Early Adopters Research Articles

Early adopters of doxycycline as post-exposure prophylaxis to prevent bacterial sexually transmitted infections in a real-world clinical setting

ObjectivesDoxycycline as post-exposure prophylaxis (DoxyPEP) is a novel prevention approach which has demonstrated efficacy in preventing bacterial sexually transmitted infections (STIs) in men who have sex with men (MSM) and...

An empirical study on driving blockchain adoption in Maritime freight: an Asian business perspective

PurposeIn the existing era, international trade is boosted by maritime freight movement. The academicians and Government are concerned about environmental contamination caused by maritime goods that transit global growth and development. Digital technologies like blockchain help the maritime freight business to stay competitive in the digital age. This study aims to illuminate blockchain technology (BCT) adoption aspects to alleviate early industry adoption restrictions.Design/methodology/approachThis study adopts a two-stage approach comprising of structural equation modeling (SEM) with artificial neural networks (ANN) to analyze critical factors influencing the adoption of BCT in the sustainable maritime freight industry.FindingsThe SEM findings from this study illustrate that social, organizational, technological and infrastructual and institutional factors affect BCT execution. Furthermore, the ANN technique uses the SEM data to determine that sustainability enabled digital freight training (S3), initial investment cost (O5) and trust over digital technology (G1) are the most essential blockchain deployment factors.Originality/valueThe hybrid approach aims to help decision-makers and policymakers examine their organizational blockchain adoption goals to construct sustainable, efficient and effective maritime freight transportation.

Review Mechanisms for Advanced Medical Therapies in Japan and Thailand: A Proposal for the Use of Expert Clinical Benefit Assessments at Designated Institutions

AbstractAdvanced new therapies, such as stem cell and gene therapies and xenotransplantation, represent challenges for regulatory and ethical review. Major drug agencies, such as in the U.S., India, and Europe, have asserted regulatory authority and require ethics review by local ethics review committees, using the same strict requirements as those for standard drug approvals. In spite of this, unapproved and undocumented stem cell clinics flourish in all of these places, suggesting that current approaches do not offer patients sufficient protection. Japan has attempted another approach, requiring approvals at local levels for all regenerative medical procedures, and a faster approval of promising new interventions. The Japanese approach has, however, also been criticized as not striking a proper balance between early access and a proper assessment of safety and effectiveness. For smaller and less-resourced countries, such as Thailand, one major challenge is limited expertise to conduct the evaluation of these advanced new therapies. This article provides an overview of the issues facing regulators and proposes that countries should restrict the early adoption of advanced new therapies to specialized clinics with appropriate scientific and ethical expertise for review. Review in these institutions should focus on expert clinical benefit assessments for individual patients being offered such interventions, independently of whether they are offered as research or therapy.

Assessing the Early Establishment and Adaptability of Italian Ryegrass (Lolium multiflorum) in Irrigated and Rainfed Conditions of Punjab, Pakistan

In Punjab, Pakistan, more than 60% expenditure incurred on the feeding of livestock and offered low quality forage thus affecting the productivity of milk and meat. The less production of livestock oriented products often results malnutrition in the society. An effort was made to evaluate the Italian Ryegrass (Lolium multiflorum) early growth and its adaptation to rainfed and irrigated environments. The main objective of this study is to provide important new information for sustainable fodder production systems. The experiment used a Randomized Complete Block Design with seeds obtained from Korea and was carried out in the winter of 2023 in both rainfed Chakwal and irrigated Sargodha zone of Punjab. The plant's response to varying soil conditions and water availability was evaluated by measuring a range of growth parameters, such as plant height, population density, root and shoot biomass, root length, and the root-shoot ratio. The results show that there are significant differences between rainfed and irrigated locations as established by the statistical analysis. Italian Ryegrass in irrigated plots showed higher mean plant height (43.75 cm), higher plant population (317.50 plants/m²), higher shoot biomass (7.425 g/plant), greater length of roots (5.950 cm), and a lower root-shoot ratio (0.1135) than in rainfed areas. Additionally, the study provides data on soil profiles that show differences between the two locations in terms of pH, electrical conductivity, nitrogen, phosphorus, and potassium. The findings provide important information for enhancing Italian Ryegrass cultivation in Punjab's various agro-ecological zones, given the critical role fodder feed plays in supporting livestock and agriculture. The study provides the basis for well-informed farming practices by highlighting the importance of water management strategies to improve fodder production during scarcity period and, by consequently, animal nutrition in the area.

