26199 research outputs found
Sort by
Credit Confidence: The Impact of Disclosure Quality and Audit Quality on Bank Ratings in Emerging Economies
Get PDFPurpose - This study aims to examine how Banks’ credit ratings can be driven by the quality of the disclosed financial and non-financial information in emerging economies.
Design/methodology/approach - Using a sample of 1590 bank‐year observations of 29 Islamic and 77 conventional banks across 17 MENA countries from 2006 to 2020, we conducted a random-effects regression model that is supported by various methods, including 2SLS and GMM models, to overcome the potential incidence of endogeneity concerns.
Findings - We found that the quality of voluntary disclosure positively influences the credit rating of Islamic and conventional banks. Although the spread and usefulness of disclosed information are positively associated with banks’ ratings, the quantity dimension is not. Audit quality also significantly influences Islamic banks' credit ratings compared to their traditional counterparts.
Originality/value - Our paper contributes to the existing literature by investigating the effect of the quality of voluntary disclosures on credit ratings along three dimensions:
quantity, spread, and usefulness of the information. Further, our research contributes to the international accounting literature by investigating the effect of audit quality on the credit ratings of both conventional and Islamic banks in a cross-country setting.
Practical implications - Our evidence offers practical implications for regulators and standards setters in emerging economies to develop more effective disclosure regimes to enhance the impact of the quality of banks’ voluntary disclosures on their credit ratings
High-risk plaques in proximal and distal segments relative to graft anastomoses and non-grafted segments
No full textBackground Coronary artery bypass grafting (CABG) is the preferred invasive treatment option for complex coronary artery disease (CAD), bypassing flow-limiting lesions and high-risk plaques (HRP), thereby reducing clinical events. It also provides graft collateralization, preventing cardiac events due to proximal plaque rupture or erosion, and vessel occlusion. This study evaluated the prevalence of HRPs in segments proximal and distal to graft anastomoses and in non-grafted segments, using coronary computed tomography angiography (CCTA) in patients with left main and three-vessel disease enrolled in the FASTTRACK CABG study. Methods Coronary segments were categorized as proximal, distal, or non-grafted. Segments ≥1.5 mm on CCTA were screened for HRP features: low-attenuation plaque, positive remodelling, spotty calcification, and napkin ring. Minimal lumen area (MLA) and plaque burden at MLA were assessed in segments ≥3 mm in diameter. Perivascular adipose tissue attenuation was evaluated in major coronary arteries. Results In 102 patients, 1767 segments were analyzed: 986 proximal, 348 distal, and 341 non-grafted. HRP prevalence was highest in proximal segments (45.13 % vs. 8.33 % distal vs. 28.74 % non-grafted, p < 0.001). Non-grafted vessels with a Fractional Flow Reserve Computed Tomography (FFRCT) ≥0.80 had High-Risk Plaques (HRPs) in 40.38 % of cases, compared to 32.58 % for those with an FFRCT <0.80. The prevalence of HRPs between patients or vessels with graft occlusions and those without, was similar. Likewise, there was no significant difference in perivascular fat attenuation between patients and vessels with and without HRP. Conclusions In patients undergoing CABG for complex CAD, surgery effectively bypassed most HRPs, however, a substantial proportion remained in non-grafted vessels. Trial registration NCT04142021
Erythropoiesis-Stimulating Agents (ESAs) in Chronic Kidney Disease and Cancer-Related Anemia: A Narrative Review of Literature
No full textAnemia associated with chronic kidney disease (CKD) and cancer is conventