Medium-term Effects Research Articles

Projecting short to medium-term effects of carbon emissions trading on Serbia's GDP

This paper presents an approach to assess the short to medium-term effects of the Emissions Trading System (ETS), an economic and climate policy instrument aimed at reducing greenhouse gas emissions, on GDP from the expenditure side. The analysis focuses on Serbia's electricity sector, which relies heavily on lignite-based production dominated by state-owned enterprises. The obtained projections suggest that in the short term, the introduction of an ETS may lead to slower GDP growth compared to official forecasts. However, by 2030, accelerated growth is observed, eventually converging with and even surpassing the projected growth in scenarios characterized by higher investments.

Artificial Intelligence: Intensifying or Mitigating Unemployment?

The rapid development of Artificial Intelligence (AI) is simultaneously fostering a proliferation of novel job opportunities while rendering some traditional roles obsolete and specific skills outdated. Previous research has failed to consider the short-, medium-, and long-term variations in AI’s impact on unemployment, which may lead to an incomplete understanding of the AI-employment relationship. This paper examines daily data from January 4, 2013, to August 12, 2024, utilising advanced wavelet-based Quantile on Quantile Regression (QQR) methodology to assess AI’s impact on the Unemployment Index (UI) across quantiles and time scales, with a sample size of 2820 drawn from a larger dataset totalling 4241 observations. The conclusions reveal that AI generally positively impacts UI in the short term, especially with AI at 0.6-0.7 quantiles, as automation replaces workers faster than new job roles emerge and skills transform. However, in the medium term, positive and negative effects balance as new jobs and skills emerge through continuous industrial restructuring. In the long run, AI predominantly mitigates UI by further enhancing economic development, fostering skill upgrading, and facilitating market adjustments, but this result does not hold during AI at 0.7 quantiles and UI at the highest quantiles, such as Coronavirus Disease 2019 (COVID-19). Under new technological revolution and industrial transformation, we formulate China-specific suggestions to avert potential AI-induced unemployment crisis from short-term, medium-term, long-term, and sector-specific perspectives.

The effectiveness of exercise interventions on psychological distress in patients with lung cancer: a systematic review and meta-analysis.

To assess the effectiveness of exercise interventions on psychological distress in lung cancer patients and how this effectiveness varies by cancer stage, treatment, intervention type (exercise/with other interventions), exercise mode, duration, and sustained effects over time. Randomized controlled trials (RCTs) investigating exercise effects on psychological distress were included. Exclusion criteria were studies with less than 50% lung cancer patients, those on pharmacotherapy/psychotherapy, and studies focused solely on breathing exercises. Data sources included PubMed, Embase, MEDLINE, CINAHL, and Scopus. Reporting followed PRISMA 2020 guidelines, with analysis via Review Manager 5.4, and quality assessed using Cochrane RoB 2. Twenty-two studies with 1524 participants were selected from 611 articles. All intervention groups were compared to usual care. Meta-analysis, including 11 studies, showed significant reductions in anxiety (SMD = - 0.52, 95% CI = - 0.94 to - 0.09, p = .02) and depression (SMD = - 0.55, 95% CI = - 0.89 to - 0.21, p = .001). The subgroup revealed that early-stage patients, surgery alone, engaging in aerobic exercise (with other exercise modes) or combined interventions showed greater effectiveness in reducing anxiety and depression. Regarding sustained effects, exercise interventions showed a significant medium-term effect on reducing anxiety. Exercise interventions show promise in reducing psychological distress among lung cancer patients. However, further research is needed to optimize these interventions and explore their long-term effects. The effectiveness of exercise interventions on psychological distress in lung cancer patients varies by cancer stage, treatment, and intervention type, supporting the use of tailored programs.

Effectiveness of Local Glucocorticoid Infiltration Versus Traditional Gauze Bandaging for the Treatment of Onychocryptosis: A Randomized Controlled Trial.

