Pregnancy after liver transplantation with tacrolimus immunosuppression: A single center's experience update at 13 years

Background. Chronic liver disease often leads to amenorrhea in women of childbearing age. There are several reports of successful pregnancy after liver transplantation (LTx) with cyclosporine A immunosuppression. Tacrolimus has been increasingly used in solid-organ transplantation, and the effect of the drug on pregnancy is still of interest to clinicians. This study updates our single-center experience. Methods. All pregnancies after LTx with tacrolimus immunosuppression were followed prospectively. Patients' clinical courses during pregnancy and labor along with gestational period and birth weight were catalogued. Changes in liver function, renal function, and immunosuppression also were recorded. The birth weight percentile was calculated on the basis of the gestational period using a standard chart. Results. Thirty-seven mothers delivered 49 babies. Three mothers delivered three times, and six mothers delivered two times. Thirty-six mothers (97%) survived the pregnancy, and 36 allografts (97%) survived. The one death and graft loss was in a patient who demonstrated infra-aortic arterial graft, which clotted by the gravid uterus during labor. The patient developed a gangrenous liver and died before she could undergo retransplantation. The mean gestational period was 36.4±3. 2 weeks, excluding two premature deliveries at 23 and 24 weeks gestation. Twenty-two babies (46.9%) were delivered by cesarean section, and the other babies were delivered vaginally. In addition to the two premature babies, one baby, who was born to a mother with Alagille syndrome, died from congenital birth defects. The rest of the newborns survived. The mean birth weight was 2,797±775 g, with 38 babies (78%) weighing more than 2,000 g. The mean birth weight percentile to gestational period was 54±23. Four babies (8.5%) had a birth weight percentile of less than 25, and 28 babies (59.6%) had a birth weight percentile greater than 50. Twelve patients demonstrated an increase in hepatic enzymes without jaundice during the pregnancy. All of them responded to augmentation of immunosuppression. Conclusion. The present report reconfirms the safety of tacrolimus during pregnancy after LTx. Preterm delivery and low birth weight seem to be a persistent problem in all solid-organ transplantation under any form of immunosuppression. However, toxemia of pregnancy and new onset of hypertension seem to be have a low occurrence with the use of tacrolimus

Poisoned at Work: An Updated Evaluation of New Hampshire Occupational Poisoning Calls to the Northern New England Poison Center from 2012 to 2014

In 2013, we published a report describing New Hampshire occupational poisoning calls to the Northern New England Poison Center (NNEPC) from 2005 to 2011. That report can be found at www.iod.unh.edu/OHSP/poisonedatwork-7-2013.pdf. This report provides new data describing occupational poisoning events reported to the NNEPC during the period of 2012 through 2014

Central Clearing Valuation Adjustment

This paper develops an XVA (costs) analysis of centrally cleared trading, parallel to the one that has been developed in the last years for bilateral transactions. We introduce a dynamic framework that incorporates the sequence of cash-flows involved in the waterfall of resources of a clearing house. The total cost of the clearance framework for a clearing member, called CCVA for central clearing valuation adjustment, is decomposed into a CVA corresponding to the cost of its losses on the default fund in case of defaults of other member, an MVA corresponding to the cost of funding its margins and a KVA corresponding to the cost of the regulatory capital and also of the capital at risk that the member implicitly provides to the CCP through its default fund contribution. In the end the structure of the XVA equations for bilateral and cleared portfolios is similar, but the input data to these equations are not the same, reflecting different financial network structures. The resulting XVA numbers differ, but, interestingly enough, they become comparable after scaling by a suitable netting ratio

Socio-psychological aspects of grassroots participation in the Transition Movement: An Italian case study

