Strategies for Providing Loans to Small Businesses

Between 2007 and 2013, the number of loans banks provided to small and medium-sized enterprises (SMEs) declined. The purpose of this single case study was to explore the strategies that senior bank lending officers used to improve lending to SMEs. The sample size consisted of 4 senior small business lending officers who have in lending for 5 or more year in Houston, Texas. The conceptual framework used was agency theory. Data were collected using semistructured interviews with 4 senior bank lending officers from a bank in the Houston, Texas area, a review of documents from lending officers, and other artifacts from the Small Business Administration. Data were analyzed with the support of software to generate themes. The data analysis included process coding of the data collected from the participants. Member checking and methodological triangulation enhanced the credibility of the findings in this study. Three themes emerged from the data analysis: the barriers and challenges lenders face when lending to business owners, bankers\u27 strategies to overcome challenges in lending to their customers, and lenders\u27 use of relationships and lending experience to provide loans to their customers. The findings from this study may contribute to social change by providing insights that can be used by senior lending officers related to strategies for providing loans to SMEs. The results of this study may also contribute to increased job creation for local residents, which can positively impact the economic viability of the Houston area

The Successful Use of Extracorporeal Membrane Oxygenation in Systemic Lupus Erythematosus-Induced Diffuse Alveolar Haemorrhage

Diffuse alveolar haemorrhage (DAH) is a catastrophic pulmonary complication of systemic lupus erythematosus. It can result in refractory hypoxaemia despite mechanical ventilation. Increasing lung compliance and worsening pulmonary hypertension can potentiate cardiogenic shock from acute right ventricular failure. In such patients with cardiopulmonary collapse, veno-arterial (V-A) ECMO maybe a viable option that can provide the required haemodynamic support. However, the use of V-A ECMO in such patients is limited due to an associated increased risk of bleeding. Our case report describes the successful use of V-A ECMO without the use of systemic anticoagulation in a patient with DAH. Despite the absence of systemic anticoagulation, no thrombotic complications within the circuit were noted

Eating behavior in children with fetal alcohol spectrum disorders: A mixed methods study

Secondary to associated physical defects, global behavioral problems, and co-occurring diagnoses, studies suggest there are problems with nutrition and eating in children with fetal alcohol spectrum disorders (FASDs); however, there is limited research on the effects of prenatal alcohol exposure on childhood eating behavior. A mixed methods approach was used to define the eating behavior in children with FASDs, aged 3 to 5 years, through responses from caregivers of children with FASDs to the Children's Eating Behavior Questionnaire and the Child Behavior Checklist 1.5-5, and through focus groups of healthcare professionals with FASD pediatric experience. There were 74 caregivers and 26 healthcare professionals from across the U.S. and internationally who participated in the study. When compared to a normative sample, the findings from caregiver responses demonstrated atypical eating behavior in preschool-aged children with FASDs characterized by maladaptive appetites, selective eating, slowness in eating, and an excessive need for drinks. In relation to global behavioral problems, it was found that the children with FASDs ate faster if taking a greater number of medications, but slower with somatic symptoms. During stress, caregivers reported the children with FASDs, who exhibited internalizing behaviors, under ate, while those with externalizing behaviors overate. In addition, the children with FASDs, who had both internalizing behaviors and sleep problems, experienced more food fussiness. The healthcare professionals identified atypical eating behavior in the children with FASDs that was influenced by co-occurring diagnoses with or without medications, food hypo- or hypersensitivities, food intolerances, late FASD diagnosis, and nutritional deficiencies. Furthermore, healthcare professionals expressed that the atypical eating behavior in the preschool-aged children with FASDs was impacted by family stress, the limited nutrition knowledge of the children's caregivers, and a need for improved caregiver feeding practices. Findings suggest that the severity of the FASD condition may underlie the children's atypical eating behaviors in association with higher levels of behavioral problems, medications, and stress in the family. With the identification and characterization of atypical eating behavior in preschool-aged children with FASDs, targeted nutrition education and interventions can be developed in an effort to improve nutrition, childhood development, and quality of family life

Polysaccharide-Degrading Complex Produced in Wood and in Liquid Media by the Brown-Rot Fungus Poria Placenta

The polysaccharide-degrading enzymes produced by Poria placenta in decayed wood and liquid media were compared qualitatively and quantitatively. A single carbohydrate-degrading complex was isolated and purified from wood and liquid cultures that was active on both polysaccharides and glycosides. Quantitative differences in enzyme activities from decayed wood versus liquid media were observed. However, the purified extracellular carbohydrate-degrading complex isolated from decayed wood and from liquid cultures must be structurally similar because of similar isoelectric points, electrophoretic properties, and molecular sieving properties

The World Federation Society of Anaesthesiologists Online Learning Inventory (WOLI): The Current State of Open Access Online Learning Resources among WFSA Member Societies

