Stimulus Direction Research Articles

Significant impact exerted on global economy by implementing pandemic-reactive global-scale public health measures

Pandemics are global disease outbreaks that have significantly impacted societies, economies, and public health systems throughout history. From the bubonic plague to the Spanish flu and the recent COVID-19 pandemic, these crises have shaped human development and exposed vulnerabilities in health and economic systems. The epidemiological transition outlines three phases of human history: famine and pandemics, reduced outbreaks, and the current phase of degenerative diseases. The COVID-19 pandemic, a historic event, caused severe health, social, and economic disruptions globally. The economic consequences of pandemics are extensive, often persisting long after the health crisis subsides. The COVID-19 pandemic caused widespread unemployment, heightened poverty levels, and significant disruptions in industries and education. Governments implemented fiscal and monetary policies, including direct stimulus measures, to mitigate these effects. However, these actions introduced inflationary pressures and increased public debt, highlighting the complex balance between relief and economic stability. Public health responses, such as vaccination drives and non-pharmaceutical interventions, played a pivotal role in containing COVID-19. The pandemic emphasized the importance of integrating public health and economic policies to ensure comprehensive crisis management. Despite advancements in medical science and policy coordination, challenges such as misinformation, geopolitical tensions, and inadequate global cooperation hindered effective responses. Moving forward, governments must prioritize coordinated health and economic strategies to mitigate future pandemics. Strengthening global collaborations, improving public health systems, and leveraging technology will be crucial to building resilience and ensuring sustainable recovery from health crises.

Visual Upward/Downward Motion Elicits Fast and Fluent High-/Low-Pitched Speech Production

Abstract Participants tend to produce a higher or lower vocal pitch in response to upward or downward visual motion, suggesting a pitch–motion correspondence between the visual and speech production processes. However, previous studies were contaminated by factors such as the meaning of vocalized words and the intrinsic pitch or tongue movements associated with the vowels. To address these issues, we examined the pitch–motion correspondence between simple visual motion and pitched speech production. Participants were required to produce a high- or low-pitched meaningless single vowel [a] in response to the upward or downward direction of a visual motion stimulus. Using a single vowel, we eliminated the artifacts related to the meaning, intrinsic pitch, and tongue movements of multiple vocalized vowels. The results revealed that vocal responses were faster when the pitch corresponded to the visual motion (consistent condition) than when it did not (inconsistent condition). This result indicates that the pitch–motion correspondence in speech production does not depend on the stimulus meaning, intrinsic pitch, or tongue movement of the vocalized words. In other words, the present study suggests that the pitch–motion correspondence can be explained more parsimoniously as an association between simple sensory (visual motion) and motoric (vocal pitch) features. Additionally, acoustic analysis revealed that speech production aligned with visual motion exhibited lower stress, greater confidence, and higher vocal fluency.

Velocity coding in the central brain of bumblebees.

Moving animals experience wide-field optic flow due to the displacement of the retinal image during motion. These cues provide information about self-motion and are important for flight control and stabilization, and for more complex tasks like path integration. While in honeybees and bumblebees the use of wide-field optic flow in behavioral tasks is well investigated, little is known about the underlying neuronal processing of these cues. Furthermore, there is a discrepancy between the temporal frequency tuning observed in most motion-sensitive neurons described so far from the optic lobe of insects and the velocity tuning that has been shown for many behaviors. Here we investigated response properties of motion-sensitive neurons in the central brain of bumblebees. Extracellular recordings allowed us to present a large number of stimuli to probe the spatiotemporal tuning of these neurons. We presented moving gratings that simulated either front-to-back or back-to-front optic flow and found three response types. Direction-selective responses of one of the groups matched those of TN-neurons, which provide optic flow information to the central complex, while the other groups contained neurons with purely excitatory responses that were either selective or non-selective for stimulus direction. Most recorded units showed velocity-coding properties at lower angular velocities, but showed spatial frequency dependent responses at higher velocities. Based on behavioral data, neuronal modelling work has previously predicted the existence of non direction-selective neurons with such properties. Our data now provides physiological evidence for these neurons and shows that neurons with TN-like properties exhibit a similar velocity-dependent coding.