Experience with the cochlear implant enhances the neural tracking of spectrotemporal patterns in the Alberti bass

Cochlear implant (CI) users experience diminished music enjoyment due to the technical limitations of the CI. Nonetheless, behavioral studies have reported that rhythmic features are well-transmitted through the CI. Still, the gradual improvement of rhythm perception after the CI switch-on has not yet been determined using neurophysiological measures. To fill this gap, we here reanalyzed the electroencephalographic responses of participants from two previous mismatch negativity studies. These studies included eight recently implanted CI users measured twice, within the first six weeks after CI switch-on and approximately three months later; thirteen experienced CI users with a median experience of 7 years; and fourteen normally hearing (NH) controls. All participants listened to a repetitive four-tone pattern (known in music as Alberti bass) for 35 min. Applying frequency tagging, we aimed to estimate the neural activity synchronized to the periodicities of the Alberti bass. We hypothesized that longer experience with the CI would be reflected in stronger frequency-tagged neural responses approaching the responses of NH controls. We found an increase in the frequency-tagged amplitudes after only 3 months of CI use. This increase in neural synchronization may reflect an early adaptation to the CI stimulation. Moreover, the frequency-tagged amplitudes of experienced CI users were significantly greater than those of recently implanted CI users, but still smaller than those of NH controls. The frequency-tagged neural responses did not just reflect spectrotemporal changes in the stimuli (i.e., intensity or spectral content fluctuating over time), but also showed non-linear transformations that seemed to enhance relevant periodicities of the Alberti bass. Our findings provide neurophysiological evidence indicating a gradual adaptation to the CI, which is noticeable already after three months, resulting in close to NH brain processing of spectrotemporal features of musical rhythms after extended CI use.

Diffusion theory, economic consequences, and adoption of international standards on auditing around the world

This paper examines the economic consequences of adopting the International Standards on Auditing (ISAs) from a diffusion of innovation theory perspective. Using a very extensive dataset with 160 countries over 20 years and generating 3,200 country-year observations, this study examines the impact of ISAs adoption on the economic consequences of adopting countries. Our findings are threefold. First, we show that early ISAs adoption has positively and significantly influenced three economic indicators of the adopting countries: (i) economic growth, (ii) foreign direct investment (FDI) inflows, and (iii) exchange rate. Second, our results show that late ISAs adoption has positively and significantly influenced two economic indicators: (i) exports and (ii) interest rates, but negatively with imports. Third, we find a significant positive association between ISAs adoption with amendments or translation and two economic indicators: (i) FDI and (ii) exchange rate, but negative with inflation. Finally, and by contrast, we find a negative link between early ISAs adoption, economic growth rate, and exports. Our findings have implications for theory and practice.

Targeted lipidomics-based study of radiation-induced metabolite profiles changes in plasma of total body irradiation cases

Purpose Lipidomics is an important tool for triaging exposed individuals, and helps early adoption of prevention and control strategies. The purpose of this study was to screen significantly perturbed lipids between pre- and post-irradiation of human plasma samples after total body irradiation (TBI) and explore potential radiation biomarkers for early radiation classification. Methods Plasma samples were collected before and after irradiation from 22 hospitalized cases of acute myeloid leukemia (AML) prepared for bone marrow transplantation. Acute total-body γ irradiation was performed at doses of 0, 4, 8, and 12 Gy. Ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) with multiple reaction monitoring (MRM) method was utilized. Self-paired studies before and after irradiation were performed to screen potential lipid categorization markers and markers of dose-response relationships for radiation perturbation in humans. Based on the screened potential markers, a human TBI dose estimation model was developed. Results In total, 426 individual lipids from 14 major classes were quantified and 152 potential biomarkers with categorical characteristics were screened. A total of 80 lipids (32 TGs, 29 SMs, 9 FAs, 5 CEs, 5 PIs) were upregulated at 4 Gy, and a total of 91 lipids (39 SMs, 18 TGs, 15 HexCers, 7 CEs, 6 Cers, 3 LacCers, 2 LPEs, 1 PI) were upregulated at 12 Gy. Comparison of the ROC curves between the non-exposed and exposed groups at different doses showed AUC values ranging from 0.807 to 0.876. The metabolic pathways of potential lipid markers are mainly sphingolipid and glycerolipid metabolism, unsaturated fatty acid biosynthesis, fatty acid degradation and biosynthesis. Among the 13 dose-dependent radiosensitive lipids, CE (20:5), CE (18:1) and PI (18:2/18:2) were gradually incorporated into the TBI dose estimation model. Conclusion This study suggested that it was feasible to acquire quantitative lipid biomarker panels using targeted lipidomics platforms for rapid, high-throughput triage. Lipidomics strategies for radiation biodosimetry in humans were established with lipid biomarkers with good dose-response relationship.

