Two Major Economic Crises in the Early Twenty-First Century and their Impact on Central Bank Independence

Two major economic crises in the early twenty-first century have had a serious impact on monetary policy and CB independence. Disruption in financial intermediation and associated deflationary pressures caused by the global financial crisis of 2007–2009 and European financial crisis of 2010–2015 pushed central banks (CBs) in major currency areas towards adoption of unconventional monetary policy measures, including large-scale purchase of government bonds (quantitative easing). The same approach has been taken by CBs in response to the COVID-19 crisis in 2020 even if the characteristics of this crisis differ from the previous one. As a result of both crises, CBs have become major holders of government bonds and de facto – main creditors of governments. Against rapidly deteriorating fiscal balances, CBs have become hostages of fiscal policies, which compromises their independence. Risks to the CB independence also come from their additional mandates (beyond price stability) and populist political pressures.

Efficiency rating of SG Diagnostics COVID-19 antigen rapid test kit.

Aim: Rapid detection is crucial in complementing vaccination to reduce transmission of SARS-CoV-2. Materials & methods: Nasopharyngeal swabs (n = 213) and oropharyngeal swabs (n = 98) were tested. with the antigen rapid test kit. Results: Overall sensitivity (97.96%), specificity (100.00%) and coincidence rate (98.71%) were high, which translated into a positive predictive value of 100.00% and a negative predictive value of 96.64%. Conclusion: Antigen rapid tests have a great potential for screening in different settings to deliver results with high sensitivity and specificity.

This study evaluated SG Diagnostics COVID-19 antigen rapid test kit. The overall sensitivity, specificity and coincidence rate were found very high with SG Diagnostics COVID-19 antigen rapid test kit performing better.

The role of economic development for the effect of oil market shocks on oil-exporting countries. Evidence from the interacted panel VAR model

This paper examines whether the effects of oil market shocks on economic activity and exchange rates in oil-exporting countries depend on the stage of economic development or the scale of oil exports. Within the framework of block-exogenous Interacted Panel Vector Autoregression (IPVAR), we show that both oil price and oil price uncertainty shocks affect the economies of oil-exporting countries. The responses of domestic variables to oil market shocks are heterogeneous across countries and the scale of these responses depend on the level of economic development. In general, the reaction of emerging market economies is more prominent than that of advanced economies. The combined contribution of oil market shocks to exchange rate volatility is inversely associated with the stage of economic development, but no such relation is observed for industrial production. The results obtained are robust to conditioning the responses on the scale of oil exports, restricting the sample to the non-covid pandemic period, and using the alternative measure for oil price uncertainty.

Comparison of Vie Scope® and Macintosh laryngoscopes for intubation during resuscitation by paramedics wearing personal protective equipment.

BACKGROUND: Endotracheal intubation (ETI) is still the gold standard of airway management, but in cases of sudden cardiac arrest in patients with suspected SARS-CoV-2 infection, ETI is associated with risks for both the patient and the medical personnel. We hypothesized that the Vie Scope® is more useful for endotracheal intubation of suspected or confirmed COVID-19 cardiac arrest patients than the conventional laryngoscope with Macintosh blade when operators are wearing personal protective equipment (PPE). METHODS: Study was designed as a prospective, multicenter, randomized clinical trial performed by Emergency Medical Services in Poland. Patients with suspected or confirmed COVID-19 diagnosis who needed cardiopulmonary resuscitation in prehospital setting were included. Patients under 18 years old or with criteria predictive of impossible intubation under direct laryngoscopy, were excluded. Patients were randomly allocated 1:1 to Vie Scope® versus direct laryngoscopy with a Macintosh blade. Study groups were compared on success of intubation attempts, time to intubation, glottis visualization and number of optimization maneuvers. RESULTS: We enrolled 90 out-of-hospital cardiac arrest (OHCA) patients, aged 43-92 years. Compared to the VieScope® laryngoscope, use of the Macintosh laryngoscope required longer times for tracheal intubation with an estimated mean difference of -48 s (95%CI confidence interval [CI], -60.23, -35.77; p < 0.001). Moreover VieScope® improved first attempt success rate, 93.3% vs. 51.1% respectively (odds ratio [OR] = 13.39; 95%CI: 3.62, 49.58; p < 0.001). CONCLUSIONS: The use of the Vie Scope® laryngoscope in OHCA patients improved the first attempt success rate, and reduced intubation time compared to Macintosh laryngoscope in paramedics wearing PPE for against aerosol generating procedures. TRIAL REGISTRATION: ClinicalTrials registration number NCT04365608.

Direct vs. Video-Laryngoscopy for Intubation by Paramedics of Simulated COVID-19 Patients under Cardiopulmonary Resuscitation: A Randomized Crossover Trial.

A safe way of securing the airway with an endotracheal tube is one of the priorities of an advanced cardiovascular life support algorithm for suspected or confirmed COVID-19 patients. The aim of this study was to compare intubation success rates (ISR) and intubation time (IT) of different laryngoscopes for simulated COVID-19 patients under cardiopulmonary resuscitation. The study was designed as a prospective, randomized, crossover trial. Fifty four active paramedics performed endotracheal intubation with a Macintosh direct laryngoscope (MAC) and McGrath videolaryngoscope (McGrath) with and without personal protective equipment (PPE). Without PPE, ISRs were 87% and 98% for MAC and McGrath, respectively (p = 0.32). ITs were 22.5 s (IQR: 19-26) and 19.5 s (IQR: 17-21) for MAC and McGrath, respectively (p = 0.005). With PPE, first-pass ISR were 30% and 89% with MAC and McGrath, respectively (p < 0.001). The overall success rates were 83% vs. 100% (p = 0.002). Median ITs were 34.0 s (IQR: 29.5-38.5) and 24.8 s (IQR: 21-29) for MAC and McGrath, respectively (p < 0.001). In conclusion, the McGrath videolaryngoscope appears to possess significant advantages over the Macintosh direct laryngoscope when used by paramedics in suspected or confirmed COVID-19 intubation scenarios.

