tilapia Oreochromis niloticus and marbled lungfish Protopterus aethiopicus) were lower than baseline estimates in the studied waterbodies. Furthermore, the Lmean in catches for all the stocks were less than the optimum lengths (Lopt), which maximize catches with a minimal impact on biomass and size structure. No significant changes in Lmean, length-frequency distributions, and size at maturity could be attributed to the management changes implemented in 2018, probably because it is too early to observe changes in these parameters. However, there are positive signs attributable to the changes in management as shown by a high proportion of mature individuals in commercial catches for most of the stocks for which the proportion was calculated, and an increase in Lmean and Lmax for some stocks, such as B. docmak, in commercial or experimental catches. New estimates from this study will enhance decision-making and further assessments of fisheries. Routine monitoring is recommended to update and improve the estimates.

Development and validation of a machine learning model integrated with the clinical workflow for inpatient discharge date prediction.

Discharge date prediction plays a crucial role in healthcare management, enabling efficient resource allocation and patient care planning. Accurate estimation of the discharge date can optimize hospital operations and facilitate better patient outcomes. In this study, we employed a systematic approach to develop a discharge date prediction model. We collaborated closely with clinical experts to identify relevant data elements that contribute to the prediction accuracy. Feature engineering was used to extract predictive features from both structured and unstructured data sources. XGBoost, a powerful machine learning algorithm, was employed for the prediction task. Furthermore, the developed model was seamlessly integrated into a widely used Electronic Medical Record (EMR) system, ensuring practical usability. The model achieved a performance surpassing baseline estimates by up to 35.68% in the F1-score. Post-deployment, the model demonstrated operational value by aligning with MS GMLOS and contributing to an 18.96% reduction in excess hospital days. Our findings highlight the effectiveness and potential value of the developed discharge date prediction model in clinical practice. By improving the accuracy of discharge date estimations, the model has the potential to enhance healthcare resource management and patient care planning. Additional research endeavors should prioritize the evaluation of the model's long-term applicability across diverse scenarios and the comprehensive analysis of its influence on patient outcomes.

Estimating pneumococcal carriage dynamics in adults living with HIV in a mature infant pneumococcal conjugate vaccine programme in Malawi, a modelling study

BackgroundAdults living with human immunodeficiency virus (ALWHIV) receiving antiretroviral therapy (ART) exhibit higher pneumococcal carriage prevalence than adults without HIV (HIV-). To assess factors influencing high pneumococcal carriage in ALWHIV, we estimated pneumococcal carriage acquisition and clearance rates in a high transmission and disease-burdened setting at least 10 years after introducing infant PCV13 in routine immunisation.MethodsWe collected longitudinal nasopharyngeal swabs from individuals aged 18–45 in Blantyre, Malawi. The study group included both HIV- individuals and those living with HIV, categorised based on ART duration as either exceeding 1 year (ART > 1y) or less than 3 months (ART < 3 m). Samples were collected at baseline and then weekly for 16 visits. To detect pneumococcal carriage, we used classical culture microbiology, and to determine pneumococcal serotypes, we used latex agglutination. We modelled trajectories of serotype colonisation using multi-state Markov models to capture pneumococcal carriage dynamics, adjusting for age, sex, number of under 5 year old (< 5y) children, social economic status (SES), and seasonality.ResultsWe enrolled 195 adults, 65 adults in each of the study groups. 51.8% were females, 25.6% lived with more than one child under 5 years old, and 41.6% lived in low socioeconomic areas. The median age was 33 years (IQR 25–37 years). The baseline pneumococcal carriage prevalence of all serotypes was 31.3%, with non-PCV13 serotypes (NVT) at 26.2% and PCV13 serotypes (VT) at 5.1%. In a multivariate longitudinal analysis, pneumococcal carriage acquisition was higher in females than males (hazard ratio [HR], NVT [1.53]; VT [1.96]). It was also higher in low than high SES (NVT [1.38]; VT [2.06]), in adults living with 2 + than 1 child < 5y (VT [1.78]), and in ALWHIV on ART > 1y than HIV- adults (NVT [1.43]). Moreover, ALWHIV on ART > 1y cleared pneumococci slower than HIV- adults ([0.65]). Residual VT 19F and 3 were highly acquired, although NVT remained dominant.ConclusionsThe disproportionately high point prevalence of pneumococcal carriage in ALWHIV on ART > 1y is likely due to impaired nasopharyngeal clearance, which results in prolonged carriage. Our findings provide baseline estimates for comparing pneumococcal carriage dynamics after implementing new PCV strategies in ALWHIV.

Incidence of Idiosyncratic Drug-Induced Liver Injury Caused by Prescription Drugs.

