Rapid Swings Research Articles

Inflation–inequality puzzle: is it still apparent?

PurposeThe primary focus of this study is to examine the distributional consequences of the widespread increase in prices. The fundamental question the study aims to address is whether the dynamics of income distribution due to higher inflation differ in the short term compared to the long run.Design/methodology/approachThe authors estimated a panel-data model (fixed effects) using inequality and inflation data available at a high frequency, i.e. on a quarterly basis for over 30 years, and found evidence that inflation causes rapid swings in income distribution.Findings The authors’ contribution to the literature lies in providing evidence that inflation rapidly causes swings in income distribution, even after controlling for the state of the economy. The authors also demonstrate that the magnitude and direction of the effect of inflation on income inequality depend on whether the initial inflation rate is below or above the Federal Reserve’s target of 2%.Originality/valueTo the best of the authors’ knowledge, the authors are the first to emphasize that the targets set by central banks can drive the strength and direction of the relationship between inflation and income inequality.

New Forms of Collaboration Between the Social and Natural Sciences Could Become Necessary for Understanding Rapid Collective Transitions in Social Systems

Human societies are complex systems and as such have tipping points. They can rapidly transit from one mode of operation to another and thereby change the way they function as a whole. Such transitions appear as financial or economic crises, rapid swings in collective opinion, political regime shifts, or revolutions. In physics collective transitions are known as phase transitions; for example, water exists in states of liquid, ice, and vapor. A few variables determine which state is realized: temperature, pressure, and volume. For social systems it is less clear what determines collective social states. A better understanding of social tipping points would allow us to tackle some of the big challenges more systematically, such as polarization, loss of social cohesion, fragmentation, or the green transition. The physics concept of universality might be key to understanding some tipping points in human societies and why agent-based models (ABMs) might make sense for identifying the transition points. If universality exists in social systems there is hope that relatively simple ABMs will be sufficient for understanding collective social systems in transition; if it does not exist, highly detailed computational models will be unavoidable. Both are possible. Both need new forms of collaboration between the social and natural sciences, and new types of data will be essential.

DNA from non-viable bacteria biases diversity estimates in the corals Acropora loripes and Pocillopora acuta

BackgroundNucleic acid-based analytical methods have greatly expanded our understanding of global prokaryotic diversity, yet standard metabarcoding methods provide no information on the most fundamental physiological state of bacteria, viability. Scleractinian corals harbour a complex microbiome in which bacterial symbionts play critical roles in maintaining health and functioning of the holobiont. However, the coral holobiont contains both dead and living bacteria. The former can be the result of corals feeding on bacteria, rapid swings from hyper- to hypoxic conditions in the coral tissue, the presence of antimicrobial compounds in coral mucus, and an abundance of lytic bacteriophages.ResultsBy combining propidium monoazide (PMA) treatment with high-throughput sequencing on six coral species (Acropora loripes, A. millepora, A. kenti, Platygyra daedalea, Pocillopora acuta, and Porites lutea) we were able to obtain information on bacterial communities with little noise from non-viable microbial DNA. Metabarcoding of the 16S rRNA gene showed significantly higher community evenness (85%) and species diversity (31%) in untreated compared with PMA-treated tissue for A. loripes only. While PMA-treated coral did not differ significantly from untreated samples in terms of observed number of ASVs, > 30% of ASVs were identified in untreated samples only, suggesting that they originated from cell-free/non-viable DNA. Further, the bacterial community structure was significantly different between PMA-treated and untreated samples for A. loripes and P. acuta indicating that DNA from non-viable microbes can bias community composition data in coral species with low bacterial diversity.ConclusionsOur study is highly relevant to microbiome studies on coral and other host organisms as it delivers a solution to excluding non-viable DNA in a complex community. These results provide novel insights into the dynamic nature of host-associated microbiomes and underline the importance of applying versatile tools in the analysis of metabarcoding or next-generation sequencing data sets.

Resources for business resilience in a COVID-19 world: A community-centric approach

COVID-19 has drawn renewed focus on the importance of resilience, both among practitioners and in academia, as companies struggle to cope with the rapid swings, changing patterns, and disruptions in supply and demand. This article identifies and delineates a way forward for companies to support resilience, particularly recognizing the wider communities they are nested in and the resources that exist there. To identify such productive resources, known as capitals, we provide a novel and actionable integrated capitals framework (ICF). ICF integrates 10 existing frameworks drawn from both practice and academia and is comprised of nine different forms of capital that businesses can leverage and contribute toward supporting resilience. We provide insights into how businesses can use this framework to achieve resilience through this useful, yet underutilized, path.