Smart Bioinspired Material‐Based Actuators: Current Challenges and Prospects

This research review discusses several examples of plant movements, either depending on the direction of the triggering stimuli (tropisms) or not (nastic responses), which have served as inspiration to develop smart biomimetic actuators. In addition, it presents an overview of the multiple approaches for the development of autonomous actuators based on synthetic materials, as well as of their advantages and disadvantages, applicability, and limitations. The classification is based on structural and conformational characteristics (mono‐, bi‐, or multimaterial assemblies, their orientation, chemical structures, and geometrical configurations). Additionally, this review presents an alternative formulation and extension of the pioneering Timoshenko's model, which provides an understanding of the underlying mechanical principle of bilayer bending actuation. Finally, upscaled applications of this actuation principle are described, focusing mainly on biomimetic architecture. Attention is given to previously reported real‐life applications based on bio‐based materials and material systems. Furthermore, this review discusses the multiple challenges for synthetic materials when an upscaling perspective is intended. In this sense, key aspects such as time responsiveness and mechanical amplification, in terms of speed, displacement, and load‐bearing capability, are discussed.

Multidigit tactile perception II:perceptual weighting during integration follows a leading-finger priority.

When we run our hand across a surface, each finger typically repeats the sensory stimulation that the leading finger has already experienced. Because of this redundancy, the leading finger may attract more attention and contribute more strongly when tactile signals are integrated across fingers to form an overall percept. To test this hypothesis, we re-analyzed data collected in a previous study (Arslanova I, Takamuku S, Gomi H, Haggard P, J Neurophysiol 128: 418-433, 2022), where two probes were moved in different directions on two different fingerpads and participants reported the probes' average direction. Here, we evaluate the relative contribution of each finger to the percept and examine whether multidigit integration gives priority to the leading finger. Although the hand actually remained static in these experiments, a "functional leading finger" could be defined with reference to the average direction of the stimuli and the direction of hand-object relative motion that this implied. When participants averaged the motion direction across fingers of the same hand, the leading finger received a higher weighting than the nonleading finger, even though this biased estimate of average direction. Importantly, this bias disappeared when averaging motion direction across the two hands. Both the reported average direction and its systematic relation to the difference between the individual stimulus directions were explained by a model of motion integration in which the sensory weighting of stimuli depends on the directions of the applied stimuli. Our finding supports the hypothesis that the leading finger, which often receives novel information in natural hand-object interactions, is prioritized in forming our tactile perception.NEW & NOTEWORTHY The capacity of the tactile system to process multiple simultaneous stimuli is restricted. One solution could be to prioritize input from more informative sources. Here, we show that sensory weighting accorded to each finger during multidigit touch is biased in a direction-dependent manner when different motions are delivered to the fingers of the same hand. We argue that tactile inputs are weighted based on purely geometric information to prioritize "novel" information from the leading finger.

A high-sensitivity flexible bionic tentacle sensor for multidimensional force sensing and autonomous obstacle avoidance applications

Bionic tentacle sensors are important in various fields, including obstacle avoidance, human‒machine interfaces, and soft robotics. However, most traditional tentacle sensors are based on rigid substrates, resulting in difficulty in detecting multidirectional forces originating from the external environment, which limits their application in complex environments. Herein, we proposed a high-sensitivity flexible bionic tentacle sensors (FBTSs). Specifically, the FBTS featured an ultrahigh sensitivity of 37.6 N−1 and an ultralow detection limit of 2.4 mN, which benefited from the design of a whisker-like signal amplifier and crossbeam architecture. Moreover, the FBTS exhibited favorable linearity (R2 = 0.98) and remarkable durability (more than 5000 cycles). This was determined according to the improvement in the uniformity of the sensing layer through a high-shear dispersion process. In addition, the FBTS could accurately distinguish the direction of external stimuli, resulting in the FBTS achieving roughness recognition, wind speed detection and autonomous obstacle avoidance. In particular, the ability of autonomous obstacle avoidance was suitably demonstrated by leading a bionic rat through a maze with the FBTS. Notably, the proposed FBTS could be widely applied in tactile sensing, orientation perception, and obstacle avoidance.