Abstract: Background and Objectives: The digital revolution has reshaped medical education and networking, making websites essential for sharingknowledge and practices. In anesthesiology education, it is unclear what online educational material has been published as open-access by anesthesia societies globally. This gap could lead educators to create new content when quality resources already exist. Our study sought to inventory open-access educational resources on WFSA member societies’ websites, including differences in types of resources available by country income bracket. Methods:An extraction template was designed to identify open-access educational resources available on society websites. To ensure reliability, thistemplate was piloted by all reviewers by assessing a subset of websites together. Subsequently, each website was assessed by twoindependent reviewers. Discrepancies were resolved through discussion. For non-English language websites, Google Translate was used. Wedid not seek institutional review board review as our research only studied public online resources and did not involve human subjects orconfidential information. Results: Of 133 WFSA member societies assessed, 53% (n=71) had functioning society websites. Among these 71 sites, at least one of thecategorized open-access educational resources was identified on 96% (n=68). The most common resources available were written, non-interactive content, present on 85% (n=60) of sites. Guidelines were available on 65% (n=46) of sites, webinars on 24% (n=17), non-livecourses on 21% (n=15), and video recordings on 18% (n=13). Discussion forums were the least common and only available on 3% (n=2) ofsites.High-income countries were more likely to have open-access educational material, with their websites contributing over 50% of total contentacross all resource categories (Figure 1). Conversely, low-income countries made up the lowest proportion and only shared written, non-interactive resources, webinars, and guidelines (Figure 1). Discussion and Conclusion: Our survey of WFSA member societies’websites revealed notable disparities. Over half had an active onlinepresence, but the resource breadth was inconsistent and often low, particularly from societies of lower-income nations.Our findings suggest anesthesia education content is available online on member society websites; however, availability differs widelybetween societies and there is a tendency for these to be limited to non-interactive resources. The higher proportion of online guidelinessuggests a priority for societies to support members with evidence-based clinical guidance practices.One of the main limitations of our study was that we were unable to assess the presence of any resources behind existing firewalls; therefore,focused efforts on identifying existing accessible content. Instead of predominantly encouraging societies to develop new resources andguidelines themselves, which often is costly and time-consuming, we should consider advocating for sharing of content already available thatmay be relevant between similar settings. This could potentially be done effectively using an anesthesia online learning community (AOLC)which may bridge gaps and enhance global collaboration

High Prevalence of Pre-Existing Liver Abnormalities Identified Via Autopsies in COVID-19: Identification of a New Silent Risk Factor?

A high prevalence of hepatic pathology (in 17 of 19 cases) was reported in post-mortem (PM) examinations of COVID-19 patients, undertaken between March 2020 and February 2021 by a single autopsy pathologist in two English Coronial jurisdictions. The patients in our cohort demonstrated high levels of recognised COVID-19 risk factors, including hypertension (8/16, 50%), type 2 diabetes mellitus (8/16, 50%) and evidence of arteriopathy 6/16 (38%). Hepatic abnormalities included steatosis (12/19; 63%), moderate to severe venous congestion (5/19; 26%) and cirrhosis (4/19; 21%). A subsequent literature review indicated a significantly increased prevalence of steatosis (49%), venous congestion (34%) and cirrhosis (9.3%) in COVID-19 PM cases, compared with a pre-pandemic PM cohort (33%, 16%, and 2.6%, respectively), likely reflecting an increased mortality risk in SARS-CoV-2 infection for patients with pre-existing liver disease. To corroborate this observation, we retrospectively analysed the admission liver function test (LFT) results of 276 consecutive, anonymised COVID-19 hospital patients in our centre, for whom outcome data were available. Of these patients, 236 (85.5%) had significantly reduced albumin levels at the time of admission to hospital, which was likely indicative of pre-existing chronic liver or renal disease. There was a strong correlation between patient outcome (length of hospital admission or death) and abnormal albumin at the time of hospital admission (p = 0.000012). We discuss potential mechanisms by which our observations of hepatic dysfunction are linked to a risk of COVID-19 mortality, speculating on the importance of recently identified anti-interferon antibodies

Calcium Handling Defects and Cardiac Arrhythmia Syndromes

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Impact of COVID-19 response on global surgical volumes:an ongoing observational study