Methane, Monsoons, and Modulation of Millennial‐Scale Climate

AbstractEarth's orbital geometry exerts a profound influence on climate by regulating changes in incoming solar radiation. Superimposed on orbitally paced climate change, Pleistocene records reveal substantial millennial‐scale variability characterized by abrupt changes and rapid swings. However, the extent to which orbital forcing modulates the amplitude and timing of these millennial variations is unclear. Here we isolate the magnitude of millennial‐scale variability (MMV) in two well‐dated records, both linked to precession cycles (19,000‐ and 23,000‐year periodicity): composite Chinese speleothem δ18O, commonly interpreted as a proxy for Asian monsoon intensity, and atmospheric methane. At the millennial timescale (1,000–10,000 years), we find a fundamental decoupling wherein precession directly modulates the MMV of methane but not that of speleothem δ18O, which is shown to be strikingly similar to the MMV of Antarctic ice core δ2H. One explanation is that the MMV of methane responds to changes in midlatitude to high‐latitude insolation, whereas speleothem δ18O is modulated by internal climate feedbacks.

X-ray study of high-and-low luminosity modes and peculiar low-soft-and-hard activity in the transitional pulsar XSS J12270−4859

XSS J12270−4859 (henceforth J12270) is the first low-mass X-ray binary to exhibit a transition, taking place at the end of 2012, from an X-ray active state to a radio pulsar state. The X-ray emission based on archival XMM-Newton observations is highly variable, showing rapid variations (∼10 s) from a high X-ray luminosity mode to a low mode and back. A flaring mode has also been observed. X-ray pulsations have been detected during the high mode only. In this work we present two possible interpretations for the rapid swings between the high and low modes. In the first scenario, this phenomenon can be explained by a rapid oscillation between a propeller state and a radio-ejection pulsar state, during which the pulsar wind prevents matter from falling onto the neutron star surface. In the second scenario, a radio pulsar is always active, the intra-binary shock is located just outside the light cylinder in the high mode, while it expands during the low mode. At variance with other transitional pulsars, J12270 shows two instances of the low mode: a low-soft and low-hard mode. Performing an X-ray spectral analysis, we show that the harder component, present in the low-hard spectra, is probably related to the tail of the flare emission. This supports the understanding that the flare mechanism is independent of the high-to-low mode transitions.

Winter Weather Whiplash: Impacts of Meteorological Events Misaligned With Natural and Human Systems in Seasonally Snow‐Covered Regions

Abstract“Weather whiplash” is a colloquial phrase for describing an extreme event that includes shifts between two opposing weather conditions. Prior media coverage and research on these types of extremes have largely ignored winter weather events. However, rapid swings in winter weather can result in crossing from frozen to unfrozen conditions, or vice versa; thus, the potential impact of these types of events on coupled human and natural systems may be large. Given rapidly changing winter conditions in seasonally snow‐covered regions, there is a pressing need for a deeper understanding of such events and the extent of their impacts to minimize their risks. Here we introduce the concept of winter weather whiplash, defined as a class of extreme event in which a collision of unexpected conditions produces a forceful, rapid, back‐and‐forth change in winter weather that induces an outsized impact on coupled human and natural systems. Using a series of case studies, we demonstrate that the effects of winter weather whiplash events depend on the natural and human context in which they occur, and discuss how these events may result in the restructuring of social and ecological systems. We use the long‐term hydrometeorological record at the Hubbard Brook Experimental Forest in New Hampshire, USA to demonstrate quantitative methods for delineating winter weather whiplash events and their biophysical impacts. Ultimately, we argue that robust conceptual and quantitative frameworks for understanding winter weather whiplash events will contribute to the ways in which we mitigate and adapt to winter climate change in vulnerable regions.

Japan's Return to Great Power Politics: Abe's Restoration

Japan's Return to Great Power Politics:Abe's Restoration Kenneth B. Pyle (bio) keywords japan, shinzo abe, foreign policy, U.S.-Japan alliance [End Page 69] executive summary This essay explains how Prime Minister Shinzo Abe is engineering a seismic shift in Japan's foreign policy from a postwar position of dependence and subordination in the U.S.-led order to a proactive and independent role, which in the uncertain regional environment is likely to gain increasing popular support. main argument After more than 70 years of subordination in the U.S.-led world order, Japan is pulling free from its self-binding constraints and restoring an activist foreign policy not seen since 1945. Coming to power with a surge of conservative nationalist support in the Liberal Democratic Party, Abe has engineered Japan's return to great-power politics. He has achieved a historic reinterpretation of the constitution to permit collective self-defense, ended the ban on arms exports and other self-binding policies, and pressed for new offensive military capacity, all of which have made possible a much more cohesive and integrated U.S.-Japan alliance. Although Abe and the policy elite have had to override public opposition in returning Japan to this activist role, in such circumstances of transition in the international order, Japan has historically experienced rapid swings in geopolitical position. With the growing uncertainty of regional conditions, we should not be surprised if the pacifist identity that postwar generations have long embraced gives way and we see changes in the prolonged resistance of the Japanese public to revision of the constitution and to an activist and assertive foreign policy. policy implications • Japan will closely weigh the reliability of U.S. assurances and the future direction of U.S. policy in Asia, especially as they relate to the management of the nuclear threat from North Korea and to Japanese interests vis-à-vis China. • Japan's immediate priority will be to strengthen its alignment with the U.S., but in the longer term it will increasingly move toward a more independent foreign policy that offers greater autonomy and room to adjust to its perception of the shifting regional balance of power. • Although Abe appears likely to remain in office until 2021, even should his term be shortened, his policies now have a momentum that will be very difficult to reverse. These policies are supported by all likely LDP candidates to succeed him, and the political opposition is weaker than at any time in the postwar period. [End Page 70] In 2018, Japan is celebrating the 150th anniversary of its modern revolution, the Meiji Restoration of 1868. The nature of a country's modern revolution illuminates a great deal about the national character, the strategic principles, and the logic of a people. Just as 1776 tells Americans so much about ourselves—the ideals and purposes that we hold central—so the Meiji Restoration reveals much about the nature and purpose of modern Japan. The restoration was not a class upheaval proclaiming new values. Rather, it was a conservative nationalist revolution, carried out "from above" by a party within the old samurai elite and driven by the dangers posed by the Western imperial powers. Its purpose was to strengthen Japan, adapt to the changes in the external environment, restore the independence that was infringed by the West, and bring Japan into the company of the great powers. Over the next two decades, borrowing broadly from the Western powers, the Meiji Restoration achieved one of the most remarkable institutional innovations in world history: Japan became Asia's first rising power. This formative experience of Japan's entry into the modern world established a strategic style of realism and pragmatism in response to shifts in the international system. In the prime ministership of Shinzo Abe, we are witnessing a similar accommodation to changes in the international system. Like the Meiji Restoration—albeit on a more limited historical scale—Abe is engineering a foreign policy revolution carried out from above by a conservative elite. When his cabinet in 2014 approved a radical reinterpretation of the constitution to allow collective self-defense, Abe reportedly told leaders of the ruling Liberal Democratic Party (LDP...

A peculiar multiwavelength flare in the blazar 3C 454.3

The blazar 3C454.3 exhibited a strong flare seen in gamma-rays, X-rays, and optical/NIR bands during 3--12 December 2009. Emission in the V and J bands rose more gradually than did the gamma-rays and soft X-rays, though all peaked at nearly the same time. Optical polarization measurements showed dramatic changes during the flare, with a strong anti-correlation between optical flux and degree of polarization (which rose from ~ 3% to ~ 20%) during the declining phase of the flare. The flare was accompanied by large rapid swings in polarization angle of ~ 170 degree. This combination of behaviors appear to be unique. We have cm-band radio data during the same period but they show no correlation with variations at higher frequencies. Such peculiar behavior may be explained using jet models incorporating fully relativistic effects with a dominant source region moving along a helical path or by a shock-in-jet model incorporating three-dimensional radiation transfer if there is a dominant helical magnetic field. We find that spectral energy distributions at different times during the flare can be fit using modified one-zone models where only the magnetic field strength and particle break frequencies and normalizations need change. An optical spectrum taken at nearly the same time provides an estimate for the central black hole mass of ~ 2.3 * 10^9 M_sun. We also consider two weaker flares seen during the $\sim 200$ d span over which multi-band data are available. In one of them, the V and J bands appear to lead the $\gamma$-ray and X-ray bands by a few days; in the other, all variations are simultaneous.

