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Holdup and Firms’ Relative Advantage in Private Infrastructure Projects
No full textPrivate sector investment in large infrastructure projects calls for firms to invest in specific assets with a high degree of government control. Under such conditions, governments can act opportunistically to appropriate returns from firms’ investments. Contrary to this view, we highlight how opportunistic firms may gain favorable outcomes at the expense of the state. Drawing on transaction cost economics (TCE) and temporal specificity, we argue that firms may hold up incumbent elected officials by threatening to delay or disrupt provision of infrastructure services. Seeking to avoid the perception of administrative incompetence and resulting adverse political consequences, elected officials acquiesce to firms’ demands in contract renegotiations and provide additional rents at the expense of the state. We expect the likelihood of firm-led holdup to increase with political competition, proximity of elections, and wide salience of the infrastructure service. Firms with weaker reputations and low-trust relationships with the state are more likely to engage in such behavior. We discuss the implications of our arguments for policy and managerial practice
Assessing quality of life in individuals with hereditary cancer risk:Results from phases 1–3a of the EORTC QLQ-HCR30 questionnaire
Get PDFBackground The aim of this study is to develop a European Organisation of Research and Treatment of Cancer (EORTC) patient-reported outcome measure (PROM) to assess quality of life (QOL) in individuals diagnosed with a hereditary cancer predisposition syndrome (HCPS) with or without a previous cancer diagnosis. We report on content generation, questionnaire construction, and questionnaire evaluation of acceptability, comprehensiveness, and linguistic validity. Methods Following phase 1–3a of the EORTC Quality of Life Group module development guidelines, QOL issues were identified through a literature review and interviews with health-care professionals and individuals undergoing HCPS genetic counseling or testing. Based upon the results, a preliminary questionnaire was developed and pre-tested internationally for relevance, clarity, and linguistic appropriateness. Revisions were guided by qualitative feedback and predefined criteria. Results 63 issues were identified from the literature and expanded to a 73-item questionnaire through interviews. Pre-testing of the questionnaire in 119 individuals (79.8 % female) across twelve centers in nine countries, including carriers of BRCA, Lynch syndrome, and Li-Fraumeni, showed limited applicability for those with negative or pending results. The target population was therefore refined to mutation carriers. Following item reduction, the final instrument comprised thirty validated and linguistically appropriate items. Conclusion The EORTC QLQ-HCR30 is relevant and applicable for assessing QOL in individuals diagnosed with a HCPS and is now ready for preliminary psychometric evaluation (phase 3b and 4).</p
Differential GABA dynamics across brain functional networks in autism
Get PDFDifferences in the ϒ-aminobutyric acid (GABA) system contribute to an excitatory-inhibitory imbalance in autism, particularly affecting sensory processing. However, the brain's broader response to interventions targeting GABA pathways in individuals with autism remains poorly understood. This study tested the hypothesis that GABAergic control of information transfer across large-scale brain functional networks is altered in autism. We conducted a phase-amplitude coupling (PAC) analysis of resting-state EEG signals within and between these networks. Responses were compared after double-blind, randomized oral administration of either a placebo or 15/30 mg of arbaclofen, a GABAB receptor agonist. Twenty-four non-autistic (9 males; 19-53 years) and 15 autistic participants (9 males; 20-51 years) completed 93 study visits. Autistic participants exhibited significantly higher theta-beta PAC, especially within the limbic network. High-dose arbaclofen shifted PAC metrics in visual and somatomotor networks towards non-autistic levels, but had minimal effects on networks related to higher cognitive functions. Interestingly, altered PAC within and between networks in the limbic system of autistic participants was normalized by low-dose arbaclofen, yet reemerged after high-dose administration. These findings provide compelling evidence for altered GABAergic responsivity in autism, helping explain some of the challenges in prescribing medications for autistic individuals, such as paradoxical reactions and dose sensitivity.</p
Employee Voice and Corporate Governance:Power and Engagement for the Environment