Objective: To determine whether location-linked anaesthesiology calculator mobile application (app) data can serve as a qualitative proxy for global surgical case volumes and therefore monitor the impact of the coronavirus disease 2019 (COVID-19) pandemic. Methods: We collected data provided by users of the mobile app "Anesthesiologist" during 1 October 2018-30 June 2020. We analysed these using RStudio and generated 7-day moving-average app use plots. We calculated country-level reductions in app use as a percentage of baseline. We obtained data on COVID-19 case counts from the European Centre for Disease Prevention and Control. We plotted changing app use and COVID-19 case counts for several countries and regions. Findings: A total of 100 099 app users within 214 countries and territories provided data. We observed that app use was reduced during holidays, weekends and at night, correlating with expected fluctuations in surgical volume. We observed that the onset of the pandemic prompted substantial reductions in app use. We noted strong cross-correlation between COVID-19 case count and reductions in app use in low- and middle-income countries, but not in high-income countries. Of the 112 countries and territories with non-zero app use during baseline and during the pandemic, we calculated a median reduction in app use to 73.6% of baseline. Conclusion: App data provide a proxy for surgical case volumes, and can therefore be used as a real-time monitor of the impact of COVID-19 on surgical capacity. We have created a dashboard for ongoing visualization of these data, allowing policy-makers to direct resources to areas of greatest need

Diel turbidity cycles in a headwater stream: evidence of nocturnal bioturbation?

Purpose: A small number of recent studies have linked daily cycles in stream turbidity to nocturnal bioturbation by aquatic fauna, principally crayfish, and demonstrated this process can significantly impact upon water quality under baseflow conditions. Adding to this limited body of research, we use high-resolution water quality monitoring data to investigate evidence of diel turbidity cycles in a lowland, headwater stream with a known signal crayfish (Pacifastacus leniusculus) population and explore a range of potential causal mechanisms. Materials and methods: Automatic bankside monitoring stations measured turbidity and other water quality parameters at 30-min resolution at three locations on the River Blackwater, Norfolk, UK during 2013. Specifically, we focused on two 20-day periods of baseflow conditions during January and April 2013 which displayed turbidity trends typical of winter and spring seasons, respectively. The turbidity time-series, which were smoothed with 6.5 hour Savitzky-Golay filters to highlight diel trends, were correlated against temperature, stage, dissolved oxygen and pH to assess the importance of abiotic influences on turbidity. Turbidity was also calibrated against suspended particulate matter (SPM) over a wide range of values via linear regression. Results and discussion: Pronounced diel turbidity cycles were found at two of the three sites under baseflow conditions during April. Spring night-time turbidity values consistently peaked between 21:00 and 04:00 with values increasing by ~10 nephelometric turbidity units (NTU) compared with the lowest recorded daytime values which occurred between 10:00 and 14:00. This translated into statistically significant increases in median midnight SPM concentration of up to 76% compared with midday, with night-time (18:00 – 05:30) SPM loads also up to 30% higher than that recorded during the daytime (06:00 – 17:30). Relating turbidity to other water quality parameters exhibiting diel cycles revealed there to be neither any correlation that might indicate a causal link, nor any obvious mechanistic connections to explain the temporal turbidity trends. Diel turbidity cycles were less prominent at all sites during the winter. Conclusions: Considering the seasonality and timing of elevated turbidity, visual observations of crayfish activity, and an absence of mechanistic connections with other water quality parameters, the results presented here are consistent with the hypothesis that nocturnal bioturbation is responsible for generating diel turbidity cycles under baseflow conditions in headwater streams. However, further research in a variety of fluvial environments is required to better assess the spatial extent, importance and causal mechanisms of this phenomenon

Cost analysis and outcomes of endoscopic, minimal access and open pancreatic necrosectomy.

To assess both individual patient and institutional costs as well as outcomes in patients with pancreatic necrosis who underwent either endoscopic, minimal access or open pancreatic necrosectomy. These data can be used to evaluate clinical effectiveness with a view to informing local health care providers. Intervention for infected pancreatic necrosis is associated with a high morbidity, mortality and long hospital stays. Minimal access surgical step-up approaches have been the gold standard of care, however endoscopic approaches are now offered preferentially. All patients undergoing endoscopic (EN), minimal access retroperitoneal (MARPN) and open (OPN) necrosectomy at a single institution from April 2015-March 2017 were included. Patients were selected for intervention based on morphology and position of the necrosis and on clinical factors. Patient level costing systems were used to determine inpatient and outpatient costs. 86 patients were included: 38 underwent EN, 35 MARPN and 13 OPN. Pre-operative APACHEII was 6 vs 9 vs 9 (p=0.017) and CRP 107 vs 204 vs 278, (p=0.012), respectively. Post-operative stay was 19 days for EN vs. 41 for MARPN vs. 42 for OPN (p=0.007). Complications occurred in 68.4%, 68.6% and 46.2% (p=0.298) while mortality was 10.5%, 22.9% and 15.4% (p=0.379) respectively. Mean total cost was £31,364 for EN, £52,770 for MARPN (p=0.008) and £60,346 for OPN. Ward and critical care costs for EN were lower than for MARPN (ward: £9,430 vs. £14,033, p=0.024; critical care: £5,317 vs. £16,648, p=0.056)