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1
Size matters: measuring the effects of inequality and growth shocks. UNU-WIDER, 2020. http://dx.doi.org/10.35188/unu-wider/2020/934-1.
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Understanding the relationship between income inequality and economic growth is of utmost importance to economists and social scientists. In this paper we use a Bayesian structural vector autoregression approach to estimate the relationship between inequality and growth via growth and inequality shocks for two large economies, China and the USA, for the years 1979–2018. We find that a growth shock is inequality-increasing, and an inequality shock is growth-reducing. We also find, however, that the sizes of the effects of these shocks are very small, accounting for under 2 per cent of the variance for both countries. Finally, we also find that the effects of the shocks dissipate within ten years, suggesting that the effects of these shocks are a short-term phenomenon.
2
Evans, Charlotte, Anne Creaton, Marcus Kennedy, and Terry Martin, eds. Shock. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198722168.003.0010.
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It is essential that the retrievalist is au fait with the clinical syndrome of shock. A précis of the pathophysiology of shock is explained and conditions that progress to shock are listed. Risk factors are identified and interventions are covered. The retrievalist is given evidence-based guidance on the use of interventions and treatments to support these patients.
3
Deakin, Charles D. Defibrillation and pacing during cardiac arrest. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0063.
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Defibrillation is the passage of electrical current across the myocardium to allow synchronized repolarisation and return of a perfusing rhythm. It is now an established intervention for patients in shockable rhythms during cardiac arrest and is administered every 2 minutes during resuscitation until return of spontaneous circulation. Modern biphasic waveforms are more effective than older monophasic waveforms, achieving first shock success rate of approximately 90%. For ventricular fibrillation in adults, the initial shock should be delivered at 150 J, and if further shocks are required, escalating energy is probably more effective than a fixed energy strategy. All paediatric shocks should be delivered at 4 J/kg. Although it is important to stand clear of the patient when the shock is delivered, defibrillation should be administered with minimal interruption to resuscitation, ideally resulting in a pause to chest compressions of no more than 5 seconds. External pacing may be life-saving in patients refractory to pharmacological support of bradyarrhythmias, but is ineffective for asystole.
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Waldmann, Carl, Neil Soni, and Andrew Rhodes. Shock. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780199229581.003.0026.
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Shock: definition and diagnosis 446Hypovolaemic shock 450Cardiogenic shock 452Anaphylactic shock 456Septic shock: pathogenesis 458Shock, or acute circulatory failure, defines a state in which the delivery of oxygen and nutrients to the tissue is insufficient to meet basal metabolic needs, leading to tissue hypoxia, and, if persistent, to MOF and death. Shock results from tissue hypoperfusion and microcirculatory dysfunction, and should thus not be restricted to hypotension. Although frequent, hypotension is not mandatory for the diagnosis of shock. In the absence of hypotension, increased lactate levels may indicate tissue hypoper-fusion and can be used to diagnose shock (at least at its initiation)....
5
Hatfield, Anthea. Shock. Oxford University Press, 2014. http://dx.doi.org/10.1093/med/9780199666041.003.0020.
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Shock is a clinical diagnosis that occurs when the circulation fails. Read this chapter carefully and learn to recognize the early signs and symptoms of shock. Ideally you should be treating shock even as you make the diagnosis. This chapter will teach you about the different types of shock, their distinguishing features, and specific treatments. You will also learn to distinguish the different stages of shock and the physiology paragraphs will help you understand the changes the body’s metabolism.
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Pang, Diana, and Joseph A. Carcillo. Pediatric Shock. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199918027.003.0008.
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The chapter on pediatric shock recognition and management provides essential information on types of shock and its management. It contains summaries of hypovolemic, hemorrhagic, cardiogenic, vasoplegic, septic, metabolic, and dysoxic shock. All types of shock are best treated when therapy is targeted toward achieving specific goals (goal-directed therapy), and this chapter provides guidelines for clinical, hemodynamic, and biochemical goals. To achieve those goals, the chapter also provides guidelines on the use of key therapies, including isotonic crystalloid and colloid, blood products, catecholamines, inodilators, vasopressors, other medications (steroids, prostaglandin, triiodothyronine), and extracorporeal life support.
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Lee, Angela, and Gebhard Wagener. Distributive Shock. Edited by Matthew D. McEvoy and Cory M. Furse. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190226459.003.0011.
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The distributive shock chapter reviews the definition, classification, epidemiology, pathophysiology, clinical manifestations, and therapeutic goals of shock. It examines the cardiovascular factors and mechanisms leading to impaired oxygen delivery and its effect on the pathogenesis of shock. It reviews the compensatory mechanisms in shock that cause symptoms and organ manifestations in patients with acute circulatory failure. This chapter also discusses the limitations and benefits of different monitoring modalities during shock management including central venous pressure, mixed venous oxygen saturation, and echocardiography. Finally, it considers therapeutic goals and treatments to restore perfusion to reverse the shock state.
8
Hearne, Rory. Housing Shock. Policy Press, 2020. http://dx.doi.org/10.1332/policypress/9781447353898.001.0001.
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The unprecedented housing and homelessness crisis in Ireland is having profound impacts on Generation Rent, the wellbeing of children, worsening wider inequality and threatening the economy. Housing Shock contextualises the Irish housing crisis within the broader global housing situation by examining the origins of the crisis in terms of austerity, marketisation and the new era of financialisation, where global investors are making housing unaffordable and turning homes into assets for the wealthy. The COVID-19 pandemic has also shown the central importance of secure, affordable, decent standard homes and housing and this book details the structural problems and inequalities that COVID has exposed. It also brings to the fore the perspectives of those most affected by the crisis, new housing activists and protesters whilst providing innovative global solutions for a new vision for affordable, sustainable homes for all including “a green new deal for housing that provides affordable sustainable homes and communities for all”, a new form of public housing and putting the right to adequate, affordable, secure housing in the constitution and law. And it points to hopeful aspects in the new civil society housing protest movements in Ireland. It also details the contribution that academics and policy makers can make in social change in housing. This book shows how housing is fundamental to our wellbeing and a housing system that ensures everyone has an affordable secure home is beneficial for all and that achieving this is a political and societal choice.
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Sobol, Julia, and Jack Louro. Obstructive Shock. Edited by Matthew D. McEvoy and Cory M. Furse. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190226459.003.0012.