Medical management and perioperative issues in pediatric pheochromocytoma – A case report with review of literature

Pheochromocytoma is a tumor arising out of embryological neural crest, being a tumor of adrenal medulla secreting predominantly norepinephrine as well as epinephrine(about 20% cases) leading to frequent surges of vasopressor catecholamines leading to systemic hypertension, hypertensive emergencies and associated cardiac, neurological, and renal sequalae. Though somewhat rare in pediatric age group, it remains an important etiological factor to think about when there is intractable hypertension or rapid swings of blood pressures leading to headaches and palpitations with family history of hypertension or as a part of familial endocrine neoplasia. Treatment remains laproscopic or open surgical resection under general anesthesia, however perioperative care remains a challenge for the anesthesiologist, intensivist requiring adequate medical control of hypertension with alpha blockers such as phenoxybenza- mine before undertaking anesthetic induction and important monitoring measures instituted during intraoperative and postoperative period for close monitoring of blood pressure and intravascular volume status as well as hemodynamics. We review a case report with literature review regarding perioperative management of pheochromocytoma.

Dynamic Simulation of EAF on RTDS for Compensation Sizing

Large sized electric arc furnaces (EAF) causes power quality problems such as flicker, harmonics etc. due to their unbalanced and non-linear behavior characteristics. The rapid swings in real and reactive power of such non-linear loads causes fast repetitive voltage variations with appreciable voltage distortion caused by harmonics and unbalance. Some form of reactive compensation is usually adopted to limit the disturbances caused by EAF in electric power system, in particular the flicker. This paper highlights the results of a case study, where the arc furnace is modelled using statistical dynamic model of the furnace using real time digital simulator which allows more real time simulations tests to be conducted in a shorter time and also provides a more detailed power system representation for the tests. The investigation of the simulation study results showed that static VAR compensators can be successfully used for reduction of flicker levels, compensation of reactive power and for the regulation of voltage levels in the EAF plant under study.

High-frequency polarity swings during the Gauss-Matuyama reversal from Baoji loess sediment

Paleomagnetic records of the Gauss-Matuyama reversal were obtained from two loess sections at Baoji on the Chinese Loess Plateau. Stepwise thermal demagnetization shows two obvious magnetization components. A low-temperature component isolated between 100 and 200–250°C is close to the present geomagnetic field direction, and a high-temperature component isolated above 200–250°C reveals clearly normal, reversed, and transitional polarities. Magnetostratigraphic results of both sections indicated that the Gauss-Matuyama reversal consists of a high-frequency polarity fluctuation zone, but the characteristic remanent magnetization directions during the reversal are clearly inconsistent. Rock magnetic experiments demonstrated that for all the specimens with normal, reversed, and transitional polarities magnetite and hematite are the main magnetic carriers. Anisotropy of magnetic susceptibility indicates that the studied loess sediments have a primary sedimentary fabric. Based on virtual geomagnetic pole latitudes, the Gauss-Matuyama reversal records in the two sections are accompanied by 14 short-lived geomagnetic episodes (15 rapid polarity swings) and 12 short-lived geomagnetic episodes (13 rapid polarity swings), respectively. Our new records, together with previous ones from lacustrine, marine, and aeolian deposits, suggest that high-frequency polarity swings coexist with the Gauss-Matuyama reversal, and that the Gauss-Matuyama reversal may have taken more than 11 kyr to complete. However, we need more detailed analyses of sections across polarity swings during reversals as well as more high-resolution reversal records to understand geomagnetic behavior and inconsistent characteristic remanent magnetization directions during polarity reversals.