The preferred retinal loci when the eyes converge.

The preferred retinal locus (PRL) is the position on the retina to which humans direct stimuli during fixation. In healthy normal eyes, it has been shown to be very stable across time and between different tasks. Previous measurements of the PRL have been made under monocular viewing conditions. The current study examines where the PRLs in the two eyes' retinas are when subjects fixate binocularly and whether they shift when the demand for the eyes to converge is changed. Our apparatus allows us to see exactly where binocular stimuli fell on the two retinas during binocular fixation. Thus, our technique bypasses some of the issues involved in measuring binocular alignment with subjective techniques and previous objective techniques that use conventional eye trackers. These results show that PRLs shift slightly but systematically as the demand for convergence increases. The shifts cause under-convergence (also called exo fixation disparity) for near targets. They are not large enough to cause a break in binocular fusion. The fixation disparity we observed with increasing vergence demand is similar to fixation disparity observed in previous reports.

Neural networks based surrogate modeling for efficient uncertainty quantification and calibration of MEMS accelerometers

This paper addresses the computational challenges inherent in the stochastic characterization and uncertainty quantification of Micro-Electro-Mechanical Systems (MEMS) capacitive accelerometers. Traditional methods, such as Markov Chain Monte Carlo (MCMC) algorithms, are often constrained by the computational intensity required for high-fidelity (e.g., finite element) simulations. To overcome these limitations, we propose to use supervised learning-based surrogate models, specifically artificial neural networks, to effectively approximate the response of MEMS capacitive accelerometers. Our approach involves training the surrogate models with data derived from initial high-fidelity finite element analyses (FEA), providing rich datasets to be generated in an offline phase. The surrogate models replicate the FEA accuracy in predicting the behavior of the accelerometer under a wide range of fabrication parameters, thereby reducing the online computational cost without compromising accuracy. This enables extensive and efficient stochastic analyses of complex MEMS devices, offering a flexible framework for their characterization. A key application of our framework is demonstrated in estimating the sensitivity of an accelerometer, accounting for unknown mechanical offsets, over-etching, and thickness variations. We employ an MCMC approach to estimate the posterior distribution of the device’s unknown fabrication parameters, informed by its response to transient voltage signals. The integration of surrogate models for mapping fabrication parameters to device responses, and subsequently to sensitivity measures, greatly enhances both backward and forward uncertainty quantification, yielding accurate results while significantly improving the efficiency and effectiveness of the characterization process. This process allows for the reconstruction of device sensitivity using only voltage signals, without the need for direct mechanical acceleration stimuli.

Differential Anti-Inflammatory Effects of Electrostimulation in a Standardized Setting.

The therapeutic usage of physical stimuli is framed in a highly heterogeneous research area, with variable levels of maturity and of translatability into clinical application. In particular, electrostimulation is deeply studied for its application on the autonomous nervous system, but less is known about the anti- inflammatory effects of such stimuli beyond the inflammatory reflex. Further, reproducibility and meta-analyses are extremely challenging, owing to the limited rationale on dosage and experimental standardization. It is specifically to address the fundamental question on the anti-inflammatory effects of electricity on biological systems, that we propose a series of controlled experiments on the effects of direct and alternate current delivered on a standardized 3D bioconstruct constituted by fibroblasts and keratinocytes in a collagen matrix, in the presence or absence of TNF-α as conventional inflammation inducer. This selected but systematic exploration, with transcriptomics backed by metabolomics at specific time points allows to obtain the first systemic overview of the biological functions at stake, highlighting the differential anti-inflammatory potential of such approaches, with promising results for 5 V direct current stimuli, correlating with the wound healing process. With our results, we wish to set the base for a rigorous systematic approach to the problem, fundamental towards future elucidations of the detailed mechanisms at stake, highlighting both the healing and damaging potential of such approaches.