The incidence of drug-induced liver injury (DILI) is not known for most prescription medications. We aimed to estimate the incidence of DILI for commonly prescribed outpatient drugs. To establish a baseline estimate of DILI incidence, we used the estimated incidence (EI) of amoxicillin/clavulanate DILI from a previous population-based study in Iceland. This was combined with the multicenter prospective DILI Network (DILIN) cohort and the US population-based Medical Expenditure Panel Survey (MEPS). From 2005 to 2019, prescription drugs with at least five bona fide DILIN cases and data from at least 10 of the 15years from MEPS during that timeframe were included. The EI for 'drug A' was calculated as follows: RESULTS: In total, 30 drugs met the inclusion criteria, of which 11 were antibiotics, 4 were antiepileptic drugs (AEDs), 4 were statins, and 11 were other drug types. The highest EI was seen with azathioprine and older AEDs, with one DILI case per 349-2329 new prescriptions. The EI of antibiotics ranged greatly, with the highest risk seen for minocycline, amoxicillin/clavulanate, and nitrofurantoin (approximately 1:1000-2400 new prescriptions), and lowest risk for clindamycin, doxycycline, azithromycin, and amoxicillin (approximately 1:40,000-170,000 new prescriptions). The EI for commonly prescribed statins was approximately 1:10,000-50,000. Important medication classes with > 5 million new prescriptions from 2005 to 2019 but fewer than five DILIN cases included β-blockers, thiazide diuretics, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, selective serotonin reuptake inhibitors, and metformin, which presumably have very low DILI incidence. The highest EI was found for azathioprine, older antiepileptics, and minocycline. In contrast, many widely used drugs are rare causes of DILI. These findings may help clinicians better weigh potential benefits of medications against hepatotoxicity risk.

The municipal government channel of monetary policy

Abstract Monetary policy in the USA affects borrowing costs for state and local governments, incentivizing municipal borrowing and spending, which in turn affects economic outcomes. Using municipal bond indices and transaction-level data, I find that responses to monetary policy are dampened relative to treasuries and heterogeneous across location and bond characteristics. In my baseline estimate, muni yields move 26 bp after a 100 bp monetary shock. To study implications for local fiscal policy, I model US localities as small open economies in a monetary union with independent fiscal agents. In a calibrated model, monetary transmission is significantly affected by municipal borrowing costs.

A - 30 Chiari Malformation Type I: the Powerful Impact of Participation in Computerized Working Memory Training on Mood and Self-Perception

Abstract Objective Chiari Malformation type I (CM-I), a disorder characterized by displaced cerebellar tonsils through the foramen magnum, is neuropsychologically complex and underrecognized. While decompressive neurosurgical intervention relieves physiological symptoms, cognitive and neuropsychiatric challenges may persist. Given the importance of attentional abilities and emotional functioning for post-operative quality of life for CM-I patients, exploring the effects of CogMed Computerized Working Memory Training (CCWMT) on aforementioned elements, specifically self-perception, is essential to the neurological surgery survivorship mission. Method Three CM-I patients diagnosed in adulthood were enrolled in CCWMT approximately three years post-operatively; each with self-reported decrements in attentional functioning following neurosurgical intervention with neurocognitive measures within normal limits and moderate levels of self-reported mood dysfunction and decline in self-perceived pre-surgical functional status. Comprehensive neuropsychological testing was completed pre and post CCWMT treatment, consisting of 25 sessions of progressively challenging working memory exercises completed within 5–12 weeks. Results There were no significant decrements in objective attentional-based measures pre-CCWMT treatment relative to baseline estimates and no significant changes pre to post CCWMT treatment. However, there were clinically significant decreases in self-reported depression. Further, post-treatment improvement in self-perception of functioning aligned with degree of improvement index within the CCWMT program. Conclusions Given the positive prognosis of post-surgical CM-I patients, clinical neuropsychological investigation can maximize a patient’s quality of life by extrapolating cognitive and emotional elements that interact as barriers to optimal outcomes. This case series underscores that effortful participation in intensive cognitive remediation may enhance mood and self-perception beyond objective cognitive enhancement, thereby supporting holistic aspects of a patient’s recovery.

Measurements of higher-order cumulants of multiplicity and net-electric charge distributions in inelastic proton–proton interactions by NA61/SHINE

This paper presents the energy dependence of multiplicity and net-electric charge fluctuations in p+p interactions at beam momenta 20, 31, 40, 80, and 158 GeV/c\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\ ext{ Ge }\\hspace{-1.00006pt}\ ext{ V }\\!/\\!c$$\\end{document}. Results are corrected for the experimental biases and quantified with the use of cumulants and factorial cumulants. Cumulant ratios are an essential tool in the search for the critical point of strongly interacting matter in heavy ion collisions. Measurements performed in p+p interactions provide a vital baseline estimation in these studies. The measured signals are compared with the string hadronic models Epos1.99 and FTFP-BERT.

The Nonlinear Nexus of Climate Policy Uncertainty and Renewable Energy Consumption in the United States of America: A Markov-Switching Approach

We employ a Markov-Switching regression model using monthly US data from April 1987 to August 2022 to investigate the effect of climate policy uncertainty (CPU) on renewable energy consumption (REC). The main findings suggest the presence of a nonlinear relationship between CPU and REC. The baseline analysis using the CPU index reveals an adverse effect in regimes characterized by high levels of uncertainty. However, the effect is not statistically significant in a low uncertainty regime. To account for potential variations in the results, we perform a robustness analysis that considers the effect of CPU on REC, which may fluctuate based on the authorities' contextual perspectives (i.e., being in favor or against climate policy) and also the effect of CPU on REC by household. In addition, we incorporate a robustness check by utilizing the environmental policy uncertainty index developed by Noailly et al. (2022). The robustness test results confirm the results obtained from the baseline estimation.