Living an unstable everyday life while attempting to perform normality – the meaning of living as an alcohol‐dependent woman

To illuminate the meaning of living with alcohol dependency as a woman. The number of women suffering from alcohol dependency is increasing. Today there are shortcomings in knowledge about the lived experiences of being a woman with alcohol dependency; knowledge which might be of importance for meeting these women's specific needs of care. The study has a qualitative design. Fourteen women with alcohol dependency participated in open in-depth interviews. Data were analysed according to a phenomenological-hermeneutic method, and interpreted by help from gender and caring perspectives as well as results from previous research of alcohol dependency. In relation to the women's senses of well-being, four main gender formations were found; An unstable self involving continual and rapid swings between emotional and bodily reactions. Ambivalence - meaning ambiguous feelings towards themselves as human beings and how they lead their lives. Introspectiveness - involving reflections, pondering and being introverted. Attempts to perform normality - covering - dealing with life through various strategies and facades to live up to the expectations of how to behave as a woman. Living with alcohol dependency as a woman constitutes of a rapid shifting everyday life resulting in senses of alienation as well as private introspection leading to self-degradation, and to a lesser extent meaningfulness and hope. It also constitutes of managing to perform normality. When supporting women with alcohol dependency towards wellbeing, professionals need to work towards approaching the woman's inner thoughts, share them and reflect over them together. To support these women to find balance in life, caregivers need to cooperate with the women to find out how best to live a life adjusted to the woman's abilities and wishes.

Subthalamic nucleus versus globus pallidus bilateral deep brain stimulation for advanced Parkinson's disease (NSTAPS study): a randomised controlled trial

Patients with advanced Parkinson's disease often have rapid swings between mobility and immobility, and many respond unsatisfactorily to adjustments in pharmacological treatment. We assessed whether globus pallidus pars interna (GPi) deep brain stimulation (DBS) gives greater functional improvement than does subthalamic nucleus (STN) DBS. We recruited patients from five centres in the Netherlands who were aged 18 years or older, had idiopathic Parkinson's disease, and had, despite optimum pharmacological treatment, at least one of the following symptoms: severe response fluctuations, dyskinesias, painful dystonias, or bradykinesia. By use of a computer-generated randomisation sequence, we randomly assigned patients to receive either GPi DBS or STN DBS (1:1), applying a minimisation procedure according to drug use (levodopa equivalent dose <1000 mg vs ≥1000 mg) and treatment centre. Patients and study assessors (but not those who assessed adverse events) were masked to treatment allocation. We had two primary outcomes: functional health as measured by the weighted Academic Medical Center Linear Disability Scale (ALDS; weighted by time spent in the off phase and on phase) and a composite score for cognitive, mood, and behavioural effects up to 1 year after surgery. Secondary outcomes were symptom scales, activities of daily living scales, a quality-of-life questionnaire, the occurrence of adverse events, and drug use. We used the intention-to-treat principle for all analyses. This trial is registered with www.controlled-trials.com, number ISRCTN85542074. Between Feb 1, 2007, and March 29, 2011, we enrolled 128 patients, assigning 65 to GPi DBS and 63 to STN DBS. We found no statistically significant difference in either of our primary outcomes: mean change in weighted ALDS (3·0 [SD 14·5] in the GPi group vs 7·7 [23·2] in the STN group; p=0·28) and the number of patients with cognitive, mood, and behavioural side-effects (36 [58%] of 62 patients in the GPi group vs 35 [56%] of 63 patients in the STN group; p=0·94). Secondary outcomes showed larger improvements in off-drug phase in the STN group compared with the GPi group in the mean change in unified Parkinson's disease rating scale motor examination scores (20·3 [16·3] vs 11·4 [16·1]; p=0·03), the mean change in ALDS scores (20·3 [27·1] vs 11·8 [18·9]; p=0·04), and medication (mean levodopa equivalent drug reduction: 546 [SD 561] vs 208 [521]; p=0·01). We recorded no difference in the occurrence of adverse events between the two groups. Other secondary endpoints showed no difference between the groups. Although there was no difference in our primary outcomes, our findings suggest that STN could be the preferred target for DBS in patients with advanced Parkinson's disease. Stichting Internationaal Parkinson Fonds, Prinses Beatrix Fonds, and Parkinson Vereniging.