Local intralesional corticosteroid injections into the periungual fold are used to treat patients with onychocryptosis, but their short- or medium-term effects are unknown. The goal was to compare the efficacy of this treatment in stages IIa, IIb, and III of the condition with a common conservative method such as gauze bandaging. A two-arm randomized trial with 40 patients with stage IIa, IIb, and III onychocryptosis equally assigned into two treatment groups-control (spiculotomy and application of gauze bandaging) and experimental group (spiculotomy and infiltration of corticosteroid)-was performed. Anthropometric data, initial clinical status, pain, and inflammatory measures were collected before and at least one month after the intervention. Pain reduction was higher in the experimental group (5.5 vs. 4.8 points) but with no significant differences (p = 0.306).Corticosteroids significantly reduced inflammation over gauze bandaging (1.9 vs. 1) with significant differences between them (p = 0.029). Corticosteroid infiltration was more effective than gauze bandaging application in reducing inflammation in patients with onychocryptosis, with similar effects on pain. These findings support the clinical importance of corticosteroid treatment for this condition, although a single infiltration may not be sufficient to prevent relapses.

Short-Term and Mid-Term Blood Pressure Variability and Long-Term Mortality

Until recently, a focus has been made on exploring the influence of average blood pressure on risk of mortality. We go beyond average blood pressure to also investigate mortality risk with respect to variation in blood pressure over two timescales – short-term variation among multiple measures at one visit, and medium-term variation between the measures at two visits several months apart. We present an application of Bayesian hierarchical modeling to the problem of estimating the effect of blood pressure (BP) variability on all-cause and cardiovascular (CV) mortality. We use data from the Third National Health and Nutrition Examination Survey linked with up to 27 years of mortality follow-up. We find that medium-term systolic BP variability had a very significant predictive value for CV and all-cause mortality, around one-third as large as the well-established impact of mean systolic BP. Medium-term diastolic variability had an additional, though smaller, predictive effect. Short-term variability, on the other hand, had little or no measurable predictive value. The medium-term variability effect persisted when controlling for Framingham risk score.

‘We want bread and work’: patterns of labour protest and union involvement in Bulgaria

ABSTRACT The end of communism in Central and Eastern Europe resulted in wide-ranging social change, with established practices and relations being overturned in a relatively short period. Labour relations were an area that saw considerable upheaval as unions were released from state control and clandestine worker bodies were able to emerge. This article considers the medium-term effects of these changes by examining the characteristics of labour focused contention in Bulgaria from 2000 to 2019. This was a period during which the uncertainty that characterised the post-transition decade was settling, with new challenges and opportunities in the form of accession to the European Union, the global financial crisis, and the anti-government protests of 2013–2014 shaping the context for labour relations. This article draws on a unique dataset of labour protests to examine the claims, actors, and actions adopted to identify how the labour movement responded to these changes and the degree of trade union involvement in contentious events. The findings suggest there has been a shift from economic claims to encompass broader rights-based issues. They also suggest that unions have been visible in contentious actions but have been joined by a more diverse group of actors in advancing workers’ claims.

Labor supply effects of a universal cash transfer

I investigate the labor supply effects of the introduction of an exceptionally large unconditional cash benefit. I exploit the unique design of the child benefit program in Poland to identify the effects of the monthly transfer in a difference-in-differences design. The transfer had no short-term effects but caused sizable negative medium-term effects on household labor supply. In the medium run, population estimates indicate that for every extra 100 dollars in monthly child benefit transfers households received, they reduced their after-tax earnings by 25 dollars, spent 32 dollars on consumption, and saved 43 dollars. These negative labor supply effects are much larger and much more precisely estimated among households with low socioeconomic status. Additional evidence shows that the program had a positive impact on investments in human capital and home production efficiency.

Reconsidering the Impact of the All Scotland Crusade of 1955 upon Children and Young People

Billy Graham led the All Scotland Crusade in Glasgow for six weeks between March and April 1955. 830,670 people attended the events he hosted at the Kelvin Hall, Ibrox and Hampden stadiums, while 19,835 of them responded to his altar call and became inquirers. A significant proportion were children and young people. This paper will examine the immediate, medium-term and long-term effects of the crusade upon this group of people. It will contend maternal influence encouraged a significant number of children and young people to respond to Graham’s altar call, emotion often accompanied their decisions, and many of them underwent an evangelical conversion experience. It will claim many became active participants in the life of their local churches where they received pastoral care and spiritual counselling. It will argue some of them found a vocation in full time Christian ministry and mission, and spent their lives serving the church. Above all, this paper will establish how the lives of several thousands of children and young people were radically transformed through their experience of the All Scotland Crusade in 1955.

