Developing financial markets

Central banks have an interest in well-functioning money markets, foreign exchange markets, and secondary markets for government securities. Efficient financial markets support both the monetary stability and financial stability goals of the central bank; and more broadly should benefit economic development. Well-functioning money markets support the transmission of an interest-rate based monetary policy and can provide information to the central bank. Liquid foreign exchange markets can help to stabilise the exchange rate and reduce transaction costs in cross-border trade and transfers. The development of these markets will support the later introduction of related financial markets such as repo and derivatives, which should in turn lead to improved risk management and financial stability, thereby enhancing economic welfare. Liquidity and price stability in short-term interest rate markets can support market-making, and thus liquidity in the securities markets. This in turn should reduce the cost of issuance for the government and other fixed-interest issuers. Indeed the secondary market for government securities may act as a catalyst for wider fixed income securities markets development: its yield curve is the benchmark for the pricing of the private sector credit. The advancement of these markets should be accompanied by the development of the appropriate market infrastructure such as robust payment and settlement systems and supportive legal framework. Many developing economies are characterised by illiquidity in these core markets, and in most cases a surplus of central bank money, in the form of excess commercial bank balances with the central bank. This handbook will look at what the central bank, and the Ministry of Finance as issuer of government securities, could do (and in some cases should not do) in support of the development of these markets.Developing financial markets

Delivering word retrieval therapies for people with aphasia in a virtual communication environment

Background: Delivering therapy remotely, via digital technology, can enhance provision for people with aphasia. EVA Park is a multi-user virtual island that can be used for such delivery. The first EVA Park study showed that daily language stimulation delivered via the platform improved functional communication and was positively received by users (Marshall et al, 2016; Amaya et al, 2018). This paper reports two single case studies, evaluating its capacity to deliver targeted language interventions. The first employed therapy for noun retrieval, using cued picture naming and modified Sematic Feature Analysis. The second employed modified Verb Network Strengthening Treatment (VNeST). Aims: This study aimed to determine if treatment delivery was feasible in EVA Park, as assessed by participant compliance, treatment fidelity and participants’ views. It explored the impact of the therapies on treated and untreated word production, connected speech and functional communication. Methods & Procedures: Two participants with aphasia each received 20 sessions of individual therapy in EVA Park, delivered over 5 weeks. Feasibility was assessed by measuring compliance with the therapy regime, recording and checking the fidelity of 20% of treatment sessions, and using post therapy interviews to explore participant views. Treatment outcomes were evaluated via repeated measures single case designs, in which assessments were administered twice before therapy, immediately post therapy and five weeks later. Outcome measures included Object Picture Naming (study 1), Sentence Elicitation Pictures (study 2), Naming 84 items from the Object and Action Naming Battery (study 2), Narrative Production (Study 2), the Northwestern Assessment of Verb and Sentences: Argument Structure Production Test (Study 2) and Communication Activities of Daily Living – 2 (Study 1 & 2). Outcomes & Results: Feasibility results were excellent. Both participants were fully compliant with the therapy regime. There was at least 90% fidelity with the treatment protocols and participant views were positive. Outcomes varied across the studies. The noun therapy significantly improved the naming of treated words, with good maintenance. Lexical gains were less evident on the Sentence Elicitation Pictures used in the VNeST study. Neither study demonstrated generalisation to untreated words, connected speech or functional communication. Conclusions: Two treatment approaches, designed for face to face delivery, could be delivered remotely in EVA Park. Outcomes for the noun treatment were comparable to previous evaluations. Comparisons with previous research were more challenging for VNeST, owing to differences in methodology. Further evaluations of other treatment approaches are warranted