In this article, we present a case study investigating the socio-psychological aspects of grassroots participation in a Transition Town Movement (TTM) community initiative. We analyzed the first Italian Transition initiative: Monteveglio (Bologna), the central hub of the Italian TTM and a key link with the global Transition Network. A qualitative methodology was used to collect and analyze the data consisting of interviews with key informants and ethnographic notes. The results provide further evidence supporting the role of social representations, shared social identities, and collective efficacy beliefs in promoting, sustaining, and shaping activists\u2019 commitment. The movement seems to have great potential to inspire and engage citizens to tackle climate change at a community level. Grassroots engagement of local communities working together provides the vision and the material starting point for a viable pathway for the changes required. Attempting to ensure their future political relevance, the TTM adherents are striving to disseminate and materially consolidate inherently political and prefigurative movement frames \u2013 primarily community resilience and re-localization \u2013 within community socio-economic and political frameworks. However, cooperation with politics is perceived by most adherents as a frustrating and dissatisfying experience, and an attempted co-optation of the Transition initiative by institutions. It highlights a tension between the open and non-confrontational approach of the movement towards institutions and their practical experience. Corresponding to this tension, activists have to cope with conflicts, contradictions, and ambivalence of social representations about community action for sustainability, which threaten the sense of collective purpose, group cohesion and ultimately its survival

Multivariate Shortfall Risk Allocation and Systemic Risk

The ongoing concern about systemic risk since the outburst of the global financial crisis has highlighted the need for risk measures at the level of sets of interconnected financial components, such as portfolios, institutions or members of clearing houses. The two main issues in systemic risk measurement are the computation of an overall reserve level and its allocation to the different components according to their systemic relevance. We develop here a pragmatic approach to systemic risk measurement and allocation based on multivariate shortfall risk measures, where acceptable allocations are first computed and then aggregated so as to minimize costs. We analyze the sensitivity of the risk allocations to various factors and highlight its relevance as an indicator of systemic risk. In particular, we study the interplay between the loss function and the dependence structure of the components. Moreover, we address the computational aspects of risk allocation. Finally, we apply this methodology to the allocation of the default fund of a CCP on real data.Comment: Code, results and figures can also be consulted at https://github.com/yarmenti/MSR

Gender as a Barrier for Women With Children in Academe

This research involved in-depth interviews with nineteen women professors, drawn from across various faculties and ranks at one Canadian university, and was intended to explore the interconnections between the women's personal and professional lives. The women in this study chose to combine having children with an academic career. Most of them depicted their career trajectory as a lifelong challenge, one that was both fulfilling and prestigious. In contrast, the women reported a number of obstacles in their career paths that served to prevent them from gaining full membership in academic life. This study probes the nature of such obstacles that are grouped into two categories: the child-related time crunch and the career-related time crunch. As a result of these obstacles, the women encountered childbearing/childrearing problems, research dilemmas, a willingness to leave the academy, and denial of tenure and promotion. Findings call for a restructuring of academic careers in order to effectively accommodate women with children in the profession.Cette recherche se base sur des entrevues en profondeur impliquant dix-neuf professeurs féminins de divers rangs et provenant de diverses facultés d'une université canadienne. Le but de la recherche était d'explorer les liens entre les vies privée et professionnelle de ces femmes qui ont choisi de fonder une famille tout en poursuivant leur carrière universitaire. Plusieurs de ces femmes ont décrit la trajectoire de leur carrière comme étant un long défi qu'elles considèrent prestigieux et offrant une occasion d'épanouissement personnel. Cependant, elles ont aussi décrit un certain nombre d'obstacles rencontrés dans leur cheminement et elles croient que ceux-ci les ont empéchées d'intégrer complètement une vie universitaire. Cette recherche tente d'élucider la nature de ces obstacles qui sont regroupés en deux categories: le temps dédié à élever les enfants et le temps dédié à la carrière professionnelle. Pour ces femmes, ces obstacles ont les conséquences suivantes: des difficultés concernant la maternité et celles à élever les enfants, des dilemmes en recherche et des difficultés que certaines doivent affronter lorsqu'elles quittent volontairement leur poste en se voyant ainsi refuser de l'ancienneté d'emploi ainsi que des promotions liées au poste. Les données de cette recherche démontrent qu'il est grand temps que ces inégalités soient reconnues afin d'établir des moyens plus efficaces pour admettre adéquatement des femmes avec des enfants à charge dans la profession universitaire