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In the perioperative period, various mechanisms can lead to the development of shock. The type of shock needs to be rapidly elucidated and initial management steps initiated to minimize the time of tissue hypoperfusion. Obstructive shock is caused by physical obstruction of circulation either into or out of the heart. The mechanisms that lead to obstructive shock either prevent blood from entering the right heart during diastole such as a tension pneumothorax or pericardial tamponade, or prevent the heart from ejecting the blood due to a physical obstruction, as in the case of pulmonary embolism or left ventricular outflow obstruction. While supportive care with volume resuscitation and inotropes to maintain cardiac output is crucial, early determination of the cause with prompt treatment is needed to prevent circulatory collapse. This chapter reviews the pathophysiologic mechanisms leading to obstructive shock and management steps to stabilize the patient and treat the underlying cause.
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Abcejo, Arnoley S., and Jeffrey J. Pasternak. Neurogenic Shock. Edited by Matthew D. McEvoy and Cory M. Furse. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190226459.003.0072.
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Neurogenic shock is a pathophysiologic state of systemic hypoperfusion characterized by a significant decrease in systemic vascular resistance secondary to loss of sympathetic tone. Neurogenic shock is most commonly seen in the setting of acute spinal cord injury (SCI) but can also occur following significant brain injury. Interruption of sympathetic fibers causes loss of basal vascular sympathetic tone, commonly allowing unopposed parasympathetic tone. As a result, severe hypotension and bradycardia can further exacerbate neurologic injury and organ perfusion. Understanding the physiologic and anatomic changes of neurogenic shock can help direct appropriate resuscitation efforts. Physiologic goals should focus on reversing hypotension, preventing hypoxia, and optimizing perfusion of the injured central nervous system and other critical organs.
11
Vostral, Sharra L. Toxic Shock. NYU Press, 2018. http://dx.doi.org/10.18574/nyu/9781479877843.001.0001.
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In 1980, young, healthy women in the United States suddenly began to get sick and even die. The unexpected link to these deaths was superabsorbent tampons. Thousands of women used them during their menstrual periods, signaling the potential for a large-scale outbreak. Toxic Shock: A Social History traces the emergence of this new illness of toxic shock syndrome (TSS) and its relationship to tampon technology. This multifaceted history engages microbiology, design and innovation, journalism and mass communication, product liability, and federal policy and regulation. The broad scope captures the various approaches that contributed to defining meaning about the emergent illness. Vostral argues that tampon-related TSS was a paradigm shift in the way that illness manifests. No longer was an infection necessarily the origin of disease, or a faulty product the direct cause of injury. Together, a new pathway to an illness formed, in which a supposedly inert tampon became interactive, and a bacterium once in equilibrium grew dominant and produced toxins. Toxic Shock: A Social History makes a case for understanding tampon-related TSS as the result of biocatalytic activity between technology and bacterium. Moreover, though women were the primary consumers of tampons, the bacterium became the unintended users. This unusual disease process challenged standard approaches to public health, required women to evaluate technological risk, and currently serves as a harbinger about other internal medical devices used and worn within the human body.
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Fiza, Babar, and Vivek Moitra. Introduction to Shock. Edited by Matthew D. McEvoy and Cory M. Furse. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190226459.003.0009.
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The chapter “Introduction to Shock” reviews the definition, classification, epidemiology, pathophysiology, clinical manifestations, and therapeutic goals of shock. It examines the cardiovascular factors and mechanisms leading to impaired oxygen delivery and its effect on end organ perfusion and the pathogenesis of shock. This chapter reviews the compensatory mechanisms in shock that cause the signs and symptoms, along with organ manifestations, reported in patients with acute circulatory failure. This chapter also discusses the limitations and benefits of different monitoring modalities during shock management including central venous pressure, mixed venous oxygen saturation, and echocardiography. Finally, it considers therapeutic goals and treatments to restore perfusion and reverse the shock state.
13
Kimmoun, Antoine, and Bruno Levy. Pathophysiology of shock. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0149.
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Shock remains a major cause of intensive care unit admission. Initially categorized into hypovolaemic, cardiogenic, and distributive shock, understanding of the pathophysiology has recently evolved such that tissue hypoperfusion in all shock states leads to a dysregulated inflammatory response. After 24 hours, septic shock and ischaemiareperfusion related to hypovolaemic and cardiogenic shock share similar haemodynamic and pro-inflammatory profiles. Vascular hyporesponsiveness to catecholamines is a major consequence of this common pathophysiology, which is focused upon activation of NF-κb with subsequent NO overproduction. Myocardial dysfunction is a frequent complication of the cytokine storm that follows septic shock and ischaemiareperfusion. It may worsen haemodynamic status, but nevertheless, remains transient and totally reversible.
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"Shock Waves, Procs of the 20th Int Symp (in 2 Volumes)". World Scientific Publishing Co Pte Ltd, 1997.
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15
Escudier, Marcel. Oblique shockwaves and expansion fans. Oxford University Press, 2018. http://dx.doi.org/10.1093/oso/9780198719878.003.0012.
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External supersonic gas flow in which changes in the fluid and flow properties are brought about by direction change is analysed in this chapter. In addition, it is shown that flow over a corner between two flat surfaces resulted in an oblique shockwave if the angle between the two surfaces is less than 180° (a concave corner). The analysis of flow through an oblique shockwave is based upon the superposition of the flowfield for a normal shock onto a uniform flow parallel to the shock. It is also shown that both weak and strong oblique shocks can occur. For an angle in excess of 180° (a convex corner), the flow is turned through an isentropic Prandtl-Meyer expansion fan. Analysis of a Prandtl-Meyer expansion fan starts from consideration of an infinitesimal flow deflection through a Mach wave.
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Jappelli, Tullio, and Luigi Pistaferri. The Response of Consumption to Unanticipated Changes in Income. Oxford University Press, 2017. http://dx.doi.org/10.1093/acprof:oso/9780199383146.003.0009.
