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ObjectivePediatric insomnia is one of the most commonly reported disorders, especially in children with neurodevelopmental disorders. Better Nights, Better Days for Children with Neurodevelopmental Disorders (BNBD-NDD) is a transdiagnostic, self-guided, eHealth behavioral sleep intervention developed for parents of children with NDDs ages 4–12 years with insomnia. After usability testing, a randomized controlled trial (RCT) was conducted to evaluate the effectiveness of the BNBD-NDD program. By interviewing RCT participants after their outcome measures were collected, we sought to determine the barriers and facilitators that affect the reach, effectiveness, adoption, implementation, and maintenance of the BNBD-NDD intervention, as well as to assess whether barriers and facilitators differ across levels of engagement with the program and NDD groups.MethodTwenty parents who had been randomized to the treatment condition of the RCT participated in this study. These parents participated in virtual semi-structured qualitative interviews about their experiences with the BNBD-NDD program. Rapid analysis was used, in which one researcher facilitated the interview, and another simultaneously coded the interview using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework.ResultsOverall, more facilitators than barriers were identified for Reach, Effectiveness, Implementation, and Maintenance, whereas for Adoption more barriers emerged. Participants who were engaged reported more facilitators about the BNBD-NDD program design and behavior change, while unengaged participants mentioned needing more support to help facilitate their use of the program. Lastly, parents of children with ASD reported more facilitators and more barriers than did parents of children with ADHD.ConclusionWith this feedback from participants, we can optimize BNBD-NDD for large-scale implementation, by modifying the program to better support parents, helping them implement the strategies effectively at home, and increasing the accessibility of this evidence-based treatment.

We present a case of a newborn with a rare presentation of obstructed supracardiac total anomalous pulmonary venous connection who required emergent cannulation to extracorporeal membrane oxygenation (ECMO). Computed tomographic angiography of the heart was performed and using novel virtual dissection techniques aided in surgical planning and guidance. Computed tomographic angiography can be successfully performed in neonates with complex congenital heart disease on ECMO without adjustment of flows to aid in surgical management and novel virtual dissection techniques aid in complex anatomical delineation and spatial orientation with noncardiac structures. The preoperative imaging in this case allowed for appropriate and detailed presurgical planning and contributed to the excellent outcome of this patient.

BACKGROUND Children with neurodevelopmental disorders have a high risk of sleep disturbances, with insomnia being the most common sleep disorder (i.e., chronic and frequent difficulties with going and staying asleep). Insomnia adversely affects the well-being of these children and their caregivers. Pediatric sleep experts recommend behavioral interventions as the first-line treatment option for children. Better Nights, Better Days for Children with Neurodevelopmental Disorders (BNBD-NDD) is a five-session eHealth behavioural intervention delivered to parents to improve outcomes (e.g., Pediatric Quality of Life Inventory) for their children (4-12 years) with insomnia and who have a diagnosis of mild-to-moderate attention-deficit/hyperactivity disorder, autism spectrum disorder, cerebral palsy, and/or fetal alcohol spectrum disorder. If effective, BNBD-NDD can be a scalable intervention that provides value to an underserved population. OBJECTIVE This protocol outlines an economic evaluation conducted alongside the BNBD-NDD randomized controlled trial (RCT) that aims to assess its costs and effectiveness compared to usual care. METHODS The BNBD-NDD RCT evaluates the impacts of the intervention on children’s sleep and quality of life, as well as parent daytime functioning and psychosocial health. Parent participants were randomized to the BNBD-NDD treatment or to usual care. The economic evaluation assesses outcomes at baseline and 8 months later, which include the Pediatric Quality of Life Inventory (PedsQL) as the primary measure. Quality of life outcomes facilitates the comparison of competing interventions across different populations and medical conditions. Cost items include the BNBD-NDD intervention and parent-reported utilization of private and publicly funded resources for their children’s insomnia. The economic evaluation involves a reference-case cost-effectiveness analysis to examine the incremental cost of BNBD-NDD per unit(s) gain in the PedsQL from the family payer perspective and a cost-consequence analysis from a societal perspective. These analyses will be conducted over an 8-month time horizon. RESULTS The BNBD-NDD RCT data collection commenced in June 2019 and ended in April 2022. The RCT data are currently being analyzed, and data relevant to the economic analysis will be analyzed concurrently. CONCLUSIONS To our knowledge, this will be the first economic evaluation of an eHealth intervention for insomnia in children with neurodevelopmental disorders. This evaluation's findings can inform users and stakeholders regarding the costs and benefits of BNBD-NDD. CLINICALTRIAL ClinicalTrial.gov ID NCT02694003