Temporal and spatial dynamics of a “Rust-Belt” urban stream: Metabolic and water quality responses to hardened land

Highly resolved (30-min period) measurements of dissolved oxygen, temperature, conductivity, and turbidity in streams over 2–6 days during dry and wet periods within and outside the heavily urbanized city of Syracuse, NY are used to calculate gross primary production (GPP), total ecosystem respiration (ER) and total and net ecosystem production (NEP). Based on results, it is proposed that a city’s stream metabolism and water quality may be regarded in a “Jekyll–Hyde” analogy, i.e., under dry conditions, this stream behaved much like a headwater system (Jekyll), but had far greater discharge as well as rapid swings in conductivity, turbidity, temperature, and oxygen concentrations during storm events (Hyde). Such dynamics could be damped by increasing soft, absorbent surfaces (green infrastructure) within the city.

Renewable energy: More distributed solar means fewer new combustion turbines

AbstractA strategic renewable energy strategy that prioritizes distributed solar would eliminate the justification of a new generation of fast‐start gas turbines presumed to be necessary to address rapid swings in output from utility‐scale solar and wind projects.

Screening of patients with tuberculosis for diabetes mellitus in China

There is a high burden of both diabetes (DM) and tuberculosis (TB) in China, and this study aimed to assess feasibility and results of screening patients with TB for DM within the routine healthcare setting of six health facilities. Agreement on how to screen, monitor and record was reached in May 2011 at a stakeholders' meeting, and training was carried out for staff in the six facilities in July 2011. Implementation started in September 2011, and we report on 7 months of activities up to 31 March 2012. There were 8886 registered patients with TB. They were first asked whether they had DM. If the answer was no, they were screened with a random blood glucose (RBG) followed by fasting blood glucose (FBG) in those with RBG ≥ 6.1 mm (one facility) or with an initial FBG (five facilities). Those with FBG ≥ 7.0 mm were referred to DM clinics for diagnostic confirmation with a second FBG. Altogether, 1090 (12.4%) patients with DM were identified, of whom 863 (9.7%) had a known diagnosis of DM. Of 8023 patients who needed screening for DM, 7947 (99%) were screened. This resulted in a new diagnosis of DM in 227 patients (2.9% of screened patients), and of these, 226 were enrolled to DM care. In addition, 575 (7.8%) persons had impaired fasting glucose (FBG 6.1 to <7.0 mm). Prevalence of DM was significantly higher in patients in health facilities serving urban populations (14.0%) than rural populations (10.6%) and higher in hospital patients (13.5%) than those attending TB clinics (8.5%). This pilot project shows that it is feasible to screen patients with TB for DM in the routine setting, resulting in a high yield of patients with known and newly diagnosed disease. Free blood tests for glucose measurement and integration of TB and DM services may improve the diagnosis and management of dually affected patients.

Operating boundaries of full-scale advanced water reuse treatment plants: many lessons learned from pilot plant experience

Three Advanced Water Treatment Plants (AWTP) have recently been built in South East Queensland as part of the Western Corridor Recycled Water Project (WCRWP) producing Purified Recycled Water from secondary treated waste water for the purpose of indirect potable reuse. At Luggage Point, a demonstration plant was primarily operated by the design team for design verification. The investigation program was then extended so that the operating team could investigate possible process optimisation, and operation flexibility. Extending the demonstration plant investigation program enabled monitoring of the long term performance of the microfiltration and reverse osmosis membranes, which did not appear to foul even after more than a year of operation. The investigation primarily identified several ways to optimise the process. It highlighted areas of risk for treated water quality, such as total nitrogen. Ample and rapid swings of salinity from 850 to 3,000 mg/l-TDS were predicted to affect the RO process day-to-day operation and monitoring. Most of the setpoints used for monitoring under HACCP were determined during the pilot plant trials.