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In this chapter we examine tests of the hypothesis that consumption will respond to unanticipated income changes and that the response will depend on the persistence of the shock and on the degree of imperfection in the credit and insurance markets. The literature has considered three approaches to estimating the effect of income shocks on consumption, that is, the marginal propensity to consume. One identifies episodes in which income changes unexpectedly and seeks to evaluate, in a quasi-experimental setting, how consumption reacts. A second estimates the marginal propensity to consume with respect to income shocks using the covariance restrictions imposed by theory on the joint behavior of consumption and income growth. The third estimates the impact of shocks by combining realizations and expectations of income or consumption in surveys where data on subjective expectations are available.
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Schott, Christopher K., and Jessica A. Fozard. Hypotension and Shock (DRAFT). Edited by Raghavan Murugan and Joseph M. Darby. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190612474.003.0008.
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Hypotension is a common cause of rapid response team (RRT) activation. It is critical to be able to rapidly identify the etiology of hypotension. In the setting of a rapid response team call, there is often limited time and information available when first encountering a hypotensive patient. With attention to key elements in the patient’s history of present illness, physical exam, and findings of predominant changes in systolic, diastolic, and pulse pressures, RRTs can rapidly narrow their differential diagnosis. We will discuss the initial evaluation and treatment recommendations based on the etiology of hypotension and shock. Resuscitation should continue until circulatory homeostasis occurs, as guided by a patient’s exam, vital signs, and trends in laboratory values. This chapter provides a framework on how to quickly differentiate between the causes of hypotension or shock when evaluating patients during a rapid response scenario to most accurately guide therapy.
18
Rajeev, S. G. Shocks. Oxford University Press, 2018. http://dx.doi.org/10.1093/oso/9780198805021.003.0006.
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When the speed of a fluid exceeds that of sound, discontinuities in density occur, called shocks.The opposite limit from incompressibility (constant density) is constant pressure. In this limit, we get Burgers equation. It can be solved exactly in one dimension using the Cole–Hopf transformation. The limit of small viscosity is found not to be the same as zero viscosity: there is a residual drag no matter how small it is. The Maxwell construction of thermodynamics was adapted by Lax and Oleneik to derive rules for shocks in this limit. The Riemann problem of time evolution with a discontinuous initial density is solved in one dimension. These simple solutions provide the basic intuition for more complicated shocks.
19
Miller, Michael K. Shock to the System. Princeton University Press, 2021. http://dx.doi.org/10.23943/princeton/9780691217000.001.0001.
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How do democracies emerge? This book presents a novel theory of democratization that focuses on how events like coups, wars, and elections disrupt autocratic regimes and trigger democratic change. The book demonstrates that more than nine in ten transitions since 1800 occur in one of two ways: countries democratize following a major violent shock or an established ruling party democratizes through elections and regains power within democracy. This framework fundamentally reorients theories on democratization by showing that violent upheavals and the preservation of autocrats in power — events typically viewed as antithetical to democracy — are in fact central to its foundation. Through in-depth examinations of 139 democratic transitions, the book shows how democratization frequently follows both domestic shocks (coups, civil wars, and assassinations) and international shocks (defeat in war and withdrawal of an autocratic hegemon) due to autocratic insecurity and openings for opposition actors. It also shows how transitions guided by ruling parties spring from their electoral confidence in democracy. Both contexts limit the power autocrats sacrifice by accepting democratization, smoothing along the transition. The book provides new insights into democratization's predictors, the limited gains from events like the Arab Spring, the best routes to democratization for long-term stability, and the future of global democracy. Disputing commonly held ideas about violent events and their effects on democracy, the book offers new perspectives on how regimes are transformed.
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Litell, John M., and Nathan I. Shapiro. Pathophysiology of septic shock. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0297.
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The pathophysiology of sepsis is the result of a dysregulated host response to infection. Interactions between conserved pathogenic signals and host recognition systems initiate a systemic reaction to local infection. Pro- and anti-inflammatory intermediates and associated coagulatory abnormalities lead to altered macrovascular, microvascular, and mitochondrial function. Uncorrected, these processes yield similar patterns of failure in multiple organ systems. Mortality increases with successive organ failures. Although commonly thought to be a manifestation of impaired renal circulation, septic acute kidney injury may be due primarily to non-haemodynamic factors. Pulmonary parenchymal dysfunction in sepsis also contributes to failures in other organ systems. Sepsis involves complex alterations in myocardial function, vascular tone, and capillary integrity, which are mediated by elevated concentrations of inflammatory cytokines, inducible nitric oxide, and reactive oxygen species, among others. Gut hypomotility and translocation of enteric flora likely contribute to a persistent inflammatory response. This perpetuates the pathophysiological pattern of sepsis, and can lead to the delayed onset of these features in patients with other types of critical illness. The neurological manifestations of sepsis include acquired delirium, which is also probably due to circulatory and inflammatory abnormalities, as well as alterations in cerebral amino acid metabolism. Critical illness-related corticosteroid insufficiency and derangements in glucose metabolism are among the endocrine abnormalities commonly seen in septic patients. Restoration of homeostasis requires early haemodynamic resuscitation and aggressive infectious source control.
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Ghodsee, Kristen, and Mitchell Orenstein. Taking Stock of Shock. Oxford University Press, 2021. http://dx.doi.org/10.1093/oso/9780197549230.001.0001.
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Using an interdisciplinary approach, this book evaluates the social consequences of the post-1989 transition from state socialism to free market capitalism across Central and Eastern Europe and Central Asia. Blending ethnographic accounts with economic, demographic, and public opinion data, it provides insight into the development of new, unequal, social orders. It explores the contradictory narratives on transition promoted by Western international institutions and their opponents, one of qualified success and another of epic catastrophe, and surprisingly shows that data support both narratives, for different countries, regions, and people. While many citizens of the postsocialist countries experienced significant progress in living standards and life satisfaction, enabling them to catch up with the West after a relatively brief recession, others suffered demographic and social collapses resulting from rising economic precarity; large-scale degradation of social welfare that came with privatization; and growing gender, class, and regional disparities that have accompanied neoliberal reforms. Transition recessions lasted for decades in many countries, exceeding the US Great Depression in severity. Some countries still have not returned to pre-1989 levels of economic production or mortality; some have lost more than one-fifth of their population and are projected to lose more. Thirty years after the fall of the Berlin Wall, this book deploys a sweeping array of data from different social science fields to provide a more holistic perspective on the successes and failures of transition while unpacking the failed assumptions and narratives of Western institutions, Eastern policymakers, and citizens of former socialist states.