Monetary Operations

Monetary operations refer to the implementation of monetary policy – ensuring that a central bank’s policy decision has the intended impact on financial markets, and on the economy more generally. For operational purposes the day-to-day tactical target is usually to achieve a particular level of interest rates or the exchange rate; and the most efficient instruments are those which best complement the workings of a market system. This Handbook examines the various different instruments: open market operations; standing facilities; and both required reserves (which have some of the characteristics of direct controls), and voluntary or contractual reserves. Open market operations are undertaken at the initiative of the central bank, whereas standing facilities are used at the initiative of the commercial banks. Participation in both is voluntary at the level of individual banks, whereas in most countries reserve requirements are an administrative imposition on all banks - albeit one which, through averaging, allows them a degree of day-to-day flexibility. Monetary instruments are not only used to implement monetary policy; they are also used for liquidity management. This is an essential part of the central bank’s operations, in order to prevent the short-term uncertainty and price volatility which day-to-day swings in market liquidity would otherwise cause. The Handbook therefore also considers liquidity forecasting and management issues.Monetary Operations

Diagnosis and surgical removal of brain abscesses in a juvenile alpaca

Case Description—A 1-month-old female alpaca was examined because of progressive clinical signs consistent with an intracranial lesion. Clinical Findings—Clinical signs included signs of depression, lethargy, tetraparesis, and neck weakness. Two large isointense intracranial masses could be seen on T1-weighted magnetic resonance images. On T2-weighted images, the masses contained concentric rings of hypointense and hyperintense material. Treatment and Outcome—2 abscesses were removed via a craniotomy that incorporated removal of the sagittal crest and surrounding skull and transection of the sagittal sinus. The bony deficit was replaced with polypropylene mesh. The alpaca recovered within 2 weeks and was fully integrated into the herd within 1 month after surgery. Clinical Relevance—Findings indicated that surgical removal is a feasible means of successfully treating intracranial abscesses in juvenile alpacas.</p

Lifeguard training sharpens brain dynamics in novices during drowning detection

Drowning is a critical global health issue, responsible for over 236,000 deaths annually. Lifeguards play a key role in preventing drowning incidents by continually monitoring bathers and detecting hazards taking place in highly dynamic environments such as pools. Previous studies have observed that specialized drowning detection training is closely associated with enhanced detection of drowning events. However, the neural mechanisms underlying this greater drowning detection performance remain unclear. Here, we address this gap in the literature by comparing brain function between lifeguards and novices, and examining changes in brain dynamics associated with drowning detection training. Using a dynamic functional connectivity analysis method called Leading Eigenvector Dynamics Analysis (LEiDA), we analysed time-varying patterns of brain activity in 18 lifeguards and 16 novices during a drowning detection task and at rest. Our findings revealed significant differences within group and between groups in the probability of occurrence of attention-related brain networks, particularly the frontoparietal, ventral attention and Default Mode networks. These findings provide novel insights into the neural basis of lifeguard expertise and how specialized training shapes neural mechanisms and improves drowning detection performance in critical lifesaving scenarios.</p

Effects of biologic therapy on novel indices of lung inhomogeneity in patients with severe type-2 high asthma

Introduction/Aim: Lung inhomogeneity measures obtained using computed cardiopulmonography (CCP) are sensitive to small-airways disease. Here, we assessed changes in lung inhomogeneity in patients with type-2 high asthma treated with biological therapy and explored the relationship between inhomogeneity measures and conventional asthma disease markers. Methods: This was an observational study of 91 severe type-2 high asthma patients recruited from a tertiary asthma clinic, of whom 67 subsequently started anti-IL5 or anti-IL5R biologics. Patients were evaluated at baseline and, 54 of those commencing biologics, at their fourth injection with either mepolizumab or benralizumab. Assessments included prebronchodilator and postbronchodilator CCP and spirometry, and measurements of blood eosinophil count (BEC), fractional exhaled nitric oxide and Asthma-Symptom Questionnaire (ACQ-5). Results: Bronchodilation significantly reduced σlnCl, a novel CCP-derived ventilation inhomogeneity index, (ΔσlnCl −0.08, 95% CI (−0.10 to –0.05), p<0.001). Baseline σlnCl, but not forced expiratory volume in 1 s (FEV1) % predicted, was significantly associated with BEC (linear mixed-effects (LME) regression coefficient for BEC 0.18, 95% CI (0.04, 0.32), p=0.01). Following biologics, improvements in σlnCl were significantly dependent on BEC (LME regression coefficient +0.19, 95% CI (0.11, 0.27), p<0.001) whereas improvements in FEV1 % predicted related to both BEC and ACQ-5 responses (LME coefficients: BEC −10.8 % pred, 95% CI (−16.1,–5.5); ACQ-5 –3.5 % pred, 95% CI (−5.1 to –1.9), p<0.001). Following biologics, the change in σlnCl followed a bimodal distribution that dichotomised patients into σlnCl-Responders and σlnCl-Non-Responders. Responders, unlike Non-Responders, experienced significant improvements in symptoms and FEV1 % predicted (Δ pre-BD FEV115±15% pred, p<0.001) and included a higher proportion of patients in clinical remission at 1 year. Conclusion: σlnCl is strongly associated with systemic eosinophilic inflammation in severe type-2 high asthma. An early σlnCl response following anti-IL5 biologics identifies patients more likely to experience improvements in symptoms and lung function when systemic eosinophils are depleted. σlnCl may provide a sensitive route for tracking inflammation involving the small airways

