Discriminatory Lending:Evidence from Bankers in the Lab

We implement a lab-in-the-field experiment with 334 Turkish loan officers to document gender discrimination in small business lending and to unpack the mechanisms at play. Each officer reviews multiple real-life loan applications in which we randomize the applicant's gender. While unconditional approval rates are the same for male and female applicants, loan officers are 26 percent more likely to require a guarantor when we present the same application as coming from a female instead of a male entrepreneur. A causal forest algorithm to estimate heterogeneous treatment effects reveals that this discrimination is strongly concentrated among young, inexperienced, and gender-biased loan officers. Discrimination mainly affects female loan applicants in male-dominated industries, indicating how financial frictions can perpetuate entrepreneurial gender segregation across sectors

Biomechanical analysis of selected risk and protective factors for an anterior cruciate ligament (re-) rupture during a training with the ExerCube

Movement patterns are altered after an anterior cruciate ligament reconstruction and rehabilitation, which could increase the risk for a second rupture. Therefore, rehabilitation needs to be improved. The use of exergaming and virtual reality has shown promising results in the rehabilitation of chronic disease patients, but not yet with patients after musculoskeletal injuries. The aim of this thesis was to investigate the biomechanical movement quality and the potential risk of an anterior cruciate ligament (re-) rupture during a training with the ExerCube, an exergaming device. Biomechanical movement patterns of female healthy athletes (n = 7) of five different type of sports were investigated. Measured biomechanical risk factors during jumps, squats, left, and right lunges were knee flexion angle (fraction between 10° and 30°) and knee adduction angle, while the investigated biomechanical protective factor was the hip flexion angle. Additionally, knee extensor and flexor strength were measured with isokinetic dynamometry. Participants showed low knee extensor strength and normal knee flexor strength. Both risk factors were present in all four exercises, even though to a different extent, whereas the protective factor was found only during the squat and the jump or lunge of some participants. Strain on the anterior cruciate ligament during the squat and lunge is controllable, but during the jump explosive movements create a high amount of loading. It can therefore be concluded that the squat and lunge can be performed during later stages of rehabilitation, but it is not recommended to perform a jump in the ExerCube training environment

The Parallel Encounter: An Alternative to the Traditional Serial Trainee–Attending Patient Evaluation Model

BackgroundThe emergency department environment requires the clinician‐educator to use adaptive teaching strategies to balance education with efficiency and patient care. Recently, alternative approaches to the traditional serial trainee–attending patient evaluation model have emerged in the literature.MethodsThe parallel encounter involves the attending physician and resident seeing the patient independently. Instead of the trainee delivering a traditional oral case presentation, the trainee does not present the history and examination to the attending physician. Rather, the attending and trainee come together following their independent evaluations to jointly discuss and formulate the assessment and plan.ResultsThe parallel encounter has the potential to enhance the teaching encounter by emphasizing clinical reasoning, reduce cognitive bias by integrating two independent assessments of the same patient, increase attending workflow flexibility and efficiency, and improve patient satisfaction and outcomes by reducing time to initial provider contact. The attending must be mindful of protecting resident autonomy. This model tends to work better for more senior learners.ConclusionsThe parallel encounter represents a novel approach to the traditional serial trainee–attending patient evaluation model that may enhance the teaching encounter and improve patient care.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/163487/2/aet210491_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/163487/1/aet210491.pd

CT Before Lumbar Puncture in Suspected Meningitis in Botswana: How Established Guidelines May Not Apply / Tomodensitométrie Avant Ponction Lombaire en Cas de Suspicion de Méningite au Botswana: Comment les Directives Classiques Peuvent ne Pas s’Appliquer

