Lessons Learned: Philip Lane

Philip Lane served as governor of the Central Bank of Ireland from 2015 to 2019. He introduced countercyclical capital and systemic buffer tools and initiated research into the role and risks of cross-border inflows across Ireland. As a member of the Governing Council of the European Central Bank (ECB) since 2015, Lane has advocated for the European Union to adopt macroprudential policies and tools. He hailed the work of the European Systemic Risk Board and similar institutions established after the Global Financial Crisis (GFC) and the European Sovereign Debt Crisis to share data, information concerning risks, and concerns over financial stability. He was named chief economist of the ECB in 2019

Russia: Otkritie Emergency Liquidity Program, 2017

In July and August 2017, Otkritie Bank, Russia’s largest privately owned bank, experienced deposit runs related to concerns over Otkritie’s recent acquisitions, including a large, troubled bank and insurance company. The runs prompted Otkritie to heavily rely on the Central Bank of Russia’s (CBR’s) standing fixed-rate repurchase agreement (repo) facility to meet the outflow. By July, Otkritie had RUB 338.1 billion in outstanding repo loans from the CBR. As depositors continued to withdraw funds in August, the CBR provided Otkritie with an unsecured emergency loan of RUB 330 billion while Otkritie continued to borrow from the repo facility. On August 29, 2017, the CBR announced a rescue plan for Otkritie. In the announcement, the CBR pledged to become Otkritie’s main investor using a newly created resolution mechanism wherein the CBR would take at least a 75% equity stake using funds from the Fund for Banking Sector Consolidation, a subsidiary of the CBR. The bank would remain open, but management would be replaced by a provisional administration composed of CBR employees. By September 1, Otkritie had RUB 1.1 trillion in borrowings outstanding with the CBR, including RUB 682 billion from the repo facility, RUB 330 billion from the unsecured emergency loan, and RUB 55 billion in other loans. In September, Otkritie repaid its outstanding repo debt and the CBR placed an additional RUB 380 billion deposit in the bank. In December 2017, the CBR purchased RUB 456.2 billion in newly issued common shares (99.9% of common shares) to cover Otkritie’s capital deficit, allow it to meet regulatory capital adequacy requirements, and extend financial assistance to Otkritie’s related entities. By February 2018, Otkritie repaid the August emergency loan to the CBR. In March 2018, the CBR decided to restructure Otkritie via a merger with B&N—a smaller, bailed-out bank. This case is part of our series on ad hoc emergency liquidity programs and focuses on the unsecured emergency loan in August and the additional deposit in September. The purpose of these measures was to cover the outflow of deposits and keep the company operating until the government could complete its recapitalization and restructuring

Cross-Sectional Study On The Distribution And Epidemiology Of Plasmodium Ovale Species In Asymptomatic And Symptomatic Individuals In Gulu, Uganda

Despite global progress in malaria control, Plasmodium ovale remains an under-recognized contributor tothe malaria burden in sub-Saharan Africa. Its ability to form dormant liver-stage hypnozoites enables silent, recurrent transmission that often escapes detection by routine diagnostics. This cross-sectional study investigated the prevalence, species distribution, and clinical profile of P . ovale infections in Gulu, Uganda, comparing asymptomatic individuals from the community to symptomatic patients presenting at Gulu Regional Referral Hospital. Molecular diagnostics, including qPCR, nested PCR, and hemi-nested PCR, were used to detect and differentiate P . ovale curtisi and P . ovale wallikeri. Geographic sampling was conducted across 33 parishes in five districts, utilizing a population-proportional stratified design. A total of 600 community samples and 102 hospital samples were collected. Results revealed that P . ovale mono-infections were more prevalent in the community (8.7%), whereas co-infections with P . falciparum were predominant in the hospital (3.9%). Logistic regression analysis demonstrated that P . falciparum co-infection significantly increased the odds of hospitalization among P . ovale-positive individuals (OR = 3.5, 95% CI: 1.2–5.8, p = 0.01). Spatial clustering was observed in Omoro District, particularly in Lukwir Parish, suggesting localized transmission dynamics. Species differentiation using nested PCR confirmed two P . ovale curtisi and two P . ovale wallikeri infections among hospital cases. Additionally, four qPCR-positive hospital samples exhibited faint bands in hemi-nested PCR, indicating low-density infections that were undetectable by standard nested PCR alone. These ambiguous results emphasize the limitations of traditional methods in low-parasitemia settings and underscore the value of employing red diagnostic strategies. The findings suggest that P . ovale is sustained in the community as a largely asymptomatic reservoir and may be contributing to ongoing transmission despite control efforts targeting P . falciparum. Integrating species-specific molecular diagnostics, liver-stage treatments, and broader surveillance of non-falciparum species is essential for achieving comprehensive malaria elimination in Uganda