Computed cardiopulmonography and the idealized lung clearance index, iLCI2.5, in early-stage cystic fibrosis

This study explored the use of computed cardiopulmonography (CCP) to assess lung function in early-stage cystic fibrosis (CF). CCP has two components. The first is a particularly accurate technique for measuring gas exchange. The second is a computational cardiopulmonary model where patient-specific parameters can be estimated from the measurements of gas exchange. Twenty-five participants (14 healthy controls, 11 early-stage CF) were studied with CCP. They were also studied with a standard clinical protocol to measure the lung clearance index (LCI2.5). Ventilation inhomogeneity, as quantified through CCP parameter σlnCl, was significantly greater (P < 0.005) in CF than in controls, and anatomical deadspace relative to predicted functional residual capacity (DS/FRCpred) was significantly more variable (P < 0.002). Participant-specific parameters were used with the CCP model to calculate idealized values for LCI2.5 (iLCI2.5) where extrapulmonary influences on the LCI2.5, such as breathing pattern, had all been standardized. Both LCI2.5 and iLCI2.5 distinguished clearly between CF and control participants. LCI2.5 values were mostly higher than iLCI2.5 values in a manner dependent on the participant’s respiratory rate (r = 0.46, P < 0.05). The within-participant reproducibility for iLCI2.5 appeared better than for LCI2.5, but this did not reach statistical significance (F ratio = 2.2, P = 0.056). Both a sensitivity analysis on iLCI2.5 and a regression analysis on LCI2.5 revealed that these depended primarily on an interactive term between CCP parameters of the form σlnCL*(DS/FRC). In conclusion, the LCI2.5 (or iLCI2.5) probably reflects an amalgam of different underlying lung changes in early-stage CF that would require a multiparameter approach, such as potentially CCP, to resolve

An investigation of the 10:20 Protection Rule for detecting aquatic hazards

Seven percent of all injury-related global deaths in 2019 were attributed to drowning, relating to 236,000 lives claimed and the stark reality persists that incidents of drowning continue to occur within zones overseen by trained lifeguards. Some lifeguard training agencies advocate the use of specific scan techniques and patterns and the 10:20 protection rule is recommended by a variety of lifeguarding agencies. This study aimed to determine the effectiveness of the 10-second element of the 10:20 protection rule (referred to as the 10-second scan strategy) compared to a more natural scan strategy. Two 30-minute videos were developed capturing scripted and unscripted swimming pool hazards. Water safety experts were then employed to collectively review, identify, and achieve consensus on hazards. In a within-subject design, lifeguards (n = 25) were instructed to watch videos under two conditions (i.e., 10-second and natural scan conditions) and respond via whistle blow and vocal response. In the 10-second scan condition, lifeguards were instructed to use the 10:20 system of supervision and scan the zone every 10-seconds whilst supervising the pool. In the natural scan condition, lifeguards were told to follow a scan strategy that felt comfortable for them. The results demonstrated that there was no significant difference in the percentage of hazards detected in the 10-second scan condition compared to the natural scan condition. However, the results show that lifeguards were unable to execute the 10-second scan strategy (i.e., scanning the full zone every 10 seconds). While results show that hazard detection is similar in both conditions, lifeguards were not adhering to the 10-second scan and thus comparisons between the 10-second scan strategy and natural scanning are not possible. The key conclusion from this study is that it is not possible for lifeguards to scan the full zone every 10 seconds, despite explicit instructions to do so, and thus the 10:20 protection rule should be carefully considered if agencies are advocating it as an effective scanning strategy