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Zeitlin, Vladimir. Wave Turbulence. Oxford University Press, 2018. http://dx.doi.org/10.1093/oso/9780198804338.003.0013.
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Main notions and ideas of wave (weak) turbulence theory are explained with the help of Hamiltonian approach to wave dynamics, and are applied to waves in RSW model. Derivation of kinetic equations under random-phase approximation is explained. Short inertia–gravity waves on the f plane, short equatorial inertia–gravity waves, and Rossby waves on the beta plane are then considered along these lines. In all of these cases, approximate solutions of kinetic equation, annihilating the collision integral, can be obtained by scaling arguments, giving power-law energy spectra. The predictions of turbulence of inertia–gravity waves on the f plane are compared with numerical simulations initialised by ensembles of random waves. Energy spectra much steeper than theoretical are observed. Finite-size effects, which prevent energy transfer from large to short scales, provide a plausible explanation. Long waves thus evolve towards breaking and shock formation, yet the number of shocks is insufficient to produce shock turbulence.
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Fieldhouse, Edward, Jane Green, Geoffrey Evans, Jonathan Mellon, Christopher Prosser, Hermann Schmitt, and Cees van der Eijk. Electoral Shocks. Oxford University Press, 2019. http://dx.doi.org/10.1093/oso/9780198800583.001.0001.
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This book offers a novel perspective on British elections, focusing on the importance of increasing electoral volatility in British elections, and the role of electoral shocks in the context of increasing volatility. It demonstrates how shocks have contributed to the level of electoral volatility, and also which parties have benefited from the ensuing volatility. It follows in the tradition of British Election Study books, providing a comprehensive account of specific election outcomes—the General Elections of 2015 and 2017—and a more general approach to understanding electoral change.We examine five electoral shocks that affected the elections of 2015 and 2017: the rise in EU immigration after 2004, particularly from Eastern Europe; the Global Financial Crisis prior to 2010; the coalition government of the Conservatives and the Liberal Democrats between 2010 and 2015; the Scottish Independence Referendum in 2014; and the European Union Referendum in 2016.Our focus on electoral shocks offers an overarching explanation for the volatility in British elections, alongside the long-term trends that have led us to this point. It offers a way to understand the rise and fall of the UK Independence Party (UKIP), Labour’s disappointing 2015 performance and its later unexpected gains, the collapse in support for the Liberal Democrats, the dramatic gains of the Scottish National Party (SNP) in 2015, and the continuing period of tumultuous politics that has followed the EU Referendum and the General Election of 2017. It provides a new way of understanding electoral choice in Britain, and beyond, and a better understanding of the outcomes of recent elections.
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Himelblau, Harry. IEST-RP-DTE012.1 : Handbook for Dynamic Data Acquisition and Analysis. Institute of Environmental Sciences and Techn, 1994.
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25
Tucker-Abramson, Myka. Novel Shocks. Fordham University Press, 2018. http://dx.doi.org/10.5422/fordham/9780823282708.001.0001.
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Novel Shocks argues that the political and cultural origins of neoliberalism lie in the battles over suburban and urban space in the 1950s and early 1960s. At the end of World War II, Harry Truman’s administration launched a national program of urban renewal that sought to create a new and distinctly American modernity, which would underpin US global hegemony. The program’s effects in Manhattan were particularly notable: throughout the 1950s and 1960s, New York bulldozed vast areas of land deemed “slums” or “blighted” to make way for freeways, public and private housing projects, medical centers, skyscrapers, and even the new United Nations headquarters. Taken together, these processes dramatically transformed New York’s metropolitan region, creating the segregated landscape of prosperous white suburbs and poor black cities, and with it new cultural forms and subjectivities. Throughout the 1950s and early 1960s, novelists such as Ralph Ellison, Patricia Highsmith, Ayn Rand, William Burroughs, Sylvia Plath, and Warren Miller all depicted and responded to these new urban spaces as forms of traumatic “shock” that required new aesthetic forms and political structures. These novels rejected older shock-based modernisms such as Surrealism and naturalism and, like the urbanization projects they depicted, forged a new kind of modernism, one that transformed shock from a traumatic and disruptive effect of urban modernity into a therapeutic force that helps strengthen and shape a more flexible, self-reliant, and resilient subject that would nourish the roots of neoliberalism.
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Lange, Barbara Rose. Epilogue. Oxford University Press, 2018. http://dx.doi.org/10.1093/oso/9780190245368.003.0011.
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The Epilogue describes how economic and social shocks of the late 2000s, in particular the 2008 world economic crisis, affected local fusion musics in Central Europe. It discusses changes in artistic personhood, musical sociality, creative processes, and connections to the West European musical market; efficiency penetrated the creative process, and more aspects of the individual became monetized. The Epilogue describes how far-right nationalism and its musical expression strengthened in the late 2000s, and how others made musical interventions against these trends. It describes how musicians changed their relationships with large arts institutions, detailing how by the 2000s, intellectually oriented musicians established some connections to the Western European world-music industry and to new modes of musical production and distribution. It concludes that few artistic experiments could continue after socioeconomic shock.
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Wise, Matt, and Paul Frost. ICU treatment of cardiovascular failure. Edited by Patrick Davey and David Sprigings. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199568741.003.0150.
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Cardiovascular failure or shock is best defined as inadequate delivery or utilization of oxygen for cellular metabolic needs. The majority of shock states are characterized by limitations in perfusion rather than extraction of oxygen by tissues. It is important to recognize that ineffectual tissue perfusion may occur in the absence of hypotension and, therefore, a normal blood pressure does not exclude shock. This chapter covers the etiology of shock, as well as symptoms, complications, diagnosis, prognosis, and treatment.
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Borsboom, Denny. Mental disorders, network models, and dynamical systems. Edited by Kenneth S. Kendler and Josef Parnas. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780198796022.003.0011.