Get PDFThe authors investigate the role of employee voice in corporate governancefor corporate environmental impact. This issue is importantgiven the potentially serious employment implications forcorporations seeking to transition to lower carbon economic activityand the urgency of moving toward a carbon neutral economy.Using secondary and interview data from Germany, the authors useQualitative Comparative Analysis (fsQCA) to demonstrate thatstrong employee voice in corporate governance is a key factor inreducing the environmental impact of corporations. The authorsalso illustrate distinct strategies by which labor representatives at thecompany level enact institutionally granted power resources forenvironmental issues. This work contributes to academic debates onlabor and the natural environment literature. In particular, ithighlights that, alongside unions, labor representatives at the companylevel constitute an important source of employee voice forenvironmental transformation
The Meaning of Agency in Contexts of Everyday Life for Mental Health Recovery in Young Adulthood:A Thematic Analysis
Get PDFObjectivesFor young adults, experiences of life-disruptive mental distress often involve social isolation, stigma and reduced self-worth, which can impede recovery during a critical period of identity formation. This study explores how six young adults in Denmark, recruited through the OPUS early psychosis intervention program, retrospectively assessed how, where and why they were enabled to act within everyday contexts to catalyse recovery.Research Design and MethodsAn abductive thematic analysis was conducted using life story interviews followed by intensive interviews focused on youth recovery.ResultsTwo themes were generated. First, overcoming isolation in safe and inclusive communities: participants sought belonging through repaired parental relationships or, when parental support was insufficient, by visiting trusted networks abroad. Second, gaining competence and recognition in self-chosen physical and creative activities: these contexts enabled participants to develop skills, experience recognition and, in some cases, reframe aspects of mental distress as personal resources. Together, the themes suggest that experiences of safety were a necessary basis for attuned exploration, self-challenge and identity formation fostering greater hope for the future.DiscussionThe analysis illuminates the relational and contextual dynamics of agency, belonging and meaning making in youth recovery, showing that agency was co-created through interactions with people, environments, activities and norms.ConclusionEveryday contexts aligning with young adults’ interests hold substantial potential to foster belonging, participation, competence and hope, supporting meaningful engagement in life while preparing young people for adulthood
Patient-centred Postpartum Care Provision:Virtual Delivery, Tiered Escalation, and Tensions between Efficiency, Preference, and Clinical Concern
Get PDFBackgroundGood quality postnatal care is of key importance for maternal and infant health. During the pandemic, healthcare services were reconfigured with increased virtual delivery, reducing infection transmission risk for pregnant women, new mothers, newborn babies, and healthcare workers. Post-pandemic, this shift of maternity care from face-to-face towards virtual care provision has persisted. Whilst some have extolled this trend, the evidence is mixed, both for clinical outcomes and for patient perceptions and experiences. We sought to explore the experiences and perceptions of women affected by these changes, to inform ongoing maternity services development.MethodsThis study reports responses of women participating in the COVID Symptom Study Biobank, drawn from the King’s College London/ZOE COVID Symptom Study, representing a convenience sample of UK women of reproductive age (18–50 years). Participants were invited to complete an online questionnaire, from 7 September to 1 December 2021. Demographic analyses are presented for all respondents. Content analysis was used to analyse all free-text responses.ResultsOverall, 1036 respondents delivered at least one live baby during the pandemic, of whom 821 respondents provided a total of 1466 qualitative responses about their care in-person (n = 550 responses), by video (n = 125), or by telephone (n = 791). Mothers liked the convenience and promptness of virtual care, and generally felt it was a good way to meet their healthcare needs, with two caveats: First, they appreciated the option to escalate care quickly (i.e. a tiered process), which seemed to occur with little difficulty in most cases; second, they perceived physical examination as very important in certain circumstances, particularly when a baby was unwell.ConclusionsOur findings show women are pragmatic and reasonable about the benefits and risks of differing modes of postpartum care delivery, including virtual care. Our study supports a tiered approach to the provision of postnatal care, which balances perceived efficiencies, preferences of the individual seeking care, and level of clinical concern