Ziprasidone-Induced Galactorrhea in an Adolescent Female

To the Editor: Prolactin is a lactogenic hormone, and its release is tonically inhibited by hypothalamic dopamine. Dopamine-2 (D2) receptor blockage in the tuberoinfundibular pathway releases prolactin.1 Second-generation neuroleptics are not particularly associated with hyperprolactinemia. With the exception of risperidone,2 it is assumed that hyperprolactinemia with second-generation antipsychotics (SGAs) is rare and transient.3–5 The rise in serum prolactin is directly associated with the degree of dopamine receptor blockage.6 Ziprasidone is considered to be a weak blocker of the D2 receptor.7 Significant prolactin elevation was not reported as being associated with ziprasidone use.8 To our knowledge, there are at least 5 case reports of ziprasidone-induced galactorrhea in the literature.9–13 Chronic elevation in prolactin in females can lead to loss of libido, galactorrhea, gynecomastia, amenorrhea, oligomenorrhea, hirsutism, disturbance of normal ovarian cycle, or increased risk of chronic osteoporosis. Case report. Ms A, a 16-year-old African American girl, has a history of neglect; sexual, physical, and emotional abuse; and multiple losses. She presented in 2009 with multidimensional symptomatology, which included attention-deficit/hyperactivity disorder (ADHD)–like symptoms (hyperactivity, impulsivity, and inattention); posttraumatic stress disorder–like symptoms (nightmares, flashbacks, numbing, avoidance, and sexually acting out behavior); psychotic symptoms (auditory hallucinations, eg, “voices asking me to do bad stuff”; paranoia, ie, “people are gossiping about me”); bipolar spectrum symptoms (eg, rapid mood swings, anger control issues, impulsivity, and decreased sleep); and oppositional defiant behavior. There was no past history of illicit substance abuse or alcohol drinking. She has a longstanding history of self-mutilating behavior (cutting her wrists) and overdosing on pills, which required multiple psychiatric hospitalizations, including long-term placement in a residential treatment facility. Prior to her current hospitalization, she had been treated with divalproex, quetiapine, and fluoxetine. During the hospitalization, she was started on ziprasidone 80 mg bid and divalproex 500 mg po twice daily was continued. Two weeks after ziprasidone treatment began, she developed galactorrhea and her blood prolactin level was 68.6 ng/mL (laboratory reference value, 1.40–24.20 ng/mL). Ziprasidone was discontinued and aripiprazole 2 mg/d was started. Three weeks later, galactorrhea had stopped and her serum prolactin level was within the normal range. She had no medical condition that could explain the elevated prolactin and galactorrhea levels. Some other known causes of galactorrhea were excluded, eg, chronic renal failure, pregnancy and lactation, and primary hypothyroidism. On a mental status examination, she reported a dysphoric mood and her affect was mood congruent. She had clear speech and had no suicidal or homicidal ideation. There were no hallucinations, but she reported paranoid ideations. Among atypical antipsychotics, ziprasidone has the highest serotonin (5-HT) receptor–dopamine receptor (5-HT2A/D2, 5-HT2C/D2, and 5-HT1A/D2) affinity ratios. Although ziprasidone is a weaker blocker of D2 receptors than conventional antipsychotics, ziprasidone-induced symptomatic hyperprolactinemia has been reported in literature.9–13 At a dose of 120 mg/d, 60% D2 receptor occupancy was obtained.14 Patients with the DRD2A1 allele had a 40% higher level of prolactin as compared to patients without this allele.15 Antipsychotic-induced hyperprolactinemia is not an uncommon condition, but it remains underdiagnosed and undertreated. In conclusion, physicians should routinely inquire about symptoms of hyperprolactinemia, eg, galactorrhea, gynecomastia, menstrual irregularities, and sexual dysfunction, in patients taking neuroleptics. If not treated, these symptoms could lead to noncompliance. Prolactin level can be elevated even in the absence of galactorrhea.

Economic prosperity recaptured: the Finnish path from crisis to rapid growth

Many countries have experienced major economic changes since the mid-1980s as a result of the deregulation and liberalization of national financial systems -- two key aspects of globalization -- with some experiencing boom and bust in rapid succession. The small Northern European country of Finland has been hailed as a success story for achieving renewed economic growth and prosperity after a financial crisis and deep depression in the early 1990s. Economic Prosperity Recaptured offers a detailed analysis of the rapid swings in Finland's recent economic development, from initial overheating in the late 1980s through deep crisis in the early 1990s to recovery and growth since the mid-1990s.Finland's complex road to recovery offers excellent examples of both unsuccessful and successful policy responses to changing circumstances. The authors examine the three relatively distinct periods of Finland's recent experience, analyzing the adequacy of the macroeconomic policy response in each case. They assess the real economic effects of financial constraints and look for evidence of the credit channel of the monetary system. Finland's rapid economic growth since the mid-1990s is largely the result of its structural transformation into a high-tech economy; Nokia is the most famous example of this information and communication technology success. Elaborating on Finland's ICT revolution, the authors demonstrate that well-designed economic policies contributed to Finland's economic turnaround.CESifo Book series