Islamic Banks’ Capital Buffers: Unique Risk Exposures and the Disciplining Effects of Charter Values

In the aftermath of the recent financial crisis, the inherent linkages between banks’ capital buffers and risk took center stage as policy makers promoted a more resilient global banking system. The growing recognition of Islamic banking as a viable alternative-banking model warrants the need to investigate the overall susceptibilities of Islamic banks’ capital buffers to unique risks emanating from their operating environments. We examine this issue over the period 2005-2012 in the 18 countries where Islamic and conventional commercial banks coexist. We employ a panel model using dynamic Generalized Methods of Moments (GMM) on a data set comprising 128 commercial banks of which 44 are Islamic commercial banks. The search for alternative forms of prudential regulation over and above risk based capital guidelines has also shifted the attention of policy makers towards investigating the disciplining effects of banks’ charter values on capital buffers. We test this issue for Islamic banks, and whether the relationship varies as a function of the size of the charter as implied by theory. We employ the cross-section threshold approach suggested by Hansen (2000) for 101 publicly listed commercial banks in the same countries. To the best of our knowledge, this study is the first attempt to examine empirically the aforementioned issues for Islamic banks. This study is expected to expose shortcomings in capital adequacy guidelines and raises distinct policy implications with regards to the regulation and supervision of Islamic banks in countries where both bank types co-exist

Islamic Banks’ Capital Buffers: Unique Risk Exposures and the Disciplining Effects of Charter Values

In the aftermath of the recent financial crisis, the inherent linkages between banks’ capital buffers and risk took center stage as policy makers promoted a more resilient global banking system. The growing recognition of Islamic banking as a viable alternative-banking model warrants the need to investigate the overall susceptibilities of Islamic banks’ capital buffers to unique risks emanating from their operating environments. We examine this issue over the period 2005-2012 in the 18 countries where Islamic and conventional commercial banks coexist. We employ a panel model using dynamic Generalized Methods of Moments (GMM) on a data set comprising 128 commercial banks of which 44 are Islamic commercial banks. The search for alternative forms of prudential regulation over and above risk based capital guidelines has also shifted the attention of policy makers towards investigating the disciplining effects of banks’ charter values on capital buffers. We test this issue for Islamic banks, and whether the relationship varies as a function of the size of the charter as implied by theory. We employ the cross-section threshold approach suggested by Hansen (2000) for 101 publicly listed commercial banks in the same countries. To the best of our knowledge, this study is the first attempt to examine empirically the aforementioned issues for Islamic banks. This study is expected to expose shortcomings in capital adequacy guidelines and raises distinct policy implications with regards to the regulation and supervision of Islamic banks in countries where both bank types co-exist

VALPROIC ACID INDUCES APOPTOSIS AND INCREASES CXCR7 EXPRESSION IN EPITHELIAL OVARIAN CANCER CELL LINE SKOV-3.

Background: The chemokine receptor, CXCR7 is described to play a biologically relevant role in tumor growth and spread. Recently, it was reported that CXCR7 overexpression is associated with an unfavorable prognosis and metastatis of epithelial ovarian cancer (EOC). Aware that, several reports indicated that Histone deacetylases (HDACs) regulate the expression and activity of many proteins involved in both cancer initiation and progression, the aim of this work, was to study the effect of the HDAC inhibitor valproic acid (VPA) on the expression of CXCR7 as well as its impact on survival function in the epithelial ovarian cell line (SKOV-3). Methods: cells were cultured with varying concentrations of VPA (1, 2, 3, 4, 5 and 10 mM) for different durations (0, 12 h, 24 h and 48 h). Cell survival was assessed by Neutral red assay and by colony counting which being stained with crystal violet. CXCR7 expression was determined at mRNA level using quantitative real-time PCR (qRT-PCR) or at the protein level using western blotting. Results: VPA reduces cell survival of SKOV-3 cancer cells. The inhibition effect of VPA was dose and time-dependent. Exposure to VPA at concentrations above 2 mM at 24 h resulted in an increase expression of CXCR7 at both the mRNA and protein levels . Conclusion: These observations provide, for the first time, a better insight into the epigenetic mechanisms involved in regulating CXCR7 expression in EOC and will open new avenues for evaluating drugs that specifically stimulate the apoptosis of EOC with minimal unwanted side effect

VALPROIC ACID INDUCES APOPTOSIS AND INCREASES CXCR7 EXPRESSION IN EPITHELIAL OVARIAN CANCER CELL LINE SKOV-3.

Background: The chemokine receptor, CXCR7 is described to play a biologically relevant role in tumor growth and spread. Recently, it was reported that CXCR7 overexpression is associated with an unfavorable prognosis and metastatis of epithelial ovarian cancer (EOC). Aware that, several reports indicated that Histone deacetylases (HDACs) regulate the expression and activity of many proteins involved in both cancer initiation and progression, the aim of this work, was to study the effect of the HDAC inhibitor valproic acid (VPA) on the expression of CXCR7 as well as its impact on survival function in the epithelial ovarian cell line (SKOV-3). Methods: cells were cultured with varying concentrations of VPA (1, 2, 3, 4, 5 and 10 mM) for different durations (0, 12 h, 24 h and 48 h). Cell survival was assessed by Neutral red assay and by colony counting which being stained with crystal violet. CXCR7 expression was determined at mRNA level using quantitative real-time PCR (qRT-PCR) or at the protein level using western blotting. Results: VPA reduces cell survival of SKOV-3 cancer cells. The inhibition effect of VPA was dose and time-dependent. Exposure to VPA at concentrations above 2 mM at 24 h resulted in an increase expression of CXCR7 at both the mRNA and protein levels . Conclusion: These observations provide, for the first time, a better insight into the epigenetic mechanisms involved in regulating CXCR7 expression in EOC and will open new avenues for evaluating drugs that specifically stimulate the apoptosis of EOC with minimal unwanted side effect