Do early adopters raise barriers to the commercial take-up of strategic high-technology products?

ABSTRACT The objective of this research is to investigate whether the behaviors and preferences of early adopters can potentially hinder the widespread proliferation of strategic high-technology industrial products. Through an extensive analysis of data collected from 1285 communication satellites, our findings reveal a significant pattern: when early adopters demonstrate a high demand for product diversity and elevated levels of innovation, this tends to delay the diffusion of these technologies to the mainstream commercial adopters. Early adopters undeniably play a pivotal role in directing the development pathways of strategic industries; however, their insistence on high innovation and diversity creates technological barriers. These barriers, in turn, slow down the mass adoption by commercial entities, which rely on more stable and universally accepted technologies. Our research enriches the existing body of diffusion literature by offering a fresh perspective, focusing on the dynamics of adopter orientation as opposed to the traditional producer-centric view. The results from our study highlight the urgent need for the implementation of targeted policy interventions and strategies aimed at fostering more equitable and widespread diffusion processes. This would ensure that the benefits of innovation are more evenly distributed across a broader range of user segments. Moreover, our findings suggest that innovation policies need to address systemic failures within the innovation ecosystem, such as the lack of a dominant design which can further facilitate diffusion. This insight is particularly beneficial for policy-makers, providing them with critical information to determine the optimal timing for transitioning from mission-oriented policies that are aimed at establishing new markets, to product diffusion policies focused on rectifying market failures.

Part 1: Pushing the boundaries of neurointerventional surgery: A historical review of the work of Dr Gerard Debrun.

French-American neurointerventionalist and pioneer, Dr Gerard Debrun, laid the groundwork for treatments which have become irreplaceable in neurointerventional surgery today. This article aims to outline the career of Dr Debrun while highlighting his accomplishments and contributions to the field of neurointerventional surgery. We selected relevant articles from PubMed authored or co-authored by Dr Debrun between 1941 and 2023. All included articles discuss the accomplishments and contributions of Dr Debrun. Dr Debrun began his career in France by investigating neurointerventional techniques, most notably the intravascular Detachable Balloon Catheter (DBC). His work was recognized by renowned neurosurgeon Dr Charles Drake, who recruited him to London, Ontario. Dr Debrun created the foundation for homemade manufacturing of DBCs, building on one of the largest series for use of DBCs in cerebrovascular disease. Dr Debrun spent time as faculty at Massachusetts General Hospital (MGH) and Johns Hopkins Hospital, before arriving at the University of Illinois Chicago (UIC) where he remained until his retirement. Dr Debrun's subsequent contributions included the calibrated-leak balloon catheter, pioneering of glue embolization, setting the foundation for preoperative AVM embolizations, and as an early adopter of the Guglielmi detachable coil (GDC), including mastering the balloon remodeling technique for wide neck aneurysms. Dr Debrun established the first integrated neurointerventional surgery program at UIC, establishing a well sought-after fellowship program. Dr Debrun lectured extensively and was a prolific writer on neurointerventional surgery throughout this career. His contributions established the foundation for several techniques which have since become standard practice in present-day neurointerventional surgery.

The lure of decentralized social media: Extending the UTAUT model for understanding users' adoption of blockchain-based social media.

The study uses 31 semi-structured interviews to explore users' motivations for adopting and using blockchain-based social media (BSM) platforms. The objective of the study is twofold-to collect empirical data on early adopters of BSM and to test the applicability of the Unified Theory of Acceptance and Use of Technology (UTAUT) model for explaining why some users are choosing BSM over mainstream social media (MSM) platforms. Manual content analysis of the interviews reveals that users are initially drawn to BSM due to social influence and financial incentives, but they continue to use it mainly because of the sense of community they experience. We also find that the steep learning curve, the absence of content moderation, as well as security and privacy concerns hinder the widespread adoption of these platforms. From the theoretical side, although the UTAUT model is generally suitable for examining why individuals use BSM, we suggest integrating two additional factors into the model: financial incentives and content moderation.

