Monetary Policy and Exchange Rate Dynamics: New Evidence from the Narrative Approach to Shock Identification

We argue that endogenous and anticipated movements in interest rates lead to underestimates of the speed and magnitude of the exchange rate response to monetary policy. Employing the Romer and Romer (2004) exogenous monetary policy shock measure, we find that the effect of a one percentage point increase in the U.S. interest rate is up to twice as large and 3 times as fast as that obtained using the actual federal funds rate to identify monetary shocks. Moreover, new evidence from open economy VARs emphasises the adjustment role of the exchange rate. U.S. prices and output respond almost twice as quickly as they do in a closed economy VAR using the Romer and Romber shock measure. There is also evidence of stronger international transmission of U.S. monetary shocks. Overall, the estimated response speeds and magnitudes are more easily reconciled with existing models than previous empirical work.monetary policy shocks, exchange rate dynamics, open economy VARs

Quality of Care and Patient Safety

This issue of Proceedings in Obstetrics and Gynecology (POG) is devoted to exploring issues related to the quality of care provided to patients and to patient safety

Importance of the physical exam and in-office tests in the evaluation of vulvovaginal irritation

Background: Vulvovaginal irritation is a common gynecologic complaint. A number of factors may lead to a trial of therapy without undertaking a physical exam or diagnostic testing. Case Report: A 45 year-old woman presented to our colposcopy clinic for evaluation of an abnormal Papanicolaou (Pap) test. She reported a one month history of vulvovaginal irritation, for which Premarin vaginal cream had been empirically prescribed. Examination of the external genitalia showed ulcers and erythema of the labia minora. Speculum exam was deferred because of the patient’s discomfort. Wet mount microscopy from a vaginal swab revealed evidence of Trichomonas vaginalis, bacterial vaginosis (BV), and yeast. A swab of the ulcers was sent for herpes simplex virus (HSV) polymerase chain reaction (PCR); this confirmed HSV-2. Treatment was initiated for each of these conditions, and the patient returned for colposcopy 21 days later. Conclusion: This case illustrates the importance of the physical exam when evaluating a complaint of vulvovaginal irritation. In many cases, the cause(s) of vulvovaginal irritation can be identified based on physical exam findings and in-office testing with wet mount microscopy, vaginal pH, and the amine “whiff” test. In some cases, additional testing may be required to establish or confirm a diagnosis. Accurate diagnosis is essential not only to initiate appropriate therapy, but also to prevent the transmission of sexually transmitted infections. In some cases, this may decrease the delay in diagnosing vulvar gynecologic malignancies

Recovery from cesarean delivery at UIHC: a comparison to Enhanced Recovery Protocols

Enhanced Recovery After Surgery programs (ERAS) have been used by some specialties for years, and are now becoming popular for gynecologic and obstetrics surgeries. ERAS programs consist of evidence-based interventions during a patient’s hospital stay that are intended to promote early return to activities such as eating, ambulation, and voiding and to manage pain. These programs reduce the risk of complications post-operatively and shorten a patient’s hospital stay. The University of Iowa Hospitals and Clinics (UIHC) is developing an ERAS protocol for cesarean deliveries. Our goal was to determine how current practices and outcomes for cesarean deliveries at UIHC compare to established ERAS programs. We also sought to identify which patients would be appropriate candidates for an ERAS protocol at UIHC

Direct thermal desorption gas chromatographic determination of toxicologically relevant concentrations of ethylene glycol in whole blood

© 2018 The Royal Society of Chemistry. A simple and rapid method involving thermal desorption gas chromatography (TD-GC) with flame ionisation detection has been successfully developed for the determination of ethylene glycol in whole blood. No sample extraction or derivatization steps were required. The conditions required for the direct determination of ethylene glycol in whole blood were optimised and require only the addition of the internal standard, 1,2-butanediol, to the sample. A 1 μL aliquot of the sample was then introduced to the thermal desorption unit, dried, and thermally desorbed directly to the gas chromatograph. A calibration curve was constructed over the concentration range of 1.0 to 200 mM and was found to be linear over the range investigated with an R2 value of 0.9997. The theoretical limit of detection based on 3σ was calculated to be 50.2 μM (3.11 mg L-1). No issues with carryover were recorded. No interferences were recorded from endogenous blood components or a number of commonly occurring alcohols. The proposed method was evaluated by carrying out replicate ethylene glycol determinations on fortified whole blood samples at the levels of 12.5 mM, 20.0 mM, 31.2 mM, 100 mM and 200 mM comparable to commonly reported blood levels in intoxications. Mean recoveries of between 84.8% and 107% were obtained with coefficients of variation of between 1.7% and 5.8%. These data suggest that the method holds promise for applications in toxicology, where a rapid, reliable method to confirm ethylene glycol poisoning is required

Extraction-free, direct determination of caffeine in microliter volumes of beverages by thermal desorption-gas chromatography mass spectrometry

An extraction-free method requiring microliter (μL) volumes has been developed for the determination of caffeine in beverages.Using a pyrolysis-gas chromatography mass spectrometry system, the conditions required for the direct thermal desorption-gaschromatography mass spectrometry (TD-GC/MS) determination of caffeine were optimised. A 5 μL aliquot was introduced to thethermal desorption unit, dried, and thermally desorbed to the GC/MS. *e response was linear over the range 10 to 500 μg/mL(R2 = 0.996). *e theoretical limit of detection (3 σ) was 0.456 μg/mL. No interferences were recorded from endogenous beveragecomponents or from commonly occurring drugs, such as nicotine, ibuprofen, and paracetamol. Replicate caffeine determinationson fortified latte style white coffee and Pepsi Max® gave mean recoveries of 93.4% (%CV = 4.1%) and 95.0% (%CV = 0.98%),respectively. Good agreement was also obtained with the stated values of caffeine for an energy drink and for Coca-Cola®. *esedata suggest that the method holds promise for the determination of caffeine in such samples

Quantitative Blood Loss (QBL) at every delivery: a quality improvement initiative utilizing Electronic Medical Record tools

Maternal hemorrhage is a major cause of maternal morbidity and mortality in the United States and efforts are in place to eliminate preventable harm. Accurate assessment of blood lost around the time of birth is essential for timely recognition and intervention. As part of the Alliance for Innovation on Maternal Health (AIM) Obstetrical Hemorrhage Patient Safety Bundle at our institution a quantitative blood loss (QBL) calculator was created within the electronic medical record. This process allows for real-time tracking of cumulative blood loss measurements and is built with triggers to alert the care team when criteria for various hemorrhage stages are achieved along with suggested interventions and assessments. The consistency of implementation and efficacy of the QBL calculator was evaluated by following both utilization of the calculator flowsheet as well as tracking of rates of erroneous QBL values, defined by negative values and cesarean deliveries with QBL2019, 14 months after implementation and post three system-based improvements. By the end of this implementation review the calculator was in use consistently at all cesarean deliveries with improved confidence in the process by providers

Does leptin predict successful induction of labor?

Obesity in pregnancy is becoming increasingly common and is associated with many pregnancy-related complications such as failed induction of labor (IOL). Leptin, an adipocytokine important in energy homeostasis, is found in higher levels in obese individuals. Leptin has also been demonstrated to have an inhibitory effect on myometrial contractility in vitro. We hypothesize that leptin may play a part in the mechanism of dysfunctional labor. Thus, we sought to compare the maternal plasma leptin levels in women that had a successful vaginal delivery post-IOL vs. those who had a C-section post-IOL