Short- and medium-term cumulative effects of traffic-related air pollution on resting heart rate in the elderly: A wearable device study

BackgroundEpidemiological evidence regarding the association between air pollution and resting heart rate (RHR), a predictor of cardiovascular disease and mortality, is limited and inconsistent. ObjectivesWe used wearable devices and time-series analysis to assess the exposure-response relationship over an extended lag period. MethodsNinety-seven elderly individuals (>65 years) from the Taipei Basin participated from May to November 2020 and wore Garmin® smartwatches continuously until the end of 2021 for heart rate monitoring. RHR was defined as the daily average of the lowest 30-min heart rate. Air pollution exposure data, covering lag periods from 0 to 60 days, were obtained from nearby monitoring stations. We used distributed lag non-linear models and linear mixed-effect models to assess cumulative effects of air pollution. Principal component analysis was utilized to explore underlying patterns in air pollution exposure, and subgroup analyses with interaction terms were conducted to explore the modification effects of individual factors. ResultsAfter adjusting for co-pollutants in the models, an interquartile range increase of 0.18 ppm in carbon monoxide (CO) was consistently associated with increased RHR across lag periods of 0–1 day (0.31, 95 % confidence interval [CI]: 0.24–0.38), 0–7 days (0.68, 95 % CI: 0.57–0.79), and 0–50 days (1.02, 95 % CI: 0.82–1.21). Principal component analysis identified two factors, one primarily influenced by CO and nitrogen dioxide (NO2), indicative of traffic sources. Increases in the varimax-rotated traffic-related score were correlated with higher RHR over 0–1 day (0.36, 95 % CI: 0.25–0.47), 0–7 days (0.62, 95 % CI: 0.46–0.77), and 0–50 days (1.27, 95 % CI: 0.87–1.67) lag periods. Over a 0–7 day lag, RHR responses to traffic pollution were intensified by higher temperatures (β = 0.80 vs. 0.29; interaction p-value [P_int] = 0.011). Males (β = 0.66 vs. 0.60; P_int < 0.0001), hypertensive individuals (β = 0.85 vs. 0.45; P_int = 0.028), diabetics (β = 0.96 vs. 0.52; P_int = 0.042), and those with lower physical activity (β = 0.70 vs. 0.54; P_int < 0.0001) also exhibited stronger responses. Over a 0–50 day lag, males (β = 0.99 vs. 0.96; P_int < 0.0001), diabetics (β = 1.66 vs. 0.69; P_int < 0.0001), individuals with lower physical activity (β = 1.49 vs. 0.47; P_int = 0.0006), and those with fewer steps on lag day 1 (β = 1.17 vs. 0.71; P_int = 0.029) showed amplified responses. ConclusionsProlonged exposure to traffic-related air pollution results in cumulative cardiovascular risks, persisting for up to 50 days. These effects are more pronounced on warmer days and in individuals with chronic conditions or inactive lifestyles.

Changes in the Centers of Rotation in Different Prosthetic Segments Following Continuous Two-Level Cervical Disc Replacement: A Retrospective Study