Perceptions of customer-facing digital technology: a qualitative interview study from grocery retail

Purpose The purpose of this study is to provide in-depth knowledge on customer-facing technology and customer experience in the grocery retail sector, including how the value-added potential of customer-facing technologies may be enhanced. Design/methodology/approach The analysis is based on 30 in-depth interviews with “early adopters” of customer-facing digital retail technologies in the Norwegian grocery sector. Theoretically, the study draws on notions of the customer journey and customer experience. Findings The study contributes to deepening insights concerning how digital retail technology is used and may be geared to further increase value for customers, specifically how retailers may use data on customers and products to personalize digital retail technology offerings and gain a competitive advantage. The findings underline how customer value is context-dependent and show that while grocery retail customers primarily emphasize utilitarian benefits related to customer-facing technologies, hedonic benefits are valuable biproducts. Moreover, the study showcases how personalization is key in addressing customers’ needs and wants, and may serve to increase the overall value of customer-facing technologies for customers and retailers. Originality/value The study’s sector-specific focus on technology in use contributes to enhance knowledge on how digital retail technologies can be leveraged to the benefit of customers and retailers, including customers’ sector-specific needs and wants.

The status of extended reality technology in South Africa's mining industry

The economic upheaval of COVID-19 forced companies to invest in emerging technologies to aid recovery. One such technology is extended reality, which is becoming a mature and innovative tool. Early adopters are seeing significant benefits in learning, training, immersive data visualization, and remote assistance. In South Africa, the mining industry is increasingly interested in using extended reality to optimize and innovate operations. The Minerals Council of South Africa's July 2021 report highlighted the potential of extended reality's to achieve zero-harm production and modernize the industry. However, the extent of extended reality adoption in mining remains unclear due to limited information on its usage. This study addressed this gap by distributing an online survey to assess awareness, knowledge, and current uses of extended reality in South Africa's mining sector. The results indicated that virtual and augmented reality had the highest levels of awareness and usage, primarily for learning and training. Mixed reality, however, had the lowest awareness and knowledge levels. In terms of applications, visualization and remote assistance had the least use cases. These findings highlight that the South African mining industry is deficient in its understanding and use of extended reality technologies. Without better awareness and application, the South African industry risks missing out on the full benefits of extended reality. The study underlines the need for the South African mining industry to improve its outlook on extended reality technologies to fully leverage their potential applications and benefits.

Competency based medical education implementation at the institutional level: A cross-discipline comparative program evaluation

Introduction As an early adopter of competency-based medical education (CBME) our postgraduate institution was uniquely positioned to analyze implementation experience data across programs, while keeping institutional factors constant. We described participants’ experiences related to CBME implementation across programs derived from early program evaluation efforts within our setting. Methods This evaluation focused on eight residency programs at a medium-sized academic institution in Canada. Participants (n = 175) included program leaders, faculty, and residents. The study consisted of 3 phases: (1) describing intended implementation; (2) documenting enacted implementation; and (3) comparing intended with enacted implementation to inform adaptations. Each program’s findings were summarized in technical reports which were then analyzed thematically. Cross program data were organized by themes. Results Six themes were identified. All groups emphasized the need for ongoing refinement of CBME resulting from shared tensions such as increased assessment burden. However, there were some disparate CBME-related experiences between programs such as the experience with entrustable professional activities, the interpretation of retrospective entrustment anchors, and quality of feedback. Conclusion We detected several cross-program successes and important challenges related to CBME. Our experience can inform other programs engaging in implementation and evaluation of CBME.

Green gold or carbon beast? Assessing the environmental implications of cryptocurrency trading on clean water management and carbon emission SDGs