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Network approaches have been proposed as an alternative way of thinking about relations between symptoms of mental disorders. Unlike traditional psychometric approaches, network models view these associations as the result of direct interactions between symptoms. Disorders are defined as alternative stable states of a network due to increased connectivity between symptoms. This increased connectivity creates a pattern of reinforcement, so the system can get stuck in a state of prolonged activation. Mental health is defined as the stable state of a weakly connected network. Although symptomatology may be temporarily increased in a healthy network (e.g., due to adverse life events), as the influence of a shock wanes the network will spontaneously return to its healthy state. Strongly connected networks, however, may transition into disordered states upon similar external shocks, and may not naturally recover. Thus, the proposed definitions yield plausible conceptualizations of resilience and vulnerability.
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Wise, Matt, and Paul Frost. ICU treatment of sepsis and septic shock. Edited by Patrick Davey and David Sprigings. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199568741.003.0152.
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Bacteria are the most frequent causes of severe sepsis and septic shock, while viruses, fungi, and parasites are implicated less often. Positive cultures are found in only 60% of cases; this may be the result of previous antibiotic therapy or inadequate sampling or testing. The etiology of sepsis is constantly changing; whereas Gram-negative organisms used to make up the majority of cases, Gram-positive bacteria now predominate. Sepsis due to fungal disease has also seen a dramatic rise. These changes may be explained by alterations in patient demographics, such as an increasingly elderly population with multiple comorbidities; an increased frequency of indwelling catheters or devices; and greater numbers of patients with immunosuppression as a result of disease or drug therapy. This chapter covers symptoms, demographics, diagnosis, investigation, prognosis, and treatment within the ITU environment.
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Kaufmann Mercantile Guide: How to Split Wood, Shuck an Oyster, and Other Simple Pleasures. Princeton Architectural Press, 2015.
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31
Spevetz, Antoinette, and Joseph E. Parrillo. Diagnosis and management of shock in the ICU. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0150.
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Sepsis is triggered by an infection and treatment of sepsis requires timely identification of the patient, and rapid treatment with antibiotics, source control, and fluids. In the absence of a true biomarker for sepsis, the clinician needs to recognize which patients are at risk, as well as the common signs and symptoms of infection. The site of infection, the patient’s phenotype, and the location of the patient will help drive decisions about initial antibiotic therapy. Patients with sepsis should be treated to ensure adequate cardiac output and organ perfusion, which usually requires infusion of intravenous fluids. Crystalloid fluids are most frequently infused, and patients will often require large doses in the first 6–24 hours of treatment. In addition to haemodynamic and fluid support, some patients require infection source control. Many sepsis patients require additional supportive therapy with vasoactive agents, mechanical ventilation, renal replacement therapy, and nutritional therapy. The use of these supportive therapies allows for a patients host defence system to work in conjunction with antibiotics to fight off the infection. When using these supportive therapies, the clinician should attempt to minimize the complications of the therapies and the causative infection. Once a patient starts to clinically improve, it is essential that therapies that are no longer necessary are withdrawn. Patients who do not respond to initial therapy should be evaluated for either resistant organisms, persistent sources, or alternate diagnoses.
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Capussela, Andrea Lorenzo. Continuity and Instability: The Spiral Sets In. Oxford University Press, 2018. http://dx.doi.org/10.1093/oso/9780198796992.003.0008.
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This chapter reviews the 1964–79 period, during which the social tensions accumulated over the previous decades erupted, a wave of political violence without parallel in Europe shook the country, and the steep rise of labour’s bargaining power caused a persistent wage shock. Political consensus was sustained by spending policies aimed at particularistic inclusion, leading to both a fragmented welfare system and growing budget deficits, which were largely monetized. Driven also by a challenging international environment, macroeconomic disequilibria accumulated. Although the country’s institutions were increasingly inappropriate, TFP growth and Italy’s convergence to the productivity frontier nonetheless continued, sustained also by the rise of industrial districts. Several mutually reinforcing vicious circles set in, however: the collusion between political and economic elites intensified, clientelism and corruption rose, organized crime strengthened, and after two decades of convergence the South resumed its decline relative to the rest of the country.
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Thiele, Holger, and Uwe Zeymer. Cardiogenic shock in patients with acute coronary syndromes. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199687039.003.0049.
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Cardiogenic shock complicating an acute coronary syndrome is observed in up to 10% of patients and is associated with high mortality still approaching 50%. The extent of ischaemic myocardium has a profound impact on the initial, in-hospital, and post-discharge management and prognosis of the cardiogenic shock patient. Careful risk assessment for each patient, based on clinical criteria, is mandatory, to decide appropriately regarding revascularization by primary percutaneous coronary intervention or coronary artery bypass grafting, drug treatment by inotropes and vasopressors, mechanical left ventricular support, additional intensive care treatment, triage among alternative hospital care levels, and allocation of clinical resources. This chapter will outline the underlying causes and diagnostic criteria, pathophysiology, and treatment of cardiogenic shock complicating acute coronary syndromes, including mechanical complications and shock from right heart failure. There will be a major focus on potential therapeutic issues from an interventional cardiologist’s and an intensive care physician’s perspective on the advancement of new therapeutical arsenals, both mechanical percutaneous circulatory support and pharmacological support. Since studying the cardiogenic shock population in randomized trials remains challenging, this chapter will also touch upon the specific challenges encountered in previous clinical trials and the implications for future perspectives in cardiogenic shock.
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Thiele, Holger, and Uwe Zeymer. Cardiogenic shock in patients with acute coronary syndromes. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199687039.003.0049_update_001.
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Cardiogenic shock complicating an acute coronary syndrome is observed in up to 10% of patients and is associated with high mortality still approaching 50%. The extent of ischaemic myocardium has a profound impact on the initial, in-hospital, and post-discharge management and prognosis of the cardiogenic shock patient. Careful risk assessment for each patient, based on clinical criteria, is mandatory, to decide appropriately regarding revascularization by primary percutaneous coronary intervention or coronary artery bypass grafting, drug treatment by inotropes and vasopressors, mechanical left ventricular support, additional intensive care treatment, triage among alternative hospital care levels, and allocation of clinical resources. This chapter will outline the underlying causes and diagnostic criteria, pathophysiology, and treatment of cardiogenic shock complicating acute coronary syndromes, including mechanical complications and shock from right heart failure. There will be a major focus on potential therapeutic issues from an interventional cardiologist’s and an intensive care physician’s perspective on the advancement of new therapeutical arsenals, both mechanical percutaneous circulatory support and pharmacological support. Since studying the cardiogenic shock population in randomized trials remains challenging, this chapter will also touch upon the specific challenges encountered in previous clinical trials and the implications for future perspectives in cardiogenic shock.