To observe the short-term to medium-term therapeutic effects and radiological outcomes of adjacent 2-level cervical spondylosis treated with artificial cervical disc replacement (ACDR) using Mobi-C and Bryan discs. To observe changes and discrepancies in the flexion-extension centers of rotation (FE-COR) of different ACDR segments. Twenty-four patients undergoing 2-level (C4/5 and C5/6) ACDR were analyzed retrospectively (11 patients in the Mobi-C group and 13 patients in the Bryan group). Clinical outcomes were assessed using modified Japanese Orthopedic Association score, Neck Disability Index, and visual analog scale. Preoperative and 2years' follow-up radiographs were collected to compare total cervical spine curvature (C2-C7) range of motion (ROM), upper and lower ACDR segmental ROM, and the operated adjacent segmental ROM. The FE-COR of the ACDR segment was measured using the mid-plumb line method. The degree of disc degeneration in the adjacent segment was observed. At the 2years' follow-up, in both group, the modified Japanese Orthopedic Association score increased significantly, and the Neck Disability Index and neck and upper extremity visual analog scale scores decreased significantly compared with preoperative (P<0.05). There were no significant statistical differences in postoperative scores between the 2 groups (P > 0.05). The overall cervical ROM, the upper and lower segmental ROM at the 2years' follow-up showed no significant statistical differences compared with the preoperative period (P > 0.05). There was no statistically significant difference in the adjacent segmental ROMs compared with the preoperative period (P > 0.05). Furthermore, the statistical analysis revealed no significant differences in the measurements of the ROM at each time points between the Mobi-C Group and the Bryan Group (P > 0.05). There was no significant difference in the preoperative FE-COR-X (indicating the horizontal position of the point in the coordinate system) and FE-COR-Y (indicating the vertical position of the point in the coordinate system) of upper or lower ACDR segments between the 2 groups (P > 0.05). At the 2years' follow-up, there were significant differences both in FE-COR-X and FE-COR-Y between the 2 groups (P < 0.05). For the Mobi-C group, in both the upper and lower segment, the FE-COR-X significantly increased compared with preoperative (P < 0.05), while the FE-COR-Y decreased compared with preoperative (P < 0.05). For the Bryan group, no significant changes were observed in the upper or lower segment in both FE-COR-X and FE-COR-Y compared with preoperative (P > 0.05). Fourty-eight adjacent segments (24 superior and 24 inferior segments) were included in the studies of adjacent segment disease. Four segments showed imaging adjacent segment disease (4/48, 8.33%) in 4 patients, of which 2 were mild and 2 were moderate according to the grading criteria. Among them, 2 were from the Mobi-C group and 2 were from the Bryan group. No severe imaging degeneration was observed. In continuous 2-level cervical ACDR surgery, both Mobi-C and Bryan artificial cervical discs achieved satisfactory clinical outcomes in the short to medium term postoperatively. The FE-COR exhibited different trends of change. In the Mobi-C group, the FE-COR for both upper and lower segments shifted anteriorly and inferiorly, whereas in the Bryan group, whether upper or lower, the FE-COR remained closer to the preoperative state. The changes in FE-COR did not significantly affect the short-term to medium-term clinical outcomes postoperatively.

Wettbewerbsfähigkeit der Industrie und Energiepreise

Abstract The rise in energy prices in 2021/22 put the competitiveness of Austrian manufacturing industry to the test. Model-based simulations and an enterprise survey were carried out to analyze the medium-term effects of high energy prices. The results show that the cost disadvantages in international competition induced by energy price increases will lead to a decline in industrial production and employment in the medium term and increase the risk of relocation of energy-intensive production.

Beyond short-term impact of COVID-19 on transport decarbonization: a scenario analysis of passenger and freight transport by mode in China, 2020–2030

BackgroundThe processes of transport decarbonisation are complicated. In this paper, we adopt the Activity-Modal Share-Energy Intensity-Carbon Intensity of Fuel (ASIF) approach and propose a conceptual framework on the direct and indirect impact of COVID-19 on transport CO2 emissions. In the Chinese context, changes of carbon emissions associated with passenger and freight transport (including urban, rural, and inter-city transport) across different transport modes are estimated. Scenario analysis is then used to estimate the impact of COVID-19 on total transport carbon emissions up to 2030. Four scenarios, from minimal to significant behavioural changes and global recession associated with COVID-19, are generated.ResultsUnder the pandemic, the transport system in China was estimated to have produced 28% less CO2 emissions (1044.2 Mt) in 2020, when compared to 2019. Compared with the business-as-usual scenario, the estimated total transport carbon emissions in 2030 would drop by 6%, 15%, and 21% and 23% under the minimal-impact, low-impact, moderate-impact, and severe-impact scenarios, respectively.ConclusionsThe results suggest that the processes triggered by COVID-19 alone will not be sufficient to meet the ambitious transport decarbonisation targets. To meet China’s pledge under the United Nations Framework on Climate Change, the medium-term effects of COVID-19 must be combined with strong transport decarbonisation measures of modal shift and new energy applications. With these additional measures, it may be possible to advance the transport carbon peak before 2030. Lessons are relevant to other developing countries.

Feasibility of individualized home exercise programs for patients with head and neck cancer-study protocol and first results of a multicentre single-arm intervention trial (OSHO #94).