This study addresses the ongoing debate concerning the environmental implications of cryptocurrencies. Specifically, it investigates the impact of Bitcoin trading volume on water and sanitation (Sustainable Development Goal (SDG) 6) and climate action (SDG 13). The research employs Ordinary Least Squares (OLS) panel data analysis to examine these relationships using a sample of 32 countries with available Bitcoin trading volume data from 2013 to 2020. The findings indicate that Bitcoin trading significantly and positively impacts progress towards SDG 6, suggesting potential benefits for water and sanitation initiatives. However, the study reveals a significant negative impact of higher Bitcoin trading volume on increased carbon emissions, underscoring the environmental costs associated with cryptocurrency activities. Similar impacts are observed for gold reserves, as their mining necessitates substantial energy consumption. These results highlight the need to regulate cryptocurrency trading and promote voluntary sustainable practices, particularly given the disparities between developed and emerging markets based on their governance frameworks. Additionally, the study considers the disparities between countries based on technology exports and economic policy uncertainty as influential determinants. The study's results emphasize the importance of proactive measures to ensure the responsible and sustainable use of cryptocurrencies. While cryptocurrencies offer significant economic returns, their early adoption stage necessitates further investigation into environmentally friendly approaches. Potential strategies include directing financial returns from cryptocurrencies towards alternative energy projects and supporting other environmental SDGs, thereby fostering a positive impact on the overall ecosystem. The study's implications extend to policymakers, regulators, and stakeholders, advocating for comprehensive and collaborative efforts to integrate sustainability into the rapidly evolving cryptocurrency market. This integration is crucial to ensure that the economic benefits of cryptocurrencies do not come at the cost of our environment.

Food neophobia scores at 8 Years and associations with nutrition-related behaviors at home in early life: Findings from a New Zealand contemporary birth cohort

Food neophobia (FN) reduces nutritional adequacy and variety which poses a significant concern for children's health and well-being We described the FN scores among 8-year-olds and examined its associations with nutrition-related behaviors at 45 months within the Growing Up in New Zealand cohort (n = 4621). FN was estimated using the Food Neophobia Scale (FNS). Mean FNS scores between variable categories were compared using t-tests for independent samples and ANOVA. Associations between FNS scores at 8 years and nutrition-related behaviors at 45-months were examined using multivariate linear regression. The mean (standard deviation) FN score was 46.2 (15.2) with statistically significant differences by sex (boys = 47.6 (15.7), girls = 43.8 (14.2), p=<0.001). For all children, in models adjusted by breastfeeding duration and sociodemographic characteristics: children who sometimes and never/almost never ate the same foods as their parents, scored, on average, 5.8 and 11 points higher in the FNS (versus those who did always/almost always); children who occasionally/never found mealtimes enjoyable scored on average 3.6 points lower in the FNS (versus mostly/quite often); children who always/almost always had the television on during mealtimes scored on average 2.7 higher in the FNS (versus never/almost never). In comparison to children who mostly/quite often had time to talk to others during mealtimes, those who never/occasionally did it scored on average higher points in the FNS overall (1.46 points higher) and within girls (1.73 points higher). These findings support the eating behavior statements in the National Children's Food and Nutrition Guidelines, which emphasize early exposure to food variety, limiting mealtime distractions, and acknowledge that parental role modeling shapes children's nutrition-related behaviors. Early adoption of preventative interventions for reducing FN in early and middle childhood are needed.

The arrival of commercial bioprinters - Towards 3D bioprinting revolution!

The dawn of commercial bioprinting is rapidly advancing the tissue engineering field. In the past few years, new bioprinting approaches as well as novel bioinks formulations have emerged, enabling biological research groups to demonstrate the use of such technology to fabricate functional and relevant tissue models. In recent years, several companies have launched bioprinters pushing for early adoption and democratisation of bioprinting. This article reviews the progress in commercial bioprinting since the inception, with a particular focus on the comparison of different available printing technologies and important features of the individual technologies as well as various existing applications. Various challenges and potential design considerations for next generations of bioprinters are also discussed.

Adaptations and early adoption of a family caregiver intervention in the Veterans Affairs Health Care System: A multimethod pragmatic approach for national scaling.

To examine the relationship between site-level adaptation and early adoption of Caregivers Finding Important Resources, Support, and Training (FIRST) training during national implementation across diverse Veteran Health Administration (VA) medical centers. We enrolled and evaluated 25 VA medical centers (VAMCs). Along with administrative data on site characteristics, we examined site-reported data on adaptations and intervention adoption, defined as ≥4 training classes delivered to ≥5 caregivers at 6 months from April through October 2022. A type III hybrid implementation-effectiveness cluster randomized controlled trial, randomized VAMCs 1:1 to receive foundational (low-touch) implementation support (n = 12) or the addition of enhanced (high-touch) implementation support (n = 13). At key implementation phases, VAMCs were asked to report adaptations including content, contextual modifications (format, setting, personnel, and population), and training of providers. We describe site-level adaptations by arm and by organizational characteristics that included VAMC complexity level, staffing, rurality, and organizational readiness to change. We used qualitative comparative analysis to identify unique adaptations that contributed to intervention adoption at 6 months. VAMCs randomized to receive enhanced support reported slightly more adaptations than those randomized to foundational support. At 6 months, VAMCs with two or more adaptations adopted Caregivers FIRST at a higher rate than those with fewer adaptations (90% vs. 44%). Staffing adaptations (e.g., who delivered the intervention), format and content (e.g., modified delivery pace), and referring provider training were unique adaptations to adopting sites. Site-level adaptations were diverse and occurred more frequently in sites with early adoption of Caregivers FIRST. Future research should identify best practices of supporting and monitoring intervention adaptation. Understanding the role of adaptation in early adoption success could assist other healthcare systems in implementing interventions for caregivers.