The providers of health services in Lebanon: a survey of physicians

BACKGROUND: Emerging from civil distress carries with it major challenges to reforming a health system. One such challenge is to ensure an adequate supply of competent human resources. The objective of this study was to assess the supply of physicians in Lebanon in 1998, with an assessment of their practice patterns and capacity building. METHODS: Lists of members of physician's associations were examined to determine the number of physicians in Lebanon and their geographical distribution. A self-administered survey targeted 388 physicians (5%) randomly stratified by the five regions of Lebanon. Some 377 providers reported information on their demographic profile, practice patterns and development. Further, information on continuing education activities was acquired. RESULTS: In Lebanon, the overall physician-to-population ratio was 248 per 100, 000, characterized by an evident maldistribution at the intracountry regional level. Physicians worked 38 hours per week examining on average 21 patients per day, with an average time of 30 minutes spent per visit. They also reported spending 11% of their time waiting for patients. Respondents reported a very wide range of income, with 90% earning less than USD 2,000 per month. Moreover, the continuing education profile revealed a total of 43.7 hours per year, similar to that required for board certification in many developed countries. Conference attendance was the dominant continuing education activity (95% of respondents) and consumed most of the time allotted for continuing education, reported at 32 hours per year. DISCUSSION AND CONCLUSION: Various economic indicators point to an oversupply of physicians in Lebanon and a poor allocation of their time for capacity building. Therefore, it is crucial for decision-makers to closely monitor the increasing supply of providers and institute appropriate intervention strategies, taking into consideration appropriate provision of good-quality services and ensuring that continuing education activities are well established, organized and monitored

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Background: Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. // Methods: We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. // Findings: We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middle-income countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in low-income countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. // Interpretation: Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between low-income, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Modélisation et analyse expérimentale d'une centrale solaire photovoltaïque en milieu désertique maritime

The objective of this work has been to develop a model for the behavior of a photovoltaic (PV) plant in an arid zone, to optimize instantaneous production and maintain performance over time. Monitoring data were collected for a solar power plant, which were then studied to infer the impact of climatic factors (temperature, irradiation and dust deposits). Performance analysis techniques including "transposition to reference conditions" (eg. PVUSA) and "estimation of standard performance measures" (eg. PR) were applied to evaluate the annual degradation rate of the facility. A first indication of expected lifetime of PV installations for the climate of Djibouti was thus obtained, as well as a capacity to predict the long-term evolution of the plant and future installations. In parallel, a numerical model of the photovoltaic installation was constructed using TRNSYS, including the modules and inverters, to transcribe the behavior of the PV system as a whole, and also the environmental conditions in which it evolves. The model included in the standard TRNSYS library was improved with the aid of experimental results, in particular with regards the thermal dependence. A predictive model was thus developed combining dust accumulation, an empirical model of module temperatures and degradation. Finally, a parametric study was undertaken with the complete model, to evaluate the impact of cleaning schedules under various dust scenarios. The results will contribute to the optimization of solar power plant design and operation in this type of climate.L'objectif de ce travail a été de développer un modèle pour prédire le comportement d'une installation photovoltaïque (PV) dans une zone désertique maritime, afin d'optimiser la production instantanée et de maintenir les performances au fil du temps. Les données issues du monitoring d’une centrale solaire ont été analysées afin d’en extraire des indicateurs de performances et d’étudier l'impact des facteurs climatiques (température, irradiation et dépôts de poussière). Les méthodes d'analyse de performance, telles que la "transposition aux conditions de référence" (Ex. PVUSA) et "estimation des mesures de performance" (Ex. PR) ont été appliquées pour évaluer le taux de dégradation annuel de l'installation. Une première indication de la durée de vie des installations PV pour le climat de Djibouti a été obtenue, ainsi qu'une capacité à prédire l'évolution à long terme de cette centrale et des futures installations PV. Parallèlement, un modèle numérique de l'installation PV a été construit en utilisant TRNSYS, incluant les modules et les onduleurs, pour retranscrire le comportement du système PV dans son ensemble, ainsi que les conditions environnementales dans lesquelles il évolue. Le modèle inclus dans la bibliothèque TRNSYS a été amélioré à l'aide de résultats expérimentaux, en particulier en ce qui concerne la dépendance thermique. Un modèle prédictif a donc été développé combinant l'accumulation de poussière, un modèle empirique de températures et de dégradation du module. Enfin, une étude paramétrique a été réalisée avec le modèle complet, afin d'évaluer l'impact du nettoyage pour divers scénarios d’empoussièrement. Les résultats contribueront à l'optimisation de la conception et de l'exploitation des centrales solaires dans ce type de climat