Spatial arrangement of the whiskers of harbor seals ( Phoca vitulina ) compared to whisker arrangements of house mice ( Mus musculus ) and brown rats ( Rattus norvegicus ).

We quantify the three-dimensional positions and orientations of the whiskers across the face of the harbor seal, and compare this geometry with the whisker arrays of rats and mice.

The effect of face race on metamemory: Examining its robustness and underlying mechanisms.

Perceivers typically exhibit better recognition memory for same-race faces than for cross-race faces, a phenomenon known as the cross-race effect (CRE). Despite its ubiquity, it is yet unclear whether people are metacognitively aware of the CRE. This research thoroughly investigates perceivers' metacognitive awareness of the CRE across five experiments. Experiments 1 and 2 demonstrated that both prospective (judgments of learning) and retrospective (confidence) metamemory judgments are sensitive to variations in the racial category and prototypicality of faces. Experiment 3 showed that participants' item-level prospective judgments are informed by beliefs about the impact of face race on memory performance. Experiment 4 revealed that global predictions are influenced by face race in the absence of direct stimulus experience, emphasizing the role of preexisting beliefs. Experiment 5 extended these findings by showing large crossover interactions between face race and participant race in both global predictions and item-level prospective judgments, indicating that both White and Black participants have higher metamemory estimates for ingroup faces. This experiment further showed that preexisting beliefs intensify the impact of face race on metamemory judgments yet do not fully account for it. Collectively, these experiments provide robust evidence of good metamemory accuracy for faces varying in racial categories and prototypicality among White participants and demonstrate that beliefs underlie the effect of face race on metamemory judgments among both White and Black participants, though this may not be the only mechanism involved. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

“No room for error”: a qualitative interview study of experiences with health insurance coverage loss and COVID-19 pandemic relief policies among people with asthma

Objectives The COVID-19 pandemic led to unemployment and associated health insurance loss, prompting an unprecedented adoption of emergency policies, including economic relief efforts and health insurance coverage expansion. We sought to understand pandemic-related challenges for people with asthma and how emergency policies served families facing both chronic disease management and health insurance loss. Study design Qualitative interview study. Methods In 2021, we conducted semi-structured telephone interviews with 21 adults who had asthma and lost employment and employer-sponsored health insurance coverage during the COVID-19 pandemic. We used thematic analysis to assess how health and economic policies affected participants’ ability to access care and manage their asthma. Results Participants reported reduced access to care, as well as worry about heightened susceptibility to COVID-19 due to their asthma. While insurance loss exacerbated these challenges, participants indicated that economic relief efforts, including direct stimulus payments, helped them afford needed asthma care. Participants were more critical of enhancements to existing coverage policies such as the Affordable Care Act (ACA) Marketplace and Consolidated Omnibus Budget Reconciliation Act (COBRA) due to difficulty understanding, accessing, and affording such coverage. Conclusions Our findings underscore that people affected by asthma and health insurance loss benefit from policies that provide flexible and easy-to-use assistance, such as direct payments, for meeting the diverse challenges posed by living with a chronic disease. Although policies that expand health insurance coverage are critical, more attention is needed to help people with chronic conditions access these programs in a timely way.

Тяжка бронхіальна астма дитячого віку: фенотип чи фенотипи?