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Thiele, Holger, and Uwe Zeymer. Cardiogenic shock in patients with acute coronary syndromes. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199687039.003.0049_update_002.
Full textAbstract:
Cardiogenic shock complicating an acute coronary syndrome is observed in up to 10% of patients and is associated with high mortality still approaching 50%. The extent of ischaemic myocardium has a profound impact on the initial, in-hospital, and post-discharge management and prognosis of the cardiogenic shock patient. Careful risk assessment for each patient, based on clinical criteria, is mandatory, to decide appropriately regarding revascularization by primary percutaneous coronary intervention or coronary artery bypass grafting, drug treatment by inotropes and vasopressors, mechanical left ventricular support, additional intensive care treatment, triage among alternative hospital care levels, and allocation of clinical resources. This chapter will outline the underlying causes and diagnostic criteria, pathophysiology, and treatment of cardiogenic shock complicating acute coronary syndromes, including mechanical complications and shock from right heart failure. There will be a major focus on potential therapeutic issues from an interventional cardiologist’s and an intensive care physician’s perspective on the advancement of new therapeutical arsenals, both mechanical percutaneous circulatory support and pharmacological support. Since studying the cardiogenic shock population in randomized trials remains challenging, this chapter will also touch upon the specific challenges encountered in previous clinical trials and the implications for future perspectives in cardiogenic shock.
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Thiele, Holger, and Uwe Zeymer. Cardiogenic shock in patients with acute coronary syndromes. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199687039.003.0049_update_003.
Full textAbstract:
Cardiogenic shock complicating an acute coronary syndrome is observed in up to 10% of patients and is associated with high mortality still approaching 50%. The extent of ischaemic myocardium has a profound impact on the initial, in-hospital, and post-discharge management and prognosis of the cardiogenic shock patient. Careful risk assessment for each patient, based on clinical criteria, is mandatory, to decide appropriately regarding revascularization by primary percutaneous coronary intervention or coronary artery bypass grafting, drug treatment by inotropes and vasopressors, mechanical left ventricular support, additional intensive care treatment, triage among alternative hospital care levels, and allocation of clinical resources. This chapter will outline the underlying causes and diagnostic criteria, pathophysiology, and treatment of cardiogenic shock complicating acute coronary syndromes, including mechanical complications and shock from right heart failure. There will be a major focus on potential therapeutic issues from an interventional cardiologist’s and an intensive care physician’s perspective on the advancement of new therapeutical arsenals, both mechanical percutaneous circulatory support and pharmacological support. Since studying the cardiogenic shock population in randomized trials remains challenging, this chapter will also touch upon the specific challenges encountered in previous clinical trials and the implications for future perspectives in cardiogenic shock.
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Peake, Sandra L., and Matthew J. Maiden. Management of septic shock in the critically ill. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0298.
Full textAbstract:
The management of septic shock is a medical emergency. Following prompt recognition, treatment priorities are haemodynamic resuscitation, empirical antimicrobials, urgent control of the source of infection and monitoring the response to therapy. Haemodynamic resuscitation is focused on maintaining an adequate macrocirculation, while also ensuring adequacy of microcirculatory blood flow to the cells. Intravenous fluids and catecholamines have been the mainstay of therapy. However, the amount and type of fluids, choice of vasoactive medications, and the appropriate resuscitation endpoints have been questioned. Greater awareness of the importance of resuscitating the microcirculation and cell function have led to endpoints such as venous O2 saturation and changes in lactate levels becoming resuscitation targets. Urgent definitive treatment of the infection is also crucial. This requires prompt broad-spectrum empirical antimicrobial therapy, draining infected collections and removing infected medical devices. Despite extensive research, no new therapies have improved survival from septic shock.
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Rostagno, Massimo, Carlo Altavilla, Giacomo Carboni, Wolfgang Lemke, Roberto Motto, Arthur Saint Guilhem, and Jonathan Yiangou. Monetary Policy in Times of Crisis. Oxford University Press, 2021. http://dx.doi.org/10.1093/oso/9780192895912.001.0001.
Full textAbstract:
The 20th anniversary of Economic and Monetary Union (EMU) offers an opportunity to look back on the record of the European Central Bank (ECB) and learn lessons that can improve the conduct of policy in the future. This volume charts the way the ECB has defined, interpreted, and applied its monetary policy framework—its strategy—over the years from its inception, in search of evidence and lessons that can inform those reflections. Our ‘Tale of Two Decades’ is largely a tale of ‘two regimes’: one—stretching slightly beyond the ECB’s mid-point—marked by decent growth in real incomes and a distribution of shocks to inflation almost universally to the upside; and the second—starting well into the post-Lehman period—characterized by endemic instability and crisis, with the distribution of shocks eventually switching from inflationary to continuously disinflationary. We show how the most defining feature of the ECB’s monetary policy framework, its characteristic definition of price stability with a hard 2 per cent ceiling, functioned as a key shock absorber in the relatively high-inflation years prior to the crisis, but offered a softer defence in the face of the disinflationary forces that hit the euro area in its aftermath. The imperative to halt persistent disinflation in the post-crisis era therefore called for a radical, unprecedented policy response, comprising negative policy rates, enhanced forms of forward guidance, a large asset purchase programme and targeted long-term loans to banks. We study the multidimensional interactions among these four instruments and quantify their impact on inflation and the macroeconomy.
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Redgrave, Alexandra, Sebastian Kaufmann, and Jessica Hundley. Kaufmann Mercantile Guide: How to Split Wood, Shuck an Oyster, and Master Other Simple Pleasures. Princeton Architectural Press, 2015.
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Leopold, Estella B. Stories From the Leopold Shack. Oxford University Press, 2016. http://dx.doi.org/10.1093/oso/9780190463229.001.0001.