Characteristics and pathways of long-stay patients in high and medium secure settings in England : a secondary publication from a large mixed-methods study

Background: Many patients experience extended stays within forensic care, but the characteristics of long-stay patients are poorly understood. Aims: To describe the characteristics of long-stay patients in high and medium secure settings in England. Method: Detailed file reviews provided clinical, offending and risk data for a large representative sample of 401 forensic patients from 2 of the 3 high secure settings and from 23 of the 57 medium secure settings in England on 1 April 2013. The threshold for long-stay status was defined as 5 years in medium secure care or 10 years in high secure care, or 15 years in a combination of high and medium secure settings. Results: 22% of patients in high security and 18% in medium security met the definition for ‘long-stay’, with 20% staying longer than 20 years. Of the long-stay sample, 58% were violent offenders (22% both sexual and violent), 27% had been convicted for violent or sexual offences whilst in an institutional setting, and 26% had committed a serious assault on staff in the last 5 years. The most prevalent diagnosis was schizophrenia (60%) followed by personality disorder (47%, predominantly antisocial and borderline types); 16% were categorised as having an intellectual disability. Overall, 7% of the long-stay sample had never been convicted of any offence, and 16.5% had no index offence prompting admission. Although some significant differences were found between the high and medium secure samples, there were more similarities than contrasts between these two levels of security. The treatment pathways of these long-stay patients involved multiple moves between settings. An unsuccessful referral to a setting of lower security was recorded over the last 5 years for 33% of the sample. Conclusions: Long-stay patients accounted for one fifth of the forensic inpatient population in England in this representative sample. A significant proportion of this group remain unsettled. High levels of personality pathology and the risk of assaults on staff and others within the care setting are likely to impact on treatment and management. Further research into the treatment pathways of longer stay patients is warranted to understand the complex trajectories of this group

Vibrotactile positional therapy for the treatment of positional obstructive sleep apnoea: a multicentre, randomised controlled trial

Background: New generation positional therapy devices provide vibrotactile feedback to patients with positional obstructive sleep apnoea (POSA), reducing supine sleep time and sleep apnoea severity. Longer-term effects on POSA severity, sleepiness and quality of life (QoL) are unclear. Methods: A randomised, parallel, double-blinded trial compared neck-worn positional therapy with sham-positional therapy over 3 months (ClinicalTrials.gov: NCT04153240). Adult patients with POSA (apnoea/hypopnoea index (AHI) >5 events/hour, 2:1 when supine vs non-supine) were randomised (1:1). The primary endpoint was AHI at 3 months, positional versus sham. Secondary analyses: interaction between the treatment effect and age; QoL, including Epworth Sleepiness Scale (ESS) and Pittsburgh Sleep Quality Index (PSQI). Results: Between October 2019 and August 2022, 120 patients with median baseline AHI of 12.8 events/hour (IQR 9.2–18.5) were randomised; 59 to positional therapy and 61 to sham; 92 (77%) completed the trial. Positional therapy significantly reduced the AHI by −4.41 events/hour (95% CI −7.77 to –1.06; p=0.011) compared with sham, a 34% improvement. There was a significant improvement in PSQI: −1.0 (95% CI −2.1 to 0.0; p=0.04), but not ESS: −0.6 (95% CI −1.8 to 0.6; p=0.3), with positional therapy compared with sham (baseline ESS 8.8). Similar results were seen in younger (18–64) and older (≥65) age groups. Patients’ bed partners reported improvements in snoring and sleep quality for the patient and themselves. Over half of participants using the active device opted to continue. Conclusion: Neck-worn positional therapy reduced the severity of OSA and improved sleep quality but not sleepiness, over 3 months. Bed partner’s reported improvements in snoring and sleep quality. Trial registration number: NCT04153240