Patients with head and neck cancer (PwHNC) benefit from targeted exercise interventions: symptom relief, compensation for dysfunction, improvement in quality of life (QoL). Data on acceptance physical interventions in PwHNC are rare. The 'OSHO #94' trial investigates the short- and medium-term effects of individualized home exercise in PwHNC on QoL, physical activity and functionality. The study includes a feasibility phase (proof of concept) in order to evaluate the acceptance. Here we present the study protocol as well as the feasibility results. This prospective, multicentre, single-arm intervention study includes PwHNC ≥18 years of age in aftercare or palliative care with stable remission under immunotherapy. The study opened in January 01, 2021, with estimated completion by December 31, 2024. The PwHNC receive an individualized home exercise program consisting of mobilization, coordination, strengthening and stretching exercises. This should be carried out at least three times a week over 12 weeks for 15 to 30 minutes, supplemented by aerobic training two to three times a week for 30 minutes (intervention). Once weekly telephone calls with a physiotherapist are performed. Subsequently, there is a 12-week follow-up (FU) without exercise specifications/contact. Outcomes are measured before and after the intervention and following the FU. Primary outcome of the feasibility phase (n = 25) was the determination of the dropout rate during the intervention with a termination cut off if more than 30% PwHNC withdrew premature. The primary outcome of the OSHO #94' trial (N = 53) is the change in global QoL score from pre- to post-intervention (EORTC QLQ-C30). Secondary outcomes include clinical and patient-reported measures, training details as well as functional diagnostic data (e.g. level of physical activity, training frequency, flexibility, fall risk and aerobic performance). 25 PwHNC were enrolled onto the feasibility cohort. Only16% (4/25 patients) did not complete the study. Therefore, recruitment of PwHNC was continued. The dropout rate was adjusted from 30% (N = 60) to 20% (N = 53, calculated sample size n = 42 PwHNC and 20% (n = 11) to dropout). Individualized home exercise programs in PwHNC in aftercare seem feasible. Consequently, the aim is now to evaluate the short and medium-term effects of individualized home exercise.

A cardiac-rehab behaviour intervention to reduce sedentary time in coronary artery disease patients: the SIT LESS randomized controlled trial

BackgroundHigh sedentary times (ST) is highly prevalent in patients with coronary artery disease (CAD), highlighting the need for behavioural change interventions that effectively reduce ST. We examined the immediate and medium-term effect of the SIT LESS intervention on changes in ST among CAD patients enrolled in cardiac rehabilitation (CR).MethodsCAD patients participating in CR at 2 regional hospitals were included in this randomized controlled trial (1:1, stratified for gender and hospital). The control group received CR, whereas SIT LESS participants additionally received a 12-week hybrid behaviour change intervention. The primary outcome was the change in accelerometer-derived ST from pre-CR to post-CR and 3 months post-CR. Secondary outcomes included changes in ST and physical activity characteristics, subjective outcomes, and cardiovascular risk factors. A baseline constrained linear mixed-model was used.ResultsParticipants (23% female; SIT LESS: n = 108, control: n = 104) were 63 ± 10 years. Greater ST reductions were found for SIT LESS compared to control post-CR (-1.7 (95% confidence interval (CI): -2.0; -1.4) versus − 1.1 (95% CI: -1.4; -0.8) h/day, pinteraction=0.009), but not at 3 months post-CR (pinteraction=0.61). Besides, larger light-intensity physical activity (LIPA) increases were found for SIT LESS compared to control post-CR (+ 1.4 (95% CI: +1.2; +1.6) versus + 1.0 (95% CI: +0.8; +1.3) h/day, pinteraction=0.020). Changes in other secondary outcomes did not differ among groups.ConclusionSIT LESS transiently reduced ST and increased LIPA, but group differences were no longer significant 3 months post-CR. These findings highlight the challenge to induce sustainable behaviour changes in CAD patients without any continued support.Trial registrationNetherlands Trial Register: NL9263. Registration Date: 24 February 2021.