English Introduction According to established guidelines from high-income countries, computed tomography of the head (CT) is indicated before lumbar puncture (LP) in the evaluation of suspected meningitis in HIV patients. In Botswana, meningitis in HIV-infected patients is common but CT is not widely available. Objective Develop a rational, evidence-based approach to CT use in the emergency evaluation of suspected meningitis in a population with high HIV prevalence. Methods Emergency center (EC) staff at Princess Marina Hospital in Gaborone, Botswana, reviewed indications for CT and LP in suspected meningitis. The authors considered existing evidence for CT before LP (mostly from high-income countries) and considered the epidemiology of central nervous system infections in Southern Africa. Draft guidelines were circulated to emergency center doctors and nurses, and to specialists in other hospital departments for review and comment before finalization. Result Available literature seems to indicate that in Botswana it would be possible to significantly limit the use of head CT before LP in HIV positive patients without increasing the incidence or risk of herniation. The guideline includes scenarios where an LP might be indicated in the presence of focal neurological findings and in the absence of a CT, in contradiction to established guidelines. Discussion The applicability of established guidelines for CT use in suspected meningitis is dependent on local epidemiology and resources. French Introduction Selon les directives classiques provenant des pays à revenu élevé, la tomodensitométrie (TDM) de la tête est indiquée avant une ponction lombaire (PL) pour l’évaluation d’une possible méningite chez les patients infectés par le VIH. Au Botswana, la méningite chez les patients infectés par le VIH est courante mais la TDM n’est pas souvent disponible. Objectif Développer une approche rationnelle fondée sur des preuves relative à l’utilisation de la TDM en cas d’évaluation d’urgence d’une possible méningite au sein d’une population à forte prévalence du VIH. Méthodes Le personnel du Centre d’Urgences (CU) de l’hôpital Princess Marina à Gaborone, Botswana, a examiné des prescriptions de TDM et de PL en cas de suspicion de méningite. Les auteurs se sont penchés sur les cas existants de TDM avant PL (la plupart provenant de pays à revenus élevés) et ont examiné l’épidémiologie des infections du système nerveux central en Afrique australe. Des directives provisoires ont été distribuées à des médecins et des infirmières de centres d’urgences et à des spécialistes dans d’autres services hospitaliers pour examen et commentaires avant finalisation. Résultat Les publications disponibles semblent indiquer qu’au Botswana, il serait possible de limiter fortement l’utilisation de la TDM de la tête avant une PL chez les patients séropositifs sans augmenter l’incidence ou le risque d’engagement cérébral. La directive comprend des scénarios dans lesquels une PL pourrait être indiquée en présence de signes neurologiques focaux et en l’absence d’une TDM, contrairement à ce que préconisent les directives classiques. Discussion L’applicabilité des directives classiques relatives à l’utilisation de la TDM dans des cas de suspicion de méningite dépend de l’épidémiologie et des ressources locales

Assistierter Suizid und die Rolle der Sozialarbeit

Die Anzahl an Menschen, die einen assistierten Suizid in Anspruch nehmen, steigt jährlich. Dadurch stellen sich Fragen nach der Zuständigkeit und der Rolle der Sozialarbeit

Sterbehilfe...und was hat das mit Sozialarbeit zu tun? eine Studie zu den Beratungsangeboten im Kanton Bern und der Rolle der Sozialarbeit

Sterbehilfe und assistierter Suizid sind nicht Themen, die üblicherweise mit Sozialarbeit in Verbindung gebracht werden. Basierend auf aktuellen Statistiken gewinnen sie jedoch stark an gesellschaftlicher Relevanz. Die vorliegende Masterarbeit untersucht die Beratungsangebote im deutschsprachigen Kanton Bern in Bezug auf die Sterbehilfe und fragt nach bestehenden Beratungsmöglichkeiten für Menschen ab dem dritten Lebensalter. Mit zwei aufeinander aufbauenden empirischen Untersuchungen (Mixed-Methods-Ansatz) von Angeboten und allfälligen Lücken auf der Angebotsebene, geht die Arbeit der Fragestellung nach, ob resp. welche Rolle und Aufgaben der Sozialarbeit in einer beratenden Funktion am Lebensende im spezifischen Feld des assistierten Suizids zukommen. Mittels eines grösstenteils quantitativ ausgerichteten Onlinefragebogens, den 53 Personen beantworteten, wurden 16 im Feld der Sterbehilfe beratende Organisationen im Kanton Bern identifiziert und nach der Ausgestaltung ihres Angebots befragt. Anhand von drei auf den Ergebnissen des Fragebogens basierenden leitfadengestützten Expert:inneninterviews, zeigen sich bei der strukturierenden Inhaltsanalyse nach Kuckartz Kontraste der verschiedenen Ausgestaltung von Beratungsangeboten. Die Ergebnisse machen deutlich, dass Sozialarbeitende nebst hauptsächlich Pflegefachpersonen und Mediziner:innen in die Beratungen zur Sterbehilfe involviert sind. Die Beratungsangebote sind jedoch generell nicht allen potenziellen Zielgruppen zugänglich, sondern meist nur Personen, die bereits Leistungsempfänger:innen der anbietenden Organisationen sind. Entsprechend besteht eine Lücke im Angebot und daher Handlungsbedarf. Die Sozialarbeit hat mit ihren (Beratungs-)kompetenzen grosses Potenzial diese Lücke zu schliessen und ihre Professionalität in diesem Handlungsfeld einzubringen. Die in dieser Arbeit skizzierte sozialarbeiterisch geführte interprofessionelle Beratungsstelle könnte eine Antwort auf aktuelle gesellschaftliche Entwicklungen in Bezug auf das Lebensende darstellen