Lessons Learned: Luis Jácome

Luis Jácome was appointed president of the board of Ecuador’s central bank in 1998 by newly elected President Jamil Mahuad. He and other members of the board resigned in 1999 in protest against a number of crisis-intervention measures they saw as threatening the bank’s independence to set monetary policy. Since the 1970s, Ecuador’s economy had experienced a period of growth fueled by oil exports, but by the mid-1990s the economy was reeling from a series of shocks, among them: a sharp drop in the price of oil, the effects of severe flooding on the country’s agricultural production, and the cost of waging a war with neighboring Peru. The shocks destabilized the country’s banking system, leading to bank runs and spiraling depreciation of the currency. Mahuad was deposed by a military coup in January 1999 and replaced by his vice president, Gustabo Noboa. Shortly after the coup, Ecuador replaced the Ecuadorian sucre with the US dollar, which helped to halt bank runs and restored some trust in the financial system

Lessons Learned: Ignazio Angeloni

Ignazio Angeloni was an adviser on financial integration, financial stability, and monetary policy to the Executive Board of the European Central Bank during the European Sovereign Debt Crisis and later became director general of financial stability. He coordinated the preparations for establishing the Single Supervisory Mechanism (SSM), a component of the European banking union. The SSM was created to address macroprudential gaps identified during the Global Financial Crisis and the Sovereign Debt Crisis. Angeloni has advocated in his academic papers for completing the work of the SSM by establishing a regional deposit insurance scheme that would backstop the work of the related Single Resolution Board of the European banking union, as the Federal Deposit Insurance Corporation does in the United States

Improving The Reporting And Tracking Of Hospital-Acquired Pressure Injuries

Hospital-acquired pressure injuries (HAPIs) affect millions of patients a year, impacting patient safety and creating a significant financial burden for healthcare systems. Inadequate reporting and tracking of HAPIs lead to delays in care, inaccurate data reporting and missed opportunities for quality improvement. This is in large part due to a lack of training and education around HAPIs, poor communication of injuries during hand-off and a lack of system integration. A process improvement program to improve the reporting and tracking accuracy of HAPIs was piloted on two post-surgical units in a large urban cancer center. This initiative combined comprehensive training via a web-based module, and the implementation of an electronic pressure injury risk report that was incorporated into morning huddles and in the hand-off process. Pre and posttests completed by participants revealed a significant increased sense of self-efficacy in identifying, reporting and tracking HAPIs after training (p \u3c.001). The units also sustained a decrease in wound care orders placed on high-risk patients and zero confirmed pressure injuries in the month immediately after implementation. Implementing targeted training and leveraging enhanced reporting via the electronic health record can improve compliance with national standards and improve patient safety overall. A collaborative, interdisciplinary approach and reinforcement of processes are essential in process improvement sustainability

Economic Burden Of Medically Attended Respiratory Syncytial Virus Illness Among Older Adults

ABSTRACTIntroduction: Respiratory syncytial virus (RSV) is a common respiratory pathogen that causes a large burden of disease among older adults. Though there are interventions, the impact and cost-effectiveness of recently licensed RSV vaccines in the United States is not well understood for this population. Thus, reliable estimates on the economic burden of RSV among older adults are needed for future economic analyses. Objective: The objective of this thesis is to evaluate the cost of medically attended RSV among older adults in the United States. Methods: Medicare claims data were used to determine average cost per visit for outpatient, inpatient, emergency department, and intensive care unit treatment through retrospective analyses. For outpatient treatment, average costs overall and costs by risk category (high-risk or non-high-risk) were reported. For inpatient, emergency department (ED), and intensive care unit (ICU) treatment, costs per visit were reported overall, by older adult age groups (60-64, 65-69, 70-74, 75-79, 80-84, ≥85), by risk category, and by clinical outcome (death or discharge). Results: From the healthcare provider perspective, the median (interquartile range) direct costs of outpatient, inpatient, ED, and ICU visits among older adults were $433 ($183-$1,512),$45,258 ($25,249-$85,271), $47,507 ($28,296-$85,335), and$79,538 ($45,930-$145,910), respectively. Additionally, age-specific costs for inpatient, ED, and ICU visits decreased with increasing age group. High-risk older adults had greater average costs per visit (~1.5-3x) than non-high-risk patients in all treatment settings. For inpatient, ED, and ICU treatment settings, the average cost was higher among patients who died compared to patients who were discharged. Conclusion: This study provides comprehensive information on the economic burden of medically attended RSV among older adults. We generally observed greater costs per visit across all treatment types than in previous studies. This study’s subgroup-specific estimates will be valuable in informing future cost-effectiveness analyses of recently licensed RSV vaccines for older adults

Power Outages And Power-Dependent Home Medical Equipment In The United States: A Spatial Analysis