Managing patients on extracorporeal membrane oxygenation support during the COVID-19 pandemic - a proposal for a nursing standard operating procedure.

BACKGROUND: Extracorporeal membrane oxygenation (ECMO) is effective in a selected critically ill patient population with promising results in refractory hypoxemia related to the novel coronavirus disease (COVID-19). However, it requires specialized clinicians and resources in advanced technology. Moreover, the COVID-19 remains an ongoing global emergency, and there is no evidence-based practice in preparedness. This article proposes an innovative and optimized nursing care protocol, the Standard Operating Procedure (SOP), that regulates safety and efficiency in using personal protective equipment (PPE) during ECMO-relevant procedures while providing ECMO therapy for patients with COVID-19. METHODS: After performing a narrative literature search, we developed a high-fidelity translational simulation scenario. It included practicing appropriate donning and doffing PPE during work organization, ECMO-related procedures, and routine daily nursing care and management of ECMO over nine hours. In addition, we held supplementary constructive debrief meetings to consult international expert in the field. RESULTS: A proposal for nursing standardized operating procedures was created, divided into categories. They included work organization, workload references, competences, infrastructural conditions, cannulation equipment, daily routine nursing care, and procedures during ECMO. CONCLUSIONS: High-fidelity medical simulation can play an important role in staff training, improvement in previously gained proficiency, and development of optimal SOP for nursing care and management during ECMO in patients with COVID-19. Optimal SOPs may further guide multidisciplinary teams, including intensive care units and interventional departments.

Comprehensive assessment of a nationwide simulation-based course for artificial life support.

BACKGROUND: Successful implementation of medical technologies applied in life-threatening conditions, including extracorporeal membrane oxygenation (ECMO) requires appropriate preparation and training of medical personnel. The pandemic has accelerated the creation of new ECMO centers and has highlighted continuous training in adapting to new pandemic standards. To reach high standards of patients' care, we created the first of its kind, National Education Centre for Artificial Life Support (NEC-ALS) in 40 million inhabitants' country in the Central and Eastern Europe (CEE). The role of the Center is to test and promote the novel or commonly used procedures as well as to develop staff skills on management of patients needing ECMO. METHOD: In 2020, nine approved and endorsed by ELSO courses of "Artificial Life Support with ECMO" were organized. Physicians participated in the three-day high-fidelity simulation-based training that was adapted to abide by the social distancing norms of the COVID-19 pandemic. Knowledge as well as crucial cognitive, behavioral and technical aspects (on a 5-point Likert scale) of management on ECMO were assessed before and after course completion. Moreover, the results of training in mechanical chest compression were also evaluated. RESULTS: There were 115 participants (60% men) predominantly in the age of 30-40 years. Majority of them (63%) were anesthesiologists or intensivists with more than 5-year clinical experience, but 54% had no previous ECMO experience. There was significant improvement after the course in all cognitive, behavioral, and technical self-assessments. Among aspects of management with ECMO that all increased significantly following the course, the most pronounced was related to the technical one (from approximately 1.0 to more 4.0 points). Knowledge scores significantly increased post-course from 11.4 ± SD to 13 ± SD (out of 15 points). The quality of manual chest compression relatively poor before course improved significantly after training. CONCLUSIONS: Our course confirmed that simulation as an educational approach is invaluable not only in training and testing of novel or commonly used procedures, skills upgrading, but also in practicing very rare cases. The implementation of the education program during COVID-19 pandemic may be helpful in founding specialized Advanced Life Support centers and teams including mobile ones. The dedicated R&D Innovation Ecosystem established in the "ECMO for Greater Poland" program, with developed National Education Center can play a crucial role in the knowledge and know-how transfer but future research is needed.

An optimal chest compression technique using personal protective equipment during resuscitation in the COVID-19 pandemic: a randomized crossover simulation study.

BACKGROUND: Cardiopulmonary resuscitation with the use of personal protective equipment (PPE) for aerosol generating procedures (AGP) in patients with suspected or confirmed coronavirus disease 2019 (COVID­19) remains challenging. AIMS: The aim of this study was to compare 3 chest compression (CC) methods used by paramedics wearing PPE. METHODS: The single­blinded, multicenter, randomized, crossover simulation study involved 67 paramedics wearing PPE AGP. They performed 2­minute continuous CCs in an adult with suspected or confirmed COVID­19 in 3 scenarios: 1) manual CCs; 2) CCs with the TrueCPR feedback device; 3) CCs with the LUCAS 3 mechanical CC device. RESULTS: The depth of CC was more frequently correct when using LUCAS 3 compared with TrueCPR and manual CC (median [IQR] 51 [50-55] mm vs 47 [43-52] mm vs 43 [38-46] mm; P = 0.005). This was also true for the CC rate (median [IQR]102 [100-102] compressions per minute [CPM] vs 105 [98-1114] CPM vs 116 [112-129] CPM; P = 0.027) and chest recoil (median [IQR]100% [98%-100%] vs 83% [60%-92%] vs 39% [25%-50%]; P = 0.001). A detailed analysis of 2­minute resuscitation with manual CCs showed a decrease in compression depth and full chest recoil after 1 minute of CCs. CONCLUSION: We demonstrated that during simulated resuscitation with the use of PPE AGP in patients with suspected or confirmed COVID­19, CC with LUCAS 3 compared with manual CCs as well as the TrueCPR essentially increased the CC quality. In the case of manual CCs by paramedics dressed in PPE AGP, it is advisable to change the person performing resuscitation every minute.