Analytical description of adolescent binge drinking patients

Background Binge drinking is a widespread health compromising behavior among adolescents and young adults, leading to significant health problems, injuries and mortality. However, data on alcohol consumption is often unreliable, as it is mainly based on self-reporting surveys. In this five-year study (2014–2019) at the University Children’s Hospital Zurich, we analyzed blood samples from adolescent binge drinking patients to investigate blood alcohol concentrations (BACs), co-ingestion of drugs, assess compliance between self-reported and measured substance use, and test for genetic components of innate alcohol tolerance. Furthermore, hair analysis was performed to retrospectively access drug exposure and to evaluate the potential of hair analysis to assess binge drinking. Methods In a prospective, single-center study, patients with alcohol intoxications aged 16 years and younger were included. Blood and hair samples were analyzed by sensitive liquid chromatography – tandem mass spectrometry drug analysis. HTTLPR genotyping was performed with PCR and fragment analysis. Results Among 72 cases, 72 blood and 13 hair samples were analyzed. BACs ranged from 0.08–3.20‰ (mean 1.63‰, median 1.60‰), while a mean concentration of 3.64 pg/mg hair (median 3.0 pg/mg) of the alcohol marker ethyl glucuronide (EtG) was detected in eleven hair samples, providing no evidence of chronic excessive drinking. In 47% of the cases, co-ingested drugs were qualitatively detected next to ethanol, but only 9% of the detected drugs had blood concentrations classified as pharmacologically active. Cannabis consumption (22%) and stimulant intake (16%) were the most frequently observed drugs. Compliance between patients’ statements and measured substances matched well. Although we investigated the genetic contribution to innate alcohol tolerance via the 5-HTTLPR polymorphism, the diverse genetic background of the cohort and small sample size did not allow any conclusions to be drawn. Conclusion Almost half of our binge drinking patients tested positive for other substances, primarily cannabis. We anticipate that our study enhances understanding of consumption behavior of young people and encourage continued efforts to address the harmful effects of binge drinking and co-occurring substance use

Older adults prefer virtual reality when playing a fruit reaching game

Exergaming, physically active gaming, is widely used for training and rehabilitation purposes. Its popularity as a training tool in older adults has seen a considerable upsurge. Apart from the physical effect of exergaming, positive effects on cognition and balance have been reported as well. Targeted balance training can reduce the risk of falling which positively influences the ability of independent living in older adults. Extended technologies such as augmented reality (AR), virtual reality (VR), or a combination thereof, passthrough (PT) have great potential to increase physical activity in older adults which leads to increased health. However, it is unclear which technology (AR, VR, or PT) is best suited for older adults. Therefore, the primary aim of this study was to find out if AR, VR, or PT is subjectively preferred by older adults while playing a reaching game. The secondary aim was to objectively measure the movement of the trunk and hip, and center of pressure in AR, VR, and PT. Seven participants aged older than 65 years with no musculoskeletal or neurological diseases were recruited for this pilot study. In a randomized order, participants played the fruit reaching game, whereby flying fruit had to be grabbed, either with a VR (Oculus Quest 2), AR (HoloLens 2), or PT (Oculus Quest 2) mode. The game was played for 3 minutes in each mode while kinematics of the hip, trunk, and shoulder were recorded with motion capture (Vicon). After each mode, the experience was subjectively rated by the participants. At the end, VR, AR, and PT were compared to each other in a survey. The outcome suggests that the VR technology was subjectively preferred compared to AR and PT. The good orientation in the room and the large field of view of the VR technology convinced the participants. The motivation to reach for the fruit was highest with the VR headset and none of the participants experienced an uneasy feeling when the real environment was not visible in the VR mode. In the AR and PT mode, the game was found to be more tiring compared to the VR mode. No participant reported dizziness or nausea during or after the game. The evaluation of the trunk flexion-extension angles indicated that participants have different reaching patterns. While some participants showed high values in trunk angles (>25°) and therefore controlled the movement from the torso, other participants showed low trunk angles (< 25°). At small angles, the reaching movement was either controlled from the hips or with the arms only. Although it seems that the VR headset was favored by most of the participants, more research is necessary to get a deeper insight into the differences between extended technologies. More participants should be included and different games with adaptive difficulty levels should be performed. In addition, it would be of interest to investigate the correlation between the trunk angle and balance ability of the participants. With this knowledge, training specific exercises or movement sequences could lead to increased balance control and reduce the risk of falling