Measuring vaccination coverage and concerns of vaccine holdouts from web search logs

To design effective vaccine policies, policymakers need detailed data about who has been vaccinated, who is holding out, and why. However, existing data in the US are insufficient: reported vaccination rates are often delayed or not granular enough, and surveys of vaccine hesitancy are limited by high-level questions and self-report biases. Here we show how search engine logs and machine learning can help to fill these gaps, using anonymized Bing data from February to August 2021. First, we develop a vaccine intent classifier that accurately detects when a user is seeking the COVID-19 vaccine on Bing. Our classifier demonstrates strong agreement with CDC vaccination rates, while preceding CDC reporting by 1–2 weeks, and estimates more granular ZIP-level rates, revealing local heterogeneity in vaccine seeking. To study vaccine hesitancy, we use our classifier to identify two groups, vaccine early adopters and vaccine holdouts. We find that holdouts, compared to early adopters matched on covariates, are 67% likelier to click on untrusted news sites, and are much more concerned about vaccine requirements, development, and vaccine myths. Even within holdouts, clusters emerge with different concerns and openness to the vaccine. Finally, we explore the temporal dynamics of vaccine concerns and vaccine seeking, and find that key indicators predict when individuals convert from holding out to seeking the vaccine.

Wine grape grower perceptions and attitudes about soil health

Developing and adopting strategies that preserve soil health from degradation due to drastic changes in climate is critical for securing sustainable viticulture. For example, healthy soils promote water infiltration, nutrient cycling, and retention functions that support grape production. However, little research has evaluated drivers of growers' decision-making processes and actions towards soil management practices that impact soil health in vineyards. The objective of this study was to assess wine grape growers' perceptions and attitudes of soil health to identify grower's most important soil health functions and definition, and to understand how these might influence behavior related to soil management practices. Therefore, we conducted semi-structured interviews with 16 wine grape growers understand current barriers, motivations, and opportunities for adopting and/or maintaining practices for building soil health in vineyards. Most growers described healthy vineyard soils as balanced, biodiverse, self-sustaining, and resilient systems that provide nutrient, and water cycling functions and support high-quality wine grape production. Three categories of growers emerged based on soil health attitudes including Early Adopter (n = 3), Early Majority (n = 4) and Late Majority (n = 9) groups. The main barriers for adoption and maintenance of soil health practices were high costs, potential economic risks, and lack of information on how these practices influence grape production especially for the Late Majority group. Most growers were willing to adopt more soil heath practices if additional specific, practical information could be provided on outcomes of soil health practices for wine grape production systems—especially economic benefits. The outcomes of this study guide future soil health research and outreach activities to better support growers in building and protecting vineyard soil health while achieving viticultural goals.

Macroprudential policy effectiveness and interaction with monetary policy: Lessons from debt service-to-income cap implementation in Kazakhstan

We take advantage of the early adoption of the debt-service-to-income cap (DSTI) measure in Kazakhstan, as well as available granular information from the local credit registry to study the effects of macroprudential instruments on core financial stability parameters. Our results show that implementation of a DSTI cap of 50 % leads to around a 9 % decrease in 12 months in the amount of outstanding debt on average for the range of credits originated just around the introduction of the DSTI cap. We find that DSTI cap implementation decreased the probability of delinquency rates of loans by about 20 % in 12 months on average compared to credits granted before the realization of the DSTI cap. We provide evidence on the importance of loan size heterogeneity across time when estimating the impact of macro-prudential intervention, which is partly overlooked in the existing literature. Finally, our results suggest that macroprudential and monetary policy tools can be complementary depending on the specific business cycle developments.