Stimulant Use in the Context of Eating Disorder Treatment:A Case Study of a Patient With Co-Occurring ADHD and an Eating Disorder
Get PDFIndividuals with attention-deficit/hyperactivity disorder (ADHD) are at increased risk of developing eating disorders (EDs) compared to the general population. Methylphenidate is a common first-line pharmacological treatment for ADHD and has been explored for symptom interruption in bulimia nervosa (BN); however, its use and efficacy in individuals with comorbid ADHD and restrictive eating pathology, such as anorexia nervosa (AN), remain underexplored. This case study presents a 28-year-old female who initially presented to eating disorder services with BN, was later diagnosed with ADHD, and subsequently re-diagnosed with AN. The patient was treated with a combination of methylphenidate alongside outpatient psychological therapy and participation in a Day Services group programme. While in Day Services, the patient restored 2.2 kg (4lb 9oz); however, the patient remained medically underweight at discharge. EDE-Q scores demonstrated a downward trend in cognitive eating disorder symptoms; however, the patient felt this was not reflective of her mental state. The case examines the interaction between ADHD and co-occurring ED symptomatology, illustrating how pharmacological management of one condition may inadvertently maintain or exacerbate the other. The case highlights a divergence between psychological improvement on self-report measures and persistent underweight status and disordered behaviours, raising questions about the interaction between ADHD pharmacotherapy and eating disorder outcomes.</p
Alterations in the brain lipidome of Alzheimer's disease donors with rare TREM2 risk variants
Get PDFTriggering Receptor Expressed on Myeloid Cells 2 (TREM2) is a microglial receptor, sensitive to Phospholipids and Sphingomyelins, associated with neurodegeneration. Hypomorphic variants in the TREM2 gene significantly increase the risk of developing Alzheimer’s disease (AD). The aim of this study was to characterize networks of lipids in post-mortem brain tissue from AD and Control donors, and to identify lipids associated with AD and impacted by dysfunctional TREM2. We studied human post-mortem brain tissue from the hippocampus and Brodmann area 9 (BA9) from 102 brains. Brain tissue from BA9 was available from n = 55 donors (14 Ad donors with a non-synonymous TREM2 risk variant [AD(TREM2+)], 20 Ad donors with no TREM2 risk variants [Ad(TREM2−)] and 21 Control donors), and brain tissue from the Hippocampus was available for n = 47 brain donors (7 Ad[ TREM2+], 20 Ad[ TREM2−] and 20 Control donors). Mass Spectrometry was performed to obtain lipidomic signatures spanning 99 lipid species that included the following lipid classes: Ceramides, Sphingomyelins, Phosphatidic acids, Phosphatidyl-cholines, Phosphatidyl-ethanolamines, Phosphatidyl-glycerols, Phosphatidyl-inositols, Phosphatidyl-serines and Triglycerides. Weighted gene co-expression network analysis (WGCNA) was used to identify highly correlated lipid modules and hubs in each brain region. Generalized least squares and linear regression analyses, adjusted for age at death, biological sex, number of Apolipoprotein E (APOE) ε4 alleles, and post-mortem delay, were used to assess the associations of lipid modules and hubs with AD and TREM2, in combined analyses across regions and in each region separately. Four lipid modules were relatively well-preserved between the two brain regions, and three of these modules were altered in AD donors and/or in AD TREM2 carriers. Levels of the BA9 ‘turquoise’ module (‘blue’ hippocampus module), enriched in Sphingolipids and Phospholipids, were elevated in AD donors and particularly in AD TREM2 carriers [AD(TREM2+)]. The hub lipid of the BA9 ‘turquoise’/hippocampus ‘blue’ module, Phosphatidyl-serine [PS(32:1)], was increased in AD versus Control donors (beta = 0.677, 95% CI 0.28–1.08, P = 1.14E−03), and in AD(TREM2+) versus Control donors (beta = 1.00, 95% CI 0.53–1.48, P = 5.57E−03), whereas the strongest association was observed with Ceramide [Cer(d38:1)] increased in AD versus Control donors (beta = 0.929, 95% CI 0.46–1.40, P = 1.67E−04) and in AD(TREM2+) versus Controls donors (beta = 1.31, 95% CI 0.78–1.84, P = 4.35E−06). The consistent increase in TREM2 ligands such as Ceramides and Phosphatidyl-serines in the brains of AD donors, particularly TREM2 risk variants carriers, could reflect the presence of AD-associated damage signals in the form of stressed or apoptotic cells and damaged myelin.</p