Background: Extreme weather events pose risks to the power grid, threatening the wellbeing of individuals reliant on electricity to meet their health needs. The aim of this study is to identify geographical locations in the U.S. that have both high risk of power outage impact and high proportions of power-dependent durable medical equipment (DME) users. Methods: To achieve this, I used the HHS emPOWER historical map dataset from years 2017 to 2022 and overlaid EAGLE-I data with county-level power outage data from the same study years. Using Local Moran’s I, I found spatially significant high-high clusters of each variable and then intersected cluster layers in ArcGIS Pro to find significant high-high clusters of both DME use and power outages. Results: Through this analysis, I identified vulnerable areas for high levels of power outages and DME; the two risk factors co-occur to the greatest degree in northwest Texas, Appalachia, and Michigan. Significant differences in both DME use and power outage person-time were found across counties of low, medium, and high levels of social vulnerability, indicating disparities between social factors as measured by the Center for Disease Control and Prevention’s Social Vulnerability Index; socioeconomic status, race and ethnicity, language, and housing. Results can inform prioritization of public health interventions to safeguard the health of vulnerable populations during power outages

Tools Of The Trained: Impact Of A Novel Observation Tool On Feedback Dialogues In Medical Education

Feedback is an essential and widely studied component of medical education, but many educational leaders continue to find challenges in the natural and effective delivery of feedback, especially among peers. The purpose of this thesis is to investigate the impact of a novel standardized observation tool on the educational leaders who use it and on the faculty who receive feedback on teaching. Participants in the Teaching Observation Training for Academic Leaders (TOTAL) Training (n=6) were taught to use a standardized observation tool to collect data on teaching. After using the tool, they were interviewed using a semi-structured approach. Interviews were transcribed and thematic analysis was used to code and categorize the data into themes. Teaching faculty who received feedback based on the observational tool (n=8) completed a standardized survey. Thematic analysis revealed five themes: setting expectations, program characteristics, role of educational leaders, role of feedback, and faculty response to feedback. Survey responses demonstrated that faculty expressed that they received relevant, respectful, professional, and supportive feedback that would help improve future performance as a teacher. Median time spent in a feedback session was 15 minutes. The major findingsdemonstrated by the data are 1) The tool improves organization and efficiency of observation and feedback dialogues as reported by educational leaders and the faculty under observation, 2) Differing understandings of the roles of educational leaders may affect the effective provision of feedback, and 3) Increasing awareness of the TOTAL training sessions and support in completing them may assist in overcoming locally observed barriers to feedback and influencing feedback culture

Insights Into Medical Surveillance Among Engineered Stone Countertop Workers In The United States Of America

Background: An alarming rise in the number of cases of silicosis, a progressive and incurable lung disease, among engineered stone (ES) workers has prompted concern about the extent of the problem in the U.S. and whether ES can be used safely. Overexposure to high levels of respirable crystalline silica (RCS) during fabrication or installation of ES can increase the risk of developing a more severe case of silicosis. Medical surveillance studies on US ES workers are limited.Aim: The overall objective of this study was to better understand the state of medical surveillance for ES workers using employer surveys and employee data from members of the National Stone Institute (NSI) and the International Surface Fabricator Association (IFSA), two trade associations representing industry. Methods: An electronic survey was given to NSI and ISFA member companies to assess industry characteristics and operations. Medical screening results, including medical questionnaires, spirometry reports, and chest x-rays findings, were obtained for 60 employees of one stone countertop fabrication company. Spirometry lower limit of normal for FEV1, FVC, and FEV1/FVC ratios were calculated using GLI data and NHANES data with age, height, sex-adjustment, and with and without race-adjustments, and descriptive analysis was performed. Results: The survey completed by 266 employers indicated a median of 10 employees (range 1-460) per company. Most companies (95.9%) reported working with both natural and ES and performing countertop fabrication and installation (81.6%). A minority reported having performed air sampling for RCS (42.5%). Most employers reported the use of both hand tools (80.5%) and automated machines such as CNC (add%) to process stone. 62.4% of employers reported providing respiratory protection, but only 53.6% of these employers have a written protocol, and only 42.8% of these have performed respirator FIT testing. Only 18.8% of employers reported performing pre-placement exams, and over 50% of these were missing one or more key components, such as a chest X-ray. 60 employee medical screening and surveillance records from one fabrication company indicated that most employees were Hispanic males with an average age of 38.9 + 11.8 and an average employment tenure of 6.3 + 6.8. Most were either fabricators (26.7%) or installers (50%). Spirometry data indicated that using GLI normative values without race correction, 5.6% had findings suggestive of restrictive physiology, and none had obstructive physiology. Chest imaging B-read reports noted only 2/59 had abnormalities (1/2 perfusion and opacities and a 2nd hilar adenopathy), changes (especially opacities) concerning for possible early silicosis. Conclusion: Overall, the majority of 266 ES stone companies are not performing recommended medical surveillance exams and workplace monitoring for silica. A review of medical surveillance records from 60 employees showed variable quality of testing. Almost all had normal spirometry and unremarkable chest imaging, except for one chest X-ray B-read suggestive of silicosis. The results identify opportunities to improve medical surveillance and compliance with OSHA silica regulations among ES employers and ES workers