How does personal bankruptcy law affect start-ups? *

Abstract We exploit state-level changes in the amount of personal wealth individuals can protect under Chapter 7 personal bankruptcy to analyze the causal effect of debtor protection on the financing structure and performance of a representative panel of U.S start-up firms. We show that a higher level of debtor protection reduces the availability of credit, employment, operating efficiency, and survival rate of firms owned by low-wealth entrepreneurs. We find no such negative effects for firms owned by high-wealth entrepreneurs, who still have large amounts of assets unprotected under the new bankruptcy regime. Our evidence actually indicates that these wealthier entrepreneurs expand their businesses by increasing employment. Our results are consistent with theories that predict that debtor-friendly bankruptcy regimes redistribute credit from the less wealthy to the more wealthy individuals. (JEL: G32, G33, K35, M13

Germline Mutations in PALB2, BRCA1, and RAD51C, Which Regulate DNA Recombination Repair, in Patients With Gastric Cancer

Up to 10% of cases of gastric cancer are familial, but so far, only mutations in CDH1 have been associated with gastric cancer risk. To identify genetic variants that affect risk for gastric cancer, we collected blood samples from 28 patients with hereditary diffuse gastric cancer (HDGC) not associated with mutations in CDH1 and performed whole-exome sequence analysis. We then analyzed sequences of candidate genes in 333 independent HDGC and non-HDGC cases. We identified 11 cases with mutations in PALB2, BRCA1, or RAD51C genes, which regulate homologous DNA recombination. We found these mutations in 2 of 31 patients with HDGC (6.5%) and 9 of 331 patients with sporadic gastric cancer (2.8%). Most of these mutations had been previously associated with other types of tumors and partially co-segregated with gastric cancer in our study. Tumors that developed in patients with these mutations had a mutation signature associated with somatic homologous recombination deficiency. Our findings indicate that defects in homologous recombination increase risk for gastric cancer.Fil: Sahasrabudhe, Ruta. University of California at Davis; Estados UnidosFil: Lott, Paul. University of California at Davis; Estados UnidosFil: Bohorquez, Mabel. Universidad del Tolima; ColombiaFil: Toal, Ted. University of California at Davis; Estados UnidosFil: Estrada, Ana P.. Universidad del Tolima; ColombiaFil: Suarez, John J.. Universidad del Tolima; ColombiaFil: Brea Fernández, Alejandro. Ciber Enfermedades Raras; EspañaFil: Cameselle Teijeiro, José. Complejo Hospitalario Universitario de Santiago; EspañaFil: Pinto, Carla. Instituto Portugues de Oncologia de Francisco Gentil Porto; PortugalFil: Ramos, Irma. Instituto Mexicano del Seguro Social; MéxicoFil: Mantilla, Alejandra. Departamento de Patologia la Unidad Medica Alta Especialidad Oncologia; MéxicoFil: Prieto, Rodrigo. Universidad del Tolima; ColombiaFil: Corvalan, Alejandro. Pontificia Universidad Católica de Chile; ChileFil: Norero, Enrique. Pontificia Universidad Católica de Chile; ChileFil: Alvarez, Carolina. Universidad Católica de Chile; ChileFil: Tapia, Teresa. Pontificia Universidad Católica de Chile; ChileFil: Carvallo, Pilar. Pontificia Universidad Católica de Chile; ChileFil: Gonzalez, Luz M.. Instituto de Cancerologia, Las Americas; ColombiaFil: Cock-Rada, Alicia. Instituto de Cancerologia, Las Americas; ColombiaFil: Solano, Angela Rosario. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Centro de Educaciones Médicas e Investigación Clínica ; Argentina. Universidad de Buenos Aires; ArgentinaFil: Neffa, Florencia. Laboratorio Genia; UruguayFil: Della Valle, Adriana. Laboratorio Genia; UruguayFil: Yau, Chris. University of Oxford; Reino UnidoFil: Soares, Gabriela. Centro Hospitalar Do Porto; PortugalFil: Borowsky, Alexander. University of California at Davis; Estados UnidosFil: Hu, Nan. National Cancer Institute; Estados UnidosFil: He, Li-Ji. Yangcheng Cancer Hospital; ChinaFil: Han, Xiao-You. Shanxi Cancer Hospital; ChinaFil: Taylor, Philip R.. National Institutes of Health; Estados UnidosFil: Goldstein, Alisa M.. National Institutes of Health; Estados UnidosFil: Torres, Javier. Instituto Mexicano del Seguro Social; MéxicoFil: Echeverry, Magdalena. Universidad del Tolima; ColombiaFil: Ruiz-Ponte, Clara. Centro de Investigación Biomédica en Red de Enfermedades Raras; EspañaFil: Teixeira, Manuel R.. Universidad de Porto; PortugalFil: Carvajal Carmona, Luis G.. University of California at Davis; Estados Unido