The study of the phenotypes of severe bronchial asthma in children is extremely relevant. The frequent deterioration of the quality of children’s life, increased dissatisfaction with therapy due to the increased risk of adverse effects, the occurrence of side effects of treatment and the development of life-threatening exacerbations of asthma are urgent problems of pediatric allergology. Aim - to study the diagnostic value of some clinical and spirographic indicators of severe bronchial asthma in order to optimize the verification of the variant of the disease in school-aged children. Materials and methods. Сlinical and paraclinical examination was carried out of 359 children with bronchial asthma. 2 clinical groups were formed: the first (I) group was formed by 138 school-aged children with severe persistent bronchial asthma (average age - 11.7±0.3 years, the share of boys - 69.3%), and the second (II) group included 221 patients for moderately severe asthma (average age - 11.6±0.2 years; the share of boys - 72.9%). According to the main clinical characteristics, the groups were comparable. Results. We found that the risk factors for severe asthma persistence associated with low birth weight (odds ratio - 2.2, relative risk - 1.4), early onset of the disease (odds ratio - 1.7, relative risk - 1.3), the triggering effect of acute respiratory infections on asthma exacerbations (odds ratio - 2.4, relative risk - 1.5). It has been established that patients with severe bronchial asthma have a higher non-specific hypersensitivity of the bronchi to direct and indirect broncho-provocative stimuli: indicators of a provocative concentration of histamine <1.0 mg/ml in the PC20H sample increase the chances of severe persistence of the disease by 5.4 times. The study of the diagnostic value in the verification of the phenotype of severe asthma for the provocation concentration of histamine <1.0 mg/ml in the PC20H sample is characterized by a sensitivity of 79.6% and a specificity of 57.9%, and for bronchospasm index >16.0% in a sample with physical exertion - sensitivity 32.8% and specificity of 81.1%. Conclusions. Phenotype of severe asthma are determined by a combination of clinical, anamnestic and paraclinical signs of the disease, accompanied by pronounced hypersensitivity of the bronchi to indirect and direct irritants. At the same time, the existence of a single phenotype of severe asthma remains a matter of debate, or it is still advisable to mention several phenotypes of severe disease. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Anisocoria After Direct Light Stimulus is Associated with Poor Outcomes Following Acute Brain Injury.

Assessing pupil size and reactivity is the standard of care in neurocritically ill patients. Anisocoria observed in critically ill patients often prompts further investigation and treatment. This study explores anisocoria at rest and after light stimulus determined using quantitative pupillometry as a predictor of discharge modified Rankin Scale (mRS) scores. This analysis includes data from an international registry and includes patients with paired (left and right eye) quantitative pupillometry readings linked to discharge mRS scores. Anisocoria was defined as the absolute difference in pupil size using three common cut points (> 0.5mm, > 1mm, and > 2mm). Nonparametric models were constructed to explore patient outcome using three predictors: the presence of anisocoria at rest (in ambient light); the presence of anisocoria after light stimulus; and persistent anisocoria (present both at rest and after light). The primary outcome was discharge mRS score associated with the presence of anisocoria at rest versus after light stimulus using the three commonly defined cut points. This analysis included 152,905 paired observationsfrom 6,654 patients witha mean age of 57.0 (standard deviation 17.9) years, and a median hospital stay of 5 (interquartile range 3-12) days. The mean admission Glasgow Coma Scale score was 12.7 (standard deviation 3.5), and the median discharge mRS score was 2 (interquartile range 0-4). The ranges for absolute differences in pupil diameters were 0-5.76mm at rest and 0-6.84mm after light. Using an anisocoria cut point of > 0.5mm, patients with anisocoria after light had worse median mRS scores (2 [interquartile range 0-4]) than patients with anisocoria at rest (1 [interquartile range 0-3]; P < .0001). Patients with persistent anisocoria had worse median mRS scores (3 [interquartile range 1-4]) than those without persistent anisocoria (1 [interquartile range 0-3]; P < .0001). Similar findings were observed using a cut point for anisocoria of > 1mm and > 2mm. Anisocoria after light is a new biomarker that portends worse outcome than anisocoria at rest. After further validation, anisocoria after light should be considered for inclusion as a reported and trended assessment value.