Pain, function and peritendinous effusion improvement after dry needling in patients with long head of biceps brachii tendinopathy: a single-blind randomized clinical trial

Introduction Long head of biceps brachii tendinopathy, a frequent source of anterior shoulder pain, may lead to discomfort and diminished function. The objective of this study is to assess the efficacy of dry needling and transcutaneous electrical nerve stimulation in these patients. Patients and methods Thirty patients were randomized into dry needling and transcutaneous electrical nerve stimulation groups and assessed before treatment, 8 and 15 days after treatment using a visual analogue scale, shoulder pain and disability index, pressure pain threshold, tissue hardness, and biceps peritendinous effusion. Results Both treatments significantly reduced the visual analogue scale in immediate (p < 0.001), short-term (p < 0.01), and medium-term effects (p < 0.01). Dry needling outperformed transcutaneous electrical nerve stimulation for the pain (p < 0.01) and disability (p < 0.03) subscales of the shoulder pain and disability index in the short-term and medium-term effects, respectively. Pressure pain threshold increased after both treatments but didn’t last beyond 8 days. Neither treatment showed any improvements in tissue hardness of the long head of biceps brachii muscle. Notably, only the dry needling group significantly reduced biceps peritendinous effusion in both short-term and medium-term effects (p < 0.01). Conclusions Dry needling showed non-inferior results to transcutaneous electrical nerve stimulation in reducing pain and disability and demonstrated even superior results in reducing biceps peritendinous effusion (see Graphical ). Trial registration The Institutional Review Board of the China Medical University Hospital (CMUH107-REC2-101) approved this study, and it was registered with Identifier NCT03639454 on ClinicalTrials.gov.

The macroeconomic impact of euro area labor market reforms: evidence from a narrative panel VAR

Using quarterly narrative evidence, the paper examines the macro-economic impact of reforms of unemployment benefits (UB) and employment protection legislation (EPL) in the euro area from a Bayesian narrative panel VAR. The approach complements micro-econometric approaches by assessing aggregate effects and aligning short- and medium-term effects in a unified framework. I find that liberalizing reforms of UB and regular contract EPL resulted in temporary wage declines and persistent increases in economic activity and employment.

LC-OCT as a tool to visualize in vivo location of dermal fillers.

Dermal fillers have emerged as a popular non-surgical solution for facial rejuvenation and enhancement. Apart from botulinum toxin injections, they are the most common non-surgical procedure performed in the US. Line-field optical coherence tomography (LC-OCT; deepLive system Damae Medical, France) represents one of the most recent developments in non-invasive skin imaging technologies. We performed LC-OCT image acquisition on six patients that were treated with hyaluronic acid (HA) dermal fillers in various locations on the face. The images were acquired before the application of the fillers (T0), immediately after (T1), and at a 6- to 8-week (T2) follow-up visit. At T0, we were able to appreciate a normal-appearing epidermis, dermoepithelial junction, and dermis. At T1, the intradermal filler deposits appeared as homogeneously hyporeflective areas, clearly discernible from surrounding vessels and other structures. At T2, the deposits were distinguishable as hyporeflective areas, although they were diminished in size compared to T1. On enface view, collagen fibers had increased thickness and were more homogeneously organized and hyperreflective. We established the usefulness of LC-OCT in the non-invasive evaluation of dermal HA fillers to visualize both short-term and medium-term effects. LC-OCT may be a valuable tool in evaluating the precise location of filler placement and follow-up of resulting in vivo changes.

Antireflux surgery for prevention of chronic lung allograft dysfunction (CLAD) onset after lung transplantation: The earlier the better before CLAD onset? A single-center series of 284 patients

BackgroundGERD is highly prevalent after lung transplantation (LTx), and suspected to favor the development of chronic lung allograft disease (CLAD), almost of BOS phenotype. The preventive effect of anti-reflux surgery (ARS) on BOS/CLAD onset in patients with GERD still remains debated. We compared the outcome (freedom from CLAD and graft survival) of patients with GERD with or without performed ARS (GERD-ARS and GERD-noARS groups) and those without GERD (noGERD group) in our LTx cohort. MethodsData from 284 LTx recipients with available post-LTx pHmetry findings were reviewed (2001-2014). We focused on the outcome of 244 patients without CLAD at the date of pHmetry. ResultsAmong 244 stable patients at the date of pHmetry, 78 patients did not have GERD and 166 patients had GERD [41 with and 125 without ARS performed]). The mean DeMeester score was higher in the GERD-ARS group than GERD-noARS group (p=0.03). An increase of DSAs MFI values was observed only in GERD after LTx (M6 vs day 0, p<0.0001; M12 vs day 0, p=0.003).Freedom from CLAD at 3 years post-pHmetry/ARS was higher for GERD-ARS patients as compared to GERD-noARS patients (p=0.002). Additionally, ARS was independently associated with a subsequent decreased risk of CLAD onset at 3 years in GERD patients (GERD-ARS versus GERD-noARS, p=0.02 [Cox models]). ARS was safe in this series, with no surgery-related deaths. ConclusionOur results suggested a preventive effect of ARS on CLAD onset in stable selected patients with GERD, with a beneficial medium-term effect. IRB approval numberIRB00012437