Germline Mutations in PALB2, BRCA1, and RAD51C, Which Regulate DNA Recombination Repair, in Patients With Gastric Cancer

Up to 10% of cases of gastric cancer are familial, but so far, only mutations in CDH1 have been associated with gastric cancer risk. To identify genetic variants that affect risk for gastric cancer, we collected blood samples from 28 patients with hereditary diffuse gastric cancer (HDGC) not associated with mutations in CDH1 and performed whole-exome sequence analysis. We then analyzed sequences of candidate genes in 333 independent HDGC and non-HDGC cases. We identified 11 cases with mutations in PALB2, BRCA1, or RAD51C genes, which regulate homologous DNA recombination. We found these mutations in 2 of 31 patients with HDGC (6.5%) and 9 of 331 patients with sporadic gastric cancer (2.8%). Most of these mutations had been previously associated with other types of tumors and partially co-segregated with gastric cancer in our study. Tumors that developed in patients with these mutations had a mutation signature associated with somatic homologous recombination deficiency. Our findings indicate that defects in homologous recombination increase risk for gastric cancer

Association of Country Income Level With the Characteristics and Outcomes of Critically Ill Patients Hospitalized With Acute Kidney Injury and COVID-19

Introduction: Acute kidney injury (AKI) has been identified as one of the most common and significant problems in hospitalized patients with COVID-19. However, studies examining the relationship between COVID-19 and AKI in low- and low-middle income countries (LLMIC) are lacking. Given that AKI is known to carry a higher mortality rate in these countries, it is important to understand differences in this population. Methods: This prospective, observational study examines the AKI incidence and characteristics of 32,210 patients with COVID-19 from 49 countries across all income levels who were admitted to an intensive care unit during their hospital stay. Results: Among patients with COVID-19 admitted to the intensive care unit, AKI incidence was highest in patients in LLMIC, followed by patients in upper-middle income countries (UMIC) and high-income countries (HIC) (53%, 38%, and 30%, respectively), whereas dialysis rates were lowest among patients with AKI from LLMIC and highest among those from HIC (27% vs. 45%). Patients with AKI in LLMIC had the largest proportion of community-acquired AKI (CA-AKI) and highest rate of in-hospital death (79% vs. 54% in HIC and 66% in UMIC). The association between AKI, being from LLMIC and in-hospital death persisted even after adjusting for disease severity. Conclusions: AKI is a particularly devastating complication of COVID-19 among patients from poorer nations where the gaps in accessibility and quality of healthcare delivery have a major impact on patient outcomes

Thrombotic and hemorrhagic complications of COVID-19 in adults hospitalized in high-income countries compared with those in adults hospitalized in low- and middle-income countries in an international registry

Background: COVID-19 has been associated with a broad range of thromboembolic, ischemic, and hemorrhagic complications (coagulopathy complications). Most studies have focused on patients with severe disease from high-income countries (HICs). Objectives: The main aims were to compare the frequency of coagulopathy complications in developing countries (low- and middle-income countries [LMICs]) with those in HICs, delineate the frequency across a range of treatment levels, and determine associations with in-hospital mortality. Methods: Adult patients enrolled in an observational, multinational registry, the International Severe Acute Respiratory and Emerging Infections COVID-19 study, between January 1, 2020, and September 15, 2021, met inclusion criteria, including admission to a hospital for laboratory-confirmed, acute COVID-19 and data on complications and survival. The advanced-treatment cohort received care, such as admission to the intensive care unit, mechanical ventilation, or inotropes or vasopressors; the basic-treatment cohort did not receive any of these interventions. Results: The study population included 495,682 patients from 52 countries, with 63% from LMICs and 85% in the basic treatment cohort. The frequency of coagulopathy complications was higher in HICs (0.76%-3.4%) than in LMICs (0.09%-1.22%). Complications were more frequent in the advanced-treatment cohort than in the basic-treatment cohort. Coagulopathy complications were associated with increased in-hospital mortality (odds ratio, 1.58; 95% CI, 1.52-1.64). The increased mortality associated with these complications was higher in LMICs (58.5%) than in HICs (35.4%). After controlling for coagulopathy complications, treatment intensity, and multiple other factors, the mortality was higher among patients in LMICs than among patients in HICs (odds ratio, 1.45; 95% CI, 1.39-1.51). Conclusion: In a large, international registry of patients hospitalized for COVID-19, coagulopathy complications were more frequent in HICs than in LMICs (developing countries). Increased mortality associated with coagulopathy complications was of a greater magnitude among patients in LMICs. Additional research is needed regarding timely diagnosis of and intervention for coagulation derangements associated with COVID-19, particularly for limited-resource settings