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Economy of Grace and the Infinite Circle: A Theological Reception of the Social Evolutionary Origins of Gratitude
Full text linkThis article considers the social evolutionary research on gratitude and reciprocity and focuses on two mechanisms, upstream reciprocity and increased gratitude to strangers, that have strong consonance with various theological accounts of gift-giving and gratitude. We argue that these two mechanisms paramountly reflect God’s superabundant, expansive economy of increasing gratuity in the creation that is established, redeemed, developed, and brought to final consummation in perfect fellowship with the Trinity. Indeed, referencing the work of Kathryn Tanner and Peter Leithart, the gifts of God to creation found, enable, and form the impetus for a creaturely gifting exchange economy that expands beyond dyadic gift exchange and includes the outcast, sinner, and stranger
Is it time for mental health services to invest in neurostimulation? An economic evaluation of transcranial magnetic stimulation therapies for the treatment of moderate to severe treatment-resistant depression in the UK
Full text linkBackground Although transcranial magnetic stimulation (TMS) protocols are safe and efficacious therapies for treatment-resistant depression (TRD), they remain inaccessible for many people in the UK and internationally. One of the main reasons for this is a lack of evidence demonstrating their value-for-money to commissioners.Objective To assess the cost-effectiveness of repetitive transcranial magnetic stimulation therapy (rTMS) and intermittent theta-burst stimulation (iTBS) versus treatment-as-usual (TAU) for treating TRD in UK mental health care services, and to evaluate operational circumstances underpinning cost-effectiveness.Methods This economic evaluation used data from the BRIGHTMIND trial (n=255), the SMD trial (n=187) and a study-specific structured expert elicitation exercise (n=7) to model the cost and consequences for each alternative. All findings were produced on a probabilistic basis from a Markov model using Monte Carlo simulation methods. Cost-effectiveness was assessed via incremental cost-effectiveness ratios (ICERs) per quality-adjusted life-year (QALY) gained over an 18-month time horizon from the perspectives of the UK’s NHS and personal social services and from a broader societal perspective recognisant of informal care hours and productivity costs. Scenario analyses and an operational sensitivity analysis explored the impacts alternative methodologies, service delivery cases and perspectives had on base case findings.Findings From a health service perspective, rTMS and iTBS had pairwise ICERs of £12 093 and £12 959 per QALY compared to TAU, respectively. When incrementally compared, iTBS had an ICER of £16 621 versus rTMS. From a broader societal perspective, both rTMS and iTBS reduced informal care hours and were cost-saving compared with TAU. Study findings were particularly sensitive to service delivery, with the probability of being cost-effective ranging from 98% with high throughput and prompt delivery to approximately 4% with low throughput and prolonged delivery.Conclusions TMS therapies improve health, reduce informal care requirements, reduce health service utilisation and offset their costs when considered in terms of productivity losses to society. rTMS and iTBS are cost-effective and should be considered for wider clinical implementation provided they are delivered at sufficient scale and in a time-efficient manner.Clinical implications TMS can serve as a cost-effective alternative for treating moderate to severe depression after second-line treatment failure with non-psychological therapies
The scenicness of historic buildings rivals that of natural features: evidence from crowdsourced photographs of English urban areas
Full text linkSpending time in more scenic areas is associated with better health and wellbeing, making it important to understand how scenicness is influenced by environmental features. Urban areas, where natural features have often been replaced by buildings, are generally perceived as less scenic than rural ones. However, historic architecture may enhance urban scenicness. Using data from Historic England and Scenic-or-Not, a crowdsourced platform rating the scenicness of UK photographs, we investigate the relationship between listed buildings (as recorded on the National Heritage List for England) and scenicness. We find that the presence of a listed building in a photograph of an urban scene is associated with a 0.61-point increase in scenicness on a 10-point scale (equivalent to 0.53 standard deviations). This association is comparable to that of forests and lakes and is greater for buildings designated as more significant, listed earlier, and dating from earlier periods. These findings highlight the positive contribution of historic buildings to urban environments and provide empirical support for their continued preservation as public goods