Short- and medium-term effects of a single session of pain neuroscience education on pain and psychological factors in patients with chronic low back pain. A single-blind randomized clinical trial.

Biopsychosocial approach in patients suffering chronic low back pain (CLBP) promotes pain self-management strategies. Current evidence recommends high dose of Pain Neuroscience Education (PNE) for clinically significant differences. However, the workload and time constraints experienced by healthcare providers impede the application of the recommended treatment regimen. In fact, Back School with a biomechanical model is the main approach to manage CLBP in public systems. The objective of this study is to explore the effect of a 60 min single session of PNE as an adjunct to back school on pain intensity and psychological variables patients with CLBP. A double-blind, two-arm randomized controlled clinical trial was conducted in patients with CLBP who attended back school sessions held in a Spanish public hospital. A total of 121 patients were randomized into control group, who received the Back School program during 5 weeks, and intervention group, who additionally received a single session of PNE. Patient-reported outcomes were the Numerical Pain Rating Scale, Central Sensitization Inventory, Pain Catastrophizing Scale, and Tampa Scale of Kinesiophobia, with a 12-week follow-up. A total of 113 patients were analysed. Intervention and control group presented similar effects on pain and kinesiophobia. At follow-up, intervention group exhibited reduced sensitization and catastrophism scores compared with control, including the subscales. Additionally, PNE reduced the percentage of participants classified as having central sensitization compared with control. Adding a single PNE session in the back school program did not reduce pain but improved psychological factors as central sensitization and pain catastrophizing at medium-term. This study highlights the potential of PNE to optimize treatment strategies for CLBP, especially in public health centres where time resources are scarce. Adding a single PNE session in the back school program did not reduce pain but improved psychological factors as central sensitization and pain catastrophism at medium-term.

Dynamic Interrelation between Aggregated Revenues and Expenditures of Regional-Level Budgets of Federal States: A Time-Frequency Approach to Analysis

Objective: The article analyzes the dynamic (time-frequency) relationship between aggregate budget expenditures and revenues of the federal constituent entities, considering four competing theoretical hypotheses: “expenditures-revenues”; “revenues-expenditures”; “fiscal synchronization”; and “fiscal neutrality”, over time (2013:12÷2023:03). Method: The study was conducted using wavelet coherence analysis, which made it possible to separate short-term, medium-term and long-term effects in the dynamic dependence of the analyzed variables, and identify the direction and intensity of this relationship. Finding: The research results indicate the existence of all four relationships between aggregated budget revenues and expenditures of the federal constituent entities for various time periods, on different time scales, throughout the entire observation time interval (2013:12÷2023:03). These findings demonstrate that, to a greater extent, the budgets of the federal constituent entities are characterized by the presence of a dynamic relationship between aggregated revenues and expenditures in the following modes: “revenues-expenditures” (when revenues are ahead of expenditures) and “expenditures-revenues” (when expenditures are ahead of revenues). In addition, the time scale and time range of the emergence of the “fiscal synchronization” and “fiscal neutrality” modes in the relationship between aggregated revenues and expenditures of the federal constituent entities are determined. Implication: The results obtained provide a possible explanation for the contradictory results of numerous studies based on traditional methods and empirical observations over different historical periods, since each of these methods only partially explains a particular mode of the dynamic relationship between revenues and expenditures. The theoretical significance of the study lies in the substantiation that continuous wavelet analysis is a powerful tool for studying the nonlinear relationship between revenues and expenditures, since understanding the causalities between revenues and expenditures on various time scales is significant for choosing measures aimed at maintaining the budget sustainability of the federal constituent entities. The practical significance of the research results is determined by the fact that they can be an essential starting point for determining the necessary fiscal policy measures aimed at increasing the budget sustainability of the federal constituent entities.