Full textAbstract:
In 1934, conservationist Aldo Leopold and his wife Estella bought a barn - the remnant of a farm - and surrounding lands in south-central Wisconsin. The entire Leopold clan - five children in all - worked together to put into practice Aldo's "land ethic," which involved ecological restoration and sustainability. In the process, they built more than a pleasant weekend getaway; they established a new way of relating to nature. In 1948, A Sand County Almanac was published, and it has become a beloved and foundational text of the conservation movement. Decades later, Estella B. Leopold, the youngest of the Leopold children - she was eight when they bought the land - now reflects on the "Shack," as they called the repurposed barn, and its inhabitants, and recalls with clear-eyed fondness the part it played in her and her siblings' burgeoning awareness of nature's miracles, season by season. In Stories from the Leopold Shack: Sand County Revisited, she unforgettably recalls the intensity of those days: the taste of fresh honey on sourdough pancakes; the trumpeting arrival of migrating Canada geese; the awesome power of river ice driven by currents - and each description is accompanied by stunning photographs by her brother, A. Carl Leopold. As the Leopolds worked to restore degraded farmland back to its original prairie and woods, they noted and celebrated all of the flora and fauna that came to share the Shack lands. As first evoked in A Sand County Almanac, and now revisited in Stories from the Leopold Shack, the Leopold family's efforts of ecological restoration were among the earliest in the United States, and their work, collectively and individually, continues to have a profound impact on land management and conservationism. All of Aldo and Estella Leopold's children went on to become distinguished scientists and to devote themselves to a life of conservation; their work continues through the Aldo Leopold Foundation. Estella B. Leopold book offers a voyage back to the place where it all began.
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Abe, Hiroyuki, Amane Sasada, Shigeki Tabata, and Minako Abe. Heat Shock Protein Vaccine Therapy for Ovarian Cancer. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190248208.003.0009.
Full textAbstract:
Despite advances in chemotherapeutic regimens, ovarian cancer has a poor prognosis. Therefore important effective treatments are urgently needed. Many studies have reported that the immune system plays a critical role in disease progression and overall survival. One known effective immunotherapy is the dendritic cell (DC)-based vaccine pulsed with tumor-associated antigens. This chapter reports on a method of production of a novel DC-based vaccine. The key technologies are (a) monocyte collection without leukapheresis, (b) monocyte expansion, (c) production of dendritic cells, (d) multiple overlapping long peptides with heat shock protein 70, and (e) combination immunotherapy approach. The next generation of immunotherapy for ovarian cancer will be focused on combination approaches that simultaneously augment immunity while preventing local immune suppression. Possible combinations which might be useful to help patients with ovarian cancer are summarized in this chapter.
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De Backer, Daniel, and Patrick Biston. Vasopressors in critical illness. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0034.
Full textAbstract:
Vasopressors are used in various shock states to correct hypotension, aiming at restoring or improving organ and tissue perfusion. Vasopressor therapy may be associated with excessive vasoconstriction, but also metabolic and other side-effects. Hence, the ideal target for arterial pressure remains undetermined. Adrenergic agents remain the most commonly used vasopressor agents. Adrenergic agents increase arterial pressure through stimulation of alpha-adrenergic receptors. The effects of the different adrenergic agents differ mostly due to variable associated beta-adrenergic effects. Epinephrine and norepinephrine are strong and equipotent vasopressor agents. Their impact on outcome is as yet unanswered, but there is no sign that epinephrine might be associated with better outcomes. Accordingly, norepinephrine is the adrenergic agent of choice, especially in patients with cardiogenic shock. Vasopressin is a non-adrenergic vasopressor acting via V1 receptor stimulation, with weak vasopressor effects in normal conditions, but markedly increased vascular tone in shock states, especially in septic shock. Splanchnic vasoconstriction may occur. Arginine vasopressin at low doses appears to be a promising alternative to adrenergic agents, but its exact place is not yet well defined.
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Neisius, Andreas, Micheal E. Lipkin, Glenn M. Preminger, and James F. Glenn. Stone fragmentation techniques. Edited by John Reynard. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199659579.003.0017.
Full textAbstract:
After its implementation in 1980, shock wave lithotripsy (SWL) became the first-line treatment for more than 80% of patients with urolithiasis. During the last three decades, SWL technology has advanced rapidly in terms of shock wave generation, focusing, patient coupling, and stone localization. Indications for SWL have evolved as well. Although endoscopic treatment techniques continue to improve, SWL continues to be considered first-line therapy for the treatment of many urinary stones. This chapter reviews the fundamental principles of SWL and presents advances in lithotripsy technology such as shock wave generation and focusing, advances in stone localization (imaging), different energy source concepts, and coupling modalities. Our understanding of the pathophysiology and the physics of shock waves can enhance extracorporeal SWL efficacy while limiting complications. Finally, current indications for and contraindications to SWL depending on stone location and in context of the updated AUA/EAU Guidelines are discussed.
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Hellwig, Timothy, Yesola Kweon, and Jack Vowles. Democracy Under Siege? Oxford University Press, 2020. http://dx.doi.org/10.1093/oso/9780198846208.001.0001.
Full textAbstract:
For the worlds democracies, the Global Financial Crisis of 2008–9 was catalyst for the most precipitous economic downturn in eight decades. This book examines how the GFC and ensuing Great Recession affected the workings of mass politics in the established democracies. The initial wave of research on the crisis concluded it did little to change the established relationships between voters, parties, and elections. Yet, nearly a decade since the initial shock, we are witnessing a wave of political changes, the extent to which has not been fully explained by existing studies. How did the economic malaise bear on the political preferences of citizens? This book pushes against the received wisdom by advancing a framework for understanding citizen attitudes, preferences, and behaviour. We make two main claims. First, while previous studies of the GFC tend to focus on an immediate impact of the crisis, we argue that economic malaise had a long-lasting impact. In addition to economic shock, we emphasize that economic recovery has a significant impact on citizens assessment of political elites. Second, we argue that unanticipated exogenous shocks like the GFC grant party elites an opening for political manoeuvre through public policy and rhetoric. As a result, political elites have a high degree of agency to shape public perceptions and behaviour. Political parties can strategically moderate citizens economic uncertainty, mobilize/demobilize voters, and alter individuals political preferences. By leveraging data from over 150,000 individuals across over 100 nationally representative post-election surveys from the 1990s to 2017, this book tests these research claims across a range of outcomes, including economic perceptions, policy demands, political participation, and the vote.
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Alonso Salinas, Gonzalo Luis, Marina Pascual Izco, Covadonga Fernández-Golfín, Luigi P. Badano, and José Luis Zamorano. Ischaemic heart disease: acute coronary syndrome. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198726012.003.0029.