Public safety personnel (PSP) are at risk of developing posttraumatic stress injury (PTSI) due to exposure to traumatic experiences and accidents. Rehabilitation programs are available, but their success varies. We studied: (1) characteristics of PSP undergoing PTSI rehabilitation in comparison to non-PSP workers; and (2) predictive value of various factors for return to work. Methods A population-based cohort study was conducted using data on injured workers undergoing PTSI rehabilitation. Of the 488 workers included, 131 were PSP. Outcome measures were: (1) return to pre-accident work at rehabilitation discharge; (2) days receiving wage replacement benefits in the year following rehabilitation. Results PSP were mainly employed (90.8%), male (59.5%), paramedics/ambulance workers (58.0%); a minority (43.5%) returned to pre-accident work after rehabilitation. Compared to non-PSP workers, PSP were more likely to initially be diagnosed with psychological injuries (94.7% versus 59.4%, p0.001) rather than musculoskeletal injuries. Return to pre-accident work was predicted by shorter injury duration, having a primary mental health diagnosis, working at time of admission, and not having symptoms requiring treatment in a complex rehabilitation program. PSPs were slower to experience full recovery in the year after rehabilitation. Factors predicting fewer benefit days included not having a secondary psychological injury, being employed, and working at time of admission. Conclusions Most PSP did not return to work in full after PTSI rehabilitation. Outcomes are likely to improve by starting treatment earlier and maintaining connections with the workplace.

Prepared for the conference on Capital Markets and Debt Management of the Italian Macroeconomic Policy Group and the Centre for Economic Policy Research, Castelgondolfo, Italy, June 15-17, 1989.--p. [1]

IN RECENT discussions of automatic fiscal stabilizers, a consensus has been reached that they are helpful in damping fluctuations but that they will not, of themselves, reverse the direction of economic activity.' But there are differences of opinion as to precisely what constitutes a stabilizer. On the one hand, the critical magnitude is held to be the relationship of marginal money tax revenues to, say, money income or output: if this ratio is positive, the fiscalmonetary system is presumed to be stabilizing; if it is zero, neutral; if it is negative, destabilizing.2 On the other I"Some economists would place exclusive reliance on built-in stabilizers. They believe that these automatic stabilizers are very likely to reduce economic fluctuations to tolerable magnitudes.... Most economists approve the greatest possible use of automatic stabilizers, but do not consider it prudent to rely solely on them" (Emile Despres et al., "The Problem of Economic Instability," American Economic Review, XL [September, 1950], 522). "We feel strongly that the existing automatic flexibility makes an important contribution to economic stability, which should not be frittered away. ... But we do not believe it prudent for policy to regard automatic flexibility as more than a first line of defense; more must be done to cope with serious economic fluctuations" (National Planning Association Conference of University Economists, "Federal Expenditure and Revenue Policy for Economic Stability" [81st Cong., 1st sess.], Hearing before the Joint Committee on the Economic Report on Federal Expenditure and Revenue Policies [Washington: Government Printing Office, 1949]), p. 9. "It must be remembered, however, that such [built-in] stabilizers, by the nature of the case, can only have the effect of dampening the range of economic fluctuations. They can mitigate the fall in consumers' demand that occurs in response to a fall in investment demand; they cannot conjure up an actual rise in consumers' demand that would be needed to offset the fall in investment demand" (report by a group of experts, National and International Measures for Full Employment [Lake Success, N.Y.: United Nations, Department of Economic Affairs, December, 1949], pp. 37-38). "We believe that this automatic flexibility is a valuable contribution to stability.... But its limitations should also be recognized. In the first place, though it can retard or perhaps even stop a decline of business activity or a rise of prices and can provide time for recovery forces to come into play, it cannot by itself reestablish full-employment conditions or push prices back to a preinflation level. In the second place, though automatic flexibility probably represents the maximum extent to which fiscal policy should be employed to combat moderate economic fluctuations, it is almost certain to be inadequate in the face of a serious depression or inflation" (Monetary, Credit, and Fiscal Policies: Report of the [Douglas] Subcommittee on Monetary, Credit, and Fiscal Policies of the Joint Committee on the Economic Report [Senate Doc. No. 129; 81st Cong., 2d sess.] [Washington: Government Printing Office, 1950], p. 16). "The built-in stabilizing effect of the budget, although obviously not a complete answer to the problem of recessions, is extremely valuable" (Research and Policy Committee of the Committee for Economic Development, Defense against Recession [New York: Committee for Economic Development, March, 1954], p. 13). For an exposition of a position embodying extreme reliance on automatic stabilization see Milton Friedman, "A Monetary and Fiscal Framework for Economic Stability," American Economic Review, XXXVIII (June, 1948), pp. 245-64. 2 The original proponents of the concept of builtin flexibility seem to have two concepts in mind, though greater reliance is clearly placed on this first. For example, they state: ". . . [The] yield of most excises is relatively insensitive to changes in income and employment; they therefore can contribute very little to the automatic stabilizing power of the tax system." And: "Other taxes have little built-in flexibility. Their yield is relatively stable, and it is larger in relation to incomes when incomes are low than when they are high" (Melvin G. deChazeau et al., Jobs and Markets [New York: McGraw-Hill Book Co., Inc., 1956], pp. 68 and 119). "The term 'built-in flexibility' is often used erroneously as a synonym for 'elasticity.' Built-in flexibility equals AT/IY, while elasticity equals