Adrenal insufficiency following systemic glucocorticoid therapy: a systematic review and meta-analysis
No full textBackground Adrenal insufficiency (AI) is a common complication following glucocorticoid (GC) therapy. However, reliable predictors of AI and GC regimens that mitigate this risk remain unclear. Previous systematic reviews (SRs) have included many observational studies with imprecise reporting of GC dose and duration. We conducted a systematic review focusing exclusively on studies with well-defined GC exposure. Methods We searched Embase, Web of Science, and MEDLINE for original studies published since 2000 that investigated adults receiving protocolised systemic GC regimens and assessed all participants for AI using the adrenocorticotropic hormone (ACTH) stimulation test. Data extracted included AI prevalence, diagnosis, administration route, GC dose and tapering, treatment duration and timing of outcome assessment. Risk of bias was assessed using an adapted Newcastle-Ottawa Scale. Meta-analysis was performed using random-effects models in R. Results Of 1340 unique records identified, 12 studies (1170 participants) met inclusion criteria. AI was present in 423 individuals, with a pooled prevalence of 30% (95% CI: 19–45%) at the earliest time point tested. Reported prevalence ranged from 0 to 70%, and was not consistently associated with diagnosis, administration route, treatment duration, or study quality. AI was significantly less common in studies that included tapering (p ' 0.01) and in those assessing AI ≥15 days after stopping GCs (15%, 95% CI: 8–26%) compared to testing at cessation (48%, 95% CI: 35–62%). Conclusion AI is frequent following systemic GC use, with considerable variability. Tapering regimens and delayed testing post-cessation appear to reduce the observed prevalence. No specific GC regimen reliably prevents AI
Introduction to special issue: Jewish and converso labour in the Crown of Aragon in the late Middle Ages
Full text linkThis article serves as an introduction to a special issue on Jewish and converso labour in the Crown of Aragon during the late Middle Ages. The first part of the introduction examines the main areas of research on the subject, as well as the differences and problems concerning the two socio-religious groups in the light of the available sources. The second part provides an overview of the articles, focusing on the diversity of the sources, their scope and limitations, as well as the interrelationships between them, taking into account their original contexts
Reworlding feminism and social movements from the Global South
No full textBased on the Womandla! Feminism and Social Movements in the Global South Online Seminar Series, this special issue originated in a conference that was to be held in South Africa but became caught up in a moment of ‘reworlding’ experienced globally. This special issue centres women’s experiences of gender in the Global South: editors and authors embrace both the feminist historical tradition and the theoretical insights of decolonial feminisms to enact the practice of writing feminist and gender histories that embody the heterogeneity of women’s historical and contemporary experiences. In tracing the global exchanges taking place between individual activists and their networks, this special issue responds to Su Lin Lewis’s call for creating deeper and more participatory histories of activism in the Global South. Authors approach the idea of the Global South through national and transnational histories of feminist social movements, and especially through the lens of African, Latin American, South Asian, Irish, and global feminisms. By connecting past and present, the articles develop new approaches to the conceptualisation of contemporary social movements and their many predecessors
Immune Profiling the Axilla with Fine Needle Aspiration Is Feasible to Risk-Stratify Breast Cancer
