Assessment of “stress tests” conducted on the French banking system.

During the first quarter of 2004, the General Secretariat of the Commission bancaire (SGCB) and the Directorate General Economics and International Relations (DGEI) of the Banque de France conducted an assessment of the stability of the French banking system and its capacity to withstand a set of macroeconomic and financial shocks, as part of a broader evaluation of the French financial system carried out under the auspices of the IMF’s Financial Sector Assessment Program (FSAP). The assessment employed a macro-prudential approach which seeks to quantify the effects of shocks to the banking system using “stress tests”. The tests measured the impact of severe shocks, deemed plausible but infrequent: e.g., a recession, a large movement in interest rates, an oil price shock, a sharp drop in stock prices. This report discusses in detail the principal characteristics of the “stress tests” and the innovations introduced during the French FSAP, including in particular the design of coherent scenarios, which were developed using the DGEI’s macroeconomic model and the SGCB’s financial models for measuring risk. The results of the assessment indicate that, given the high average solvency ratio, the French banking system is currently in a position to withstand a major macroeconomic shock, such as a prolonged recession lasting two years. This type of shock would, however, erode the quality of bank assets and reduce bank profits by 38.5% in the second year, compared with the baseline, resulting in a decline in the international solvency ratio of one percentage point (using the Basel I methodology) or two percentage points (using the new methodology proposed in the Basel II Accord). Other scenarios, such as a 32% depreciation of the dollar against the euro for two years or an increase of nearly 50% in the price of oil also for two years, would have more limited effects on net income and solvency ratios.

Evolutionary History of Helicobacter pylori Sequences Reflect Past Human Migrations in Southeast Asia

The human population history in Southeast Asia was shaped by numerous migrations and population expansions. Their reconstruction based on archaeological, linguistic or human genetic data is often hampered by the limited number of informative polymorphisms in classical human genetic markers, such as the hypervariable regions of the mitochondrial DNA. Here, we analyse housekeeping gene sequences of the human stomach bacterium Helicobacter pylori from various countries in Southeast Asia and we provide evidence that H. pylori accompanied at least three ancient human migrations into this area: i) a migration from India introducing hpEurope bacteria into Thailand, Cambodia and Malaysia; ii) a migration of the ancestors of Austro-Asiatic speaking people into Vietnam and Cambodia carrying hspEAsia bacteria; and iii) a migration of the ancestors of the Thai people from Southern China into Thailand carrying H. pylori of population hpAsia2. Moreover, the H. pylori sequences reflect iv) the migrations of Chinese to Thailand and Malaysia within the last 200 years spreading hspEasia strains, and v) migrations of Indians to Malaysia within the last 200 years distributing both hpAsia2 and hpEurope bacteria. The distribution of the bacterial populations seems to strongly influence the incidence of gastric cancer as countries with predominantly hspEAsia isolates exhibit a high incidence of gastric cancer while the incidence is low in countries with a high proportion of hpAsia2 or hpEurope strains. In the future, the host range expansion of hpEurope strains among Asian populations, combined with human motility, may have a significant impact on gastric cancer incidence in Asia

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Uncertainties in Redesigning an Existing Quay Wall

A feasibility study was carried out on the redesigning of an existing quay wall of a core harbor in the Netherlands, which was more than 45 years old. The geotechnical behavior of the existing quay wall, especially because of its age, as a response to the maximum load change is undoubtedly the uncertain parameter here. The design and redesign aspects have been considered: the evaluation of the current situation, the remaining lifetime of the structure and other aspects like corrosion and fatigue of the construction materials and the change in design standards between the past and the future situations. No monitoring and measurements were available. Inspection on steel structural elements showed some corrosion, to which extend was unknown. The history of load usage of the quay wall was not registered. After a preliminary redesign, it is clear that some uncertainties would remain. It was concluded that the lack of information in the current situation constitutes the main obstacle to a straightforward redesign and the use of Finite Element Method modelling reveals a failure mechanism, which was not encountered earlier. Because of the technical risks, a redesign of such existing and complex quay wall would necessitate an extensive design procedure to increase reliability

Geocontainers: Kleinschalige proeven in de Brutusbak

In dit meetrapport van de bij GeoDelft. uitgevoerde proeven worden eerst de schaalregels besproken voor dit modelonderzoek, op basis daarvan wordt een modelgeocontainer geselecteerd. Vervolgens wordt de opzet van de metingen en de meetresultaten besproken. Afgesloten wordt met aanbevelingen voor analyseKWP-collectio