Full textAbstract:
Transthoracic echocardiography (TTE) is a non-invasive and accessible tool that should be widely used in the evaluation of patients with suspected or known acute coronary syndrome (ACS). Its role is crucial in the management of patients with suspected ACS without electrocardiographic changes or elevation of cardiac markers, allowing the formulation of differential diagnosis between cardiac and extracardiac aetiologies. If the ACS is confirmed, initial assessment of regional and global left and right ventricle contractile function is fundamental in establishing the management strategy and may help in the risk stratification of these patients. TTE can also characterize the ischaemic myocardium in the acute phase, exposing any myocardial regional wall motion abnormalities. Furthermore, TTE is an excellent tool for the initial assessment of the aetiology of cardiogenic shock. It provides additional information regarding the haemodynamic status of the patient, including filling pressures and stroke volume, and it may rule out other causes of shock; thus, immediate TTE, or transoesophageal echocardiography if necessary, should be performed when cardiogenic shock is suspected. In the chronic phase, TTE plays an important role in characterizing myocardial infarction scar and its extent. TTE can accurately differentiate viable myocardium from scar tissue, and may guide revascularization if needed, improving patient care.
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LoPiccalo, Katherine, Jonathan Robinson, and Ethan Yeh. Income, Income Shocks, and Transactional Sex. Edited by Scott Cunningham and Manisha Shah. Oxford University Press, 2016. http://dx.doi.org/10.1093/oxfordhb/9780199915248.013.21.
Full textAbstract:
Transactional sex is an important factor in the spread of HIV, particularly in sub-Saharan Africa. This chapter reviews empirical evidence on the economic incentives that influence the decision to supply transactional sex, and it discusses several policies that may affect supply decisions. While the primary motivation for entering the transactional-sex market is the large income premium relative to other jobs, unexpected income shocks also affect sexual behavior. Based largely on a set of studies in western Kenya, the chapter shows that women are more likely to supply unprotected sex when they experience unexpected income shocks. We also show that sex workers receive informal insurance transfers from regular clients when shocks occur. Such support may induce some women into supplying sex. The chapter concludes with a discussion of possible policy options, including providing conditional cash transfers, giving information on health risks, and introducing risk-coping mechanisms such as insurance or bank accounts.
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Yoshino, Naoyuki, Pornpinun Chantapacdepong, and Matthias Helble, eds. Macroeconomic Shocks and Unconventional Monetary Policy. Oxford University Press, 2019. http://dx.doi.org/10.1093/oso/9780198838104.001.0001.
Full textAbstract:
Barely two decades after the Asian financial crisis Asia was suddenly confronted with multiple challenges originating outside the region: the 2008 global financial crisis, the European debt crisis, and, finally developed economies’ implementation of unconventional monetary policies. Especially the implementation of quantitative easing (QE), ultra-low interest rate policies, and negative interest rate policies by a number of large central banks has given rise to concerns over financial stability and international capital flows. One of the regions most profoundly affected by the crisis was Asia due to its high dependence on international trade and international financial linkages. The objective of this book is to explain how macroeconomic shocks stemming from the global financial crisis and recent unconventional monetary policies in developed economies have affected macroeconomic and financial stability in emerging markets, with a particular focus on Asia. In particular, the book covers the following thematic areas: (i) the spillover effects of macroeconomic shocks on financial markets and flows in emerging economies; (ii) the impact of recent macroeconomic shocks on real economies in emerging markets; and (iii) key challenges for the monetary, exchange rate, trade, and macroprudential policies of developing economies, especially Asian economies, and suggestions and recommendations to increase resiliency against external shocks.
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Tao, Jing, and Jeffrey J. Schwartz. Perioperative Adrenal Crisis. Edited by Matthew D. McEvoy and Cory M. Furse. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190226459.003.0028.
Full textAbstract:
Perioperative adrenal insufficiency (AI) (adrenal crisis) is an uncommon life-threatening condition manifested by distributive shock that is poorly responsive to the administration of fluids and vasopressors. Timely treatment with high doses of glucocorticoids can be life saving. The difficulty is in recognizing the patient at risk, suspecting the diagnosis, and distinguishing it from other forms of shock. The incidence of adrenal crisis is rare, in large part, due to the liberal use of perioperative “stress dose” steroids in patients already receiving steroids. In this chapter we review the pathophysiology involved in both primary and secondary AI, and provide step-by-step treatment recommendations for patients as risk for this condition.
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Piatkowski, Marcin. Drivers of Poland’s Successful Transition. Oxford University Press, 2018. http://dx.doi.org/10.1093/oso/9780198789345.003.0006.
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In this chapter I explain the proximate drivers of Poland’s economic success since 1989. I divide the transition into the initial period of ‘shock therapy’ during 1989 1991 and then the second period of economic recovery after 1992. I discuss the ongoing debate on the pros and cons of ‘shock therapy’ versus a ‘gradual’ approach to post-communist transition. I use the example of Poland’s ‘shock therapy’ to analyze both approaches. I conclude that that the differences in actual policies were smaller than implied by the rhetoric of both sides of the debate. I then explain why Poland was more successful than other transition economies, and discuss whether Poland could have grown even faster. I argue that on the whole the Polish transition was almost ‘as good as it gets’. I draw the lessons learned and policy insights from Poland’s transition for other countries.
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Seidman, Laurence. Would Stimulus without Debt Work in a Plausible Model? Oxford University Press, 2018. http://dx.doi.org/10.1093/oso/9780190462178.003.0013.
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Laurence Seidman and Kenneth Lewis (2015) studied the impact of stimulus without debt in a plausible macroeconomic model. In this model, stimulus without debt definitely works in a severe recession. The large fiscal stimulus promptly eliminates a large output gap. Because the large fiscal stimulus is financed by a large transfer (not loan) from the Federal Reserve to the Treasury so that the Treasury doesn’t have to borrow to finance it, the large fiscal stimulus doesn’t increase the deficit or debt beyond the increase caused by the recession shock itself. By contrast, without the Fed transfer to the Treasury, the same large fiscal stimulus would cause the deficit and debt to rise significantly more than with the recession shock alone. Moreover, stimulus without debt is not inflationary: the inflation rate never rises above its low target value.