MOST ECONOMISTS IN the United States would now include flexible taxes and transfers in their ideal fiscal programs. Widely differing emphasis would be given their role, however. Not only are various views held on how heavily economic stability should be weighted among various policy goals, but also divergences in opinion arise over the efficacy of automatic fiscal changes in promoting such a goal. In contrast to this present concern with automatic stabilizers, discretionary fiscal changes would have dominated, if not completely occupied, the stage only a decade ago. And if we go back two decades, the preponderance of professional opinion would have favored insensitive taxes and transfers. Indeed, the major works on tax sensitivity up to the time that Bretherton made his important contribution' were motivated by the search for taxes that were insensitive to national income and would thus not unbalance depression budgets.2 Such a major change in attitude raises the interesting question of how and why it came about. It depended, of course, on the development of an adequate body of theory to point toward and support a changed position on fiscal policy, the high spots of which are reviewed in Section II of this paper. But the appeal of automatic stabilizers also depended on failures of discretionary policies, discussed in Section III. With this ground cleared, we then detail, in Section IV, the gradual appearance of automatic fiscal stabilizers in policy statements on governmental fiscal policy. A discussion of this sort cannot help leaning heavily on personal judgments. Yet the dominant pattern reveals itself clearly enough, I think, to minimize differences in personal interpretation.

pROFESSOR GURLEY has made a valuable contribution to the systematic formulation of the fiscal problems of economic development in his article "Fiscal Policy in a Growing Economy."' Of particular interest is his strong conclusion that the warranted rate of growth is independent of the size relative to income of a balanced government budget. This result seems remarkable because we have learned that under static conditions the size of the balanced budget does influence the size of equilibrium income. We might expect, therefore, to find that it could also affect the warranted growth rate. This note points out some of the restrictions in Gurley's formulation which prevent this result. But first a word regarding Gurley's undue strictures on static analysis. He writes