Electrokinetics of Erosive Seepage through Deformable Porous Media.

Channelization and branching patterns frequently appear in porous structures as a result of fluid-flow-mediated erosion, which causes spatiotemporal changes in the medium. However, most studies on electrokinetic effects in porous media focus on the overall impact of the electric field on electrical double-layer formation in micropores and its influence on ionic transport, without addressing the spatiotemporal erosive characteristics and resulting porosity distribution. In this study, we explore the interplay between flow-induced shear stress and an external electric field on the dynamic evolution of porosity in deformable porous media using semi-analytical modeling. Our numerical simulations accurately predict the differences in porosity and erosive development when the electric field aligns with or opposes the flow, highlighting the importance of the direction of the external stimulus and not just its magnitude. Our findings establish a foundation for electric-field-mediated control of porous media properties and explain electrokinetic transport by considering dynamic porosity variations as a result of erosive deformation, an aspect previously unaddressed.

4D Printing of Magneto‐Thermo‐Responsive PLA/PMMA/Fe3O4 Nanocomposites with Superior Shape Memory and Remote Actuation

AbstractThis study presents the development and 4D printing of magnetic shape memory polymers (MSMPs) utilizing a composite of polylactic acid (PLA), polymethyl methacrylate (PMMA), and Fe3O4 nanoparticles. The dynamic mechanical analysis reveals that the integration of Fe3O4 maintains the broad thermal transition without significantly affecting α‐relaxation time, indicating high compatibility and homogeneous distribution of the nanoparticles within the polymer matrix. Field emission scanning electron microscopy further confirms the high compatibility of PLA and PMMA phases as well as uniform dispersion of Fe3O4 nanoparticles, essential for the effective transfer of heat during the shape memory process. Significantly, the incorporation of magnetic nanoparticles enables remote actuation capabilities, presenting a substantial advancement for biomedical applications. 4D‐printed MSMP nanocomposites exhibit exceptional mechanical properties and rapid, efficient shape memory responses under both inductive and direct heating stimuli, achieving 100% shape fixity and 100% recovery within ≈85 s. They are proposed as promising candidates for biomedical implants, specifically for minimally invasive implantation of bone scaffolds, due to their rapid remote actuation, biocompatibility, and mechanical robustness. This research not only demonstrates the 4D printability of high‐performance MSMPs but also introduces new possibilities for the application of MSMPs in regenerative medicine.

Magnetic flexible sensor with randomly distributed pine-branch microstructure for bidirectional recognition

Flexible sensors have been widely used in smart wearable devices, in which the multifunctional selectivity and mechanical property receive the main attention. However, a simple process for preparing sensors which can recognize different forms of mechanical stimuli is still a challenge. This paper reports a magnetic thin-film sensor (MP-Ag-MP) consisting of magnetic PDMS matrix and conductive Ag nanowires film with pine-branch microstructure by using sandpaper as an abrasive template. Due to its upper and lower asymmetric microstructures, the sensor has diametrically opposed electrical signal responses to bending stimuli in different directions, thus enabling the differentiated monitoring of in-plane and out-plane bending, and the sensitivities can respectively reach −9.04 × 10−2/mm and 12.87 × 10−2/mm in the sensing range. Moreover, it can also respond promptly to different magnetic field directions and intensities, which demonstrates excellent magnetic sensing performance. The sensor can be applied to monitor various human joint motions and construct a Morse code encryption-decryption system. Furthermore, a stress-magnetic bi-functional control system integrated with Bluetooth transmission function can be designed to wirelessly control the motion of the smart cart. As a result, this randomly distributed pine-branch microstructure endows the wonderful bi-directional sensing function and provides high potential application in smart wearable devices.

Diverse task-driven modeling of macaque V4 reveals functional specialization towards semantic tasks.

Responses to natural stimuli in area V4-a mid-level area of the visual ventral stream-are well predicted by features from convolutional neural networks (CNNs) trained on image classification. This result has been taken as evidence for the functional role of V4 in object classification. However, we currently do not know if and to what extent V4 plays a role in solving other computational objectives. Here, we investigated normative accounts of V4 (and V1 for comparison) by predicting macaque single-neuron responses to natural images from the representations extracted by 23 CNNs trained on different computer vision tasks including semantic, geometric, 2D, and 3D types of tasks. We found that V4 was best predicted by semantic classification features and exhibited high task selectivity, while the choice of task was less consequential to V1 performance. Consistent with traditional characterizations of V4 function that show its high-dimensional tuning to various 2D and 3D stimulus directions, we found that diverse non-semantic tasks explained aspects of V4 function that are not captured by individual semantic tasks. Nevertheless, jointly considering the features of a pair of semantic classification tasks was sufficient to yield one of our top V4 models, solidifying V4's main functional role in semantic processing and suggesting that V4's selectivity to 2D or 3D stimulus properties found by electrophysiologists can result from semantic functional goals.

How does economic policy uncertainty impact CO2 emissions? Investigating investment's role across 22 economies (1997–2021)

Economic policy uncertainty (EPU) has significant implications for both economic growth and CO2 emissions through investment and consumption. Existing research has produced mixed findings on the impact of EPU on CO2 emissions. Nevertheless, there is a need for further empirical investigation into the role of investment in the relationship between EPU and CO2 emissions in various economies. This article contributes to the literature by examining the investment channel in the EPU-CO2 emissions nexus in 22 economies using annual panel data from 1997 to 2021. The analysis was conducted using eight specifications to classify the empirical estimates of the direct and indirect impacts of EPU on CO2 emissions through the investment channel. The CD test, CADF test, and CIPS test were used to test for cross-sectional dependence, unit root, and cointegration, respectively. The GMM estimation technique was used to test for the long-run relationship. The empirical results suggest that both direct and indirect EPU stimuli on CO2 emissions through the investment channel are positive, and the EKC hypothesis holds. Furthermore, findings show that fossil-fuel energy usage leads to an increase in CO2 emissions. Given the significant impact of economic policy uncertainty on CO2 emissions, policymakers should consider the environmental implications of their policy decisions. Second, reducing fossil fuel energy usage in the production process should be a priority to mitigate the impact of EPU on CO2 emissions.

Effect of prophylactic corticosteroids on postoperative neurocognitive dysfunction in the adult population: An updated systematic review, meta-analysis, and trial sequential analysis of randomised controlled trials.

Postoperative neurocognitive dysfunction (PNCD) commonly occurs after surgery and prolongs hospital stays. Both direct noxious stimuli to the central nervous system and systemic inflammation have been implicated. Due to their potent anti-inflammatory effects, corticosteroids have been utilised to attenuate the incidence and severity of PNCD. This systematic review and meta-analysis strived to evaluate the prophylactic role of perioperative corticosteroids for PNCD. A search was run in pre-defined databases for randomised controlled trials (RCTs) assessing the role of corticosteroids in preventing PNCD. The incidence of PNCD within 1 month was the primary outcome. Secondary outcomes included the use of antipsychotic medications for the treatment, postoperative infection, and hospital length of stay. The results are exhibited as odds ratio (OR) and the mean difference (MD) with 95% confidence interval (CI). Fifteen RCTs comprising 15,398 patients were included. The incidence of PNCD was significantly lower in the corticosteroid group than in the control group, with a pooled OR of 0.75 (95% CI 0.58, 0.96; P = 0.02; I2 = 66%). Trial sequential analysis showed the clinical benefit of corticosteroids in preventing PNCD; however, the requisite information size is still inadequate. The sub-group analysis supported the prophylactic effect of corticosteroids on delirium prevention but not on delayed neurocognitive recovery. Our meta-analysis revealed statistically significant protective effects of corticosteroids on the incidence of PNCD. However, further studies are still needed to confirm the protective role of this commonly used and relatively safe strategy for preventing PNCD.