Full text linkBackground: Axillary lymph node (ALN) metastasis is a critical prognostic determinant in breast cancer (BC) that informs surgical management. However, surgically clearing the axilla carries morbidity, so less invasive methods of risk-stratifying patients are needed. ALN fine needle aspiration (FNA) is currently used to detect BC metastases, but these samples also contain immune cells. Methods: Cells obtained via FNA from BC-patient-derived ALNs were analysed using flow cytometry. Results: FNA acquires sufficient leukocytes for comprehensive immunophenotyping of reactive, patient-derived ALNs. All CD4+ and CD8+ T-cell subsets (naïve, terminal effector, central memory, and effector memory) and rarer (<2%) natural killer (NK) and plasmacytoid dendritic cell (pDC) populations are represented. Importantly, the immune-cell profile of one reactive ALN appears to reflect the immune status of the patient’s axilla. Furthermore, FNA captures immune differences between patients with ≤1 or ≥2 metastatic ALNs. Increased numbers of naïve CD4+ T cells, but fewer terminal effector, central memory, and effector memory subpopulations, were obtained from patients with ≥2 metastatic ALNs. Moreover, despite their sparse distribution pattern on whole-section immunohistochemistry (WSI), FNA revealed that CD56+ NK cell activation receptors were decreased in patients with ≥2 metastatic ALNs. Finally, FNA captured a decrease in pDCs in patients with ≤1 metastatic ALNs, despite their clustered distribution pattern on WSI. Conclusions: FNA is not only feasible for sampling leukocytes from reactive, patient-derived ALNs, but also identifies immune-cell profiles that reflect axillary tumour burden in BC. Thus, this technique could be used to risk-stratify BC patients in the future
Red Blood Cell-Encapsulated Nanoparticles for Long-Circulating, Improved Specificity Functional MRI
Full text linkNanoparticle-based MRI contrast agents have shown promise for advancing noninvasive imaging, but their clinical utility is limited by rapid clearance, poor biocompatibility, and lack of sustained signal. Here, we present a red blood cell (RBC)-based nanocarrier platform that encapsulates superparamagnetic iron oxide nanoparticles (SPIONs) following hypotonic dialysis and resealing of the cell membranes. This biomimetic “Trojan horse” strategy exploits the inherent circulation time, deformability, and biocompatibility of RBCs to prolong the nanoparticle lifetime and enhance the translational potential. In vivo rodent studies demonstrated that SPION-loaded human RBCs provide robust, long-lasting cerebral blood volume (CBV)-weighted functional (f) MRI signal with >5-fold magnitude stronger responses over conventional/established blood oxygenation level-dependent (BOLD) contrast. In addition, functional brain mapping using cell encapsulated SPIONs show improved laminar specificity, with activity localized to cortical layer IV. Compared with free SPIONs, loaded cells achieved >30 min of stable T2* contrast at one-quarter of the iron dose, while maintaining physiologically plausible CBV maps. These findings confirm efficacy and establish RBC encapsulation as a versatile and biocompatible nanomedicine platform for extending nanoparticle circulation and enabling high-resolution functional imaging with broad implications for translational applications in neurology, oncology, and theragnostics
Light a Fire under Green Technological Innovation Quality: Stabilising the Effect of Environmental Fee-to-Tax Reform Policy through Government Guarantees
Full text linkChina's rapid economic growth has come at the cost of high resource consumption and significant emissions, prompting the implementation of various environmental regulations. This study examines the impact of the Environmental Fee-to-Tax Reform (EFTR), introduced in 2018 as a market-based regulatory instrument, on corporate green technological innovation. It particularly explores the role of government guarantees within the EFTR context and their interaction with firm characteristics. Using data on A-share listed firms in China from 2012 to 2022, we find that while the EFTR promotes the quantity of green technological innovation, both the EFTR and standalone government guarantees individually hinder its quality, revealing both "compensation" and "crowding-out" effects. However, when government guarantees are provided in conjunction with the EFTR, they significantly mitigate the EFTR's adverse impact on green technological innovation quality, with their effectiveness varying by firm attributes. Government guarantees exacerbate the policy's adverse effects for state-owned enterprises but alleviate them for non-state-owned enterprises. High-tech certified firms benefit more from government guarantees in offsetting the policy's adverse impact than their non-high-tech counterparts. These findings provide valuable insights for policymakers seeking to optimise environmental regulations and enhance the efficiency of government guarantees, ensuring better alignment between corporate strategies and sustainability goals
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