HE personal income tax has risen in imT portance in many state and local tax systems over the past two decades and has become the mainstay of the American federal tax structure. The shape of the present federal structure effected through the revolutionary modifications of World War II contrasts sharply with that of state structures, which arose in response primarily to depression fiscal problems. This sharp increase in relative and absolute size of yield fromn the personal income tax coupled with the current collection of a substantial fraction of it through withholding has endowed it with major significance as an automatic fiscal stabilizer. Such a position warrants a more precise appraisal of its automatic contribution to economic stability. The automatic contribution to stability of even a fairly simple personal income tax rests in the first instance on the way tax liabilities respond to income changes a function of the tax base and the rate structure. The income sensitivity of the tax base depends on the distribution of income changes, on the manner in which gross taxable income is defined, on the kind and amount of deductions that are permitted in arriving at net taxable income, and on the system of exemptions for the income earner and his dependents. Tax liabilities are then determined by applying to this base either a single bracket or multiple bracket rate structure. Consumer spending decisions as based on disposable income may, however, be more responsive to tax yields than to tax liabilities, and it is obvious that it is consumer reaction to the tax that determines ultimately its automatic effects. Tax yields may, of course, differ markedly from tax liabilities. Their sensitivity to income changes will be determined by payment requirements by the speed with which liabilities are liquidated. We restrict ourselves in this paper to the measurement of the liability response of a simple personal income tax to changes in personal income. The simple tax considered is one imposed at a proportional rate on income after exemptions (similar to the first bracket of the federal income tax). While a major portion of the agrgregate response of the existing multiple bracket personal income tax is contained in this first bracket,2 a complete picture of the tax must include an analysis of the higher brackets as well.3 Moreover, while we here relate tax liabilities to personal income, ultimately they must be related to changes in national income or product. We are simply developing here one of the several building blocks needed to get a complete picture. In the next section we consider the conclusions of existing studies; in the subsequent section we present our data and findings; in the last section some of their implications.

FOR many economic problems it is important to know how business expectations behave. Are they external to the system or are they related to current or past economic events? And, if the latter, how are they related? Expansion of our knowledge in this area meets with rather formidable difficulties. If one proceeds on the basis of a questionnaire, the answers procured may fail to capture the real expectation of a business manager. His answer may be colored by the use that he believes will be made of the information, or he may be annoyed at the intrusion of an irrelevant question, or at its difficulty, and give off-the-cuff replies. "Objective" data would be of real usefulness, fragmentary or incomplete as they might be. For more than a decade corporations were required to pay federal taxes which implicitly called for a profit forecast of varying lengths of time. Under the capital-stock tax and declaredvalue excess-profits tax, repealed by the Revenue Act of I945, the more precisely could income be forecast, the lower would be total tax liabilities of the firm. A direct monetary reward was granted for precision of estimate. The data these taxes provide are unique in that the forecaster had to place a bet on his guess. Subject to the qualifications discussed later, these data for the period I933 to I94I seem to bear out the conclusion that expected future income was intimately related to current income. A change in current income led to a change in expected future income of almost an equal amount (94 per cent of the change in current income).

The First World War: Revenue Act of 1916, 630; Revenue Acts of 1918 and 1921, 631; criteria used by the Government, 632; extent of amortization under this law, 634; the question of incentives, 634. — The Second World War: Second Revenue Act of 1940, 636; administration of this law, 637; changes in the law in 1942, 639. — Accelerated depreciation as an incentive to plant expansion, 641. — Conclusions, 645.

The corporation tax structure as most recently revised in I942 is yielding an unprecedented volume of revenue. Total tax liabilities of corporations in I942 will be ten times as large as they were in I939 (Table I), the major part of the increase coming from an excess profits tax which was not enacted until 1940. This tax alone accounts for almost $8 billion, or two thirds of total corporate tax liabilities in 1942. But in spite of the huge increase in corporate taxes, it is estimated that income after taxes for all corporations will have increased from $4 billion in I939 to over $7 billion in I942. For profitable corporations, alone, income after taxes will have increased from $6 billion to over $8 billion. These increases in income after taxes are explained by the fact that corporate income before taxes rose from over $5 billion in 1939 to almost $i9 billion in I942. A comparison of income after taxes in I942 with I94I of corporations in general shows an increase of 40%. However, Treasury estimates indicate that net income after taxes for profitable corporations, alone, will be less in I942 than in I94I. The estimated increase of net income after taxes in 1942 over I941 results from a decline in the estimated deficits of unprofitable corporations. Therefore, many individual corporations will have suffered diminutions in net income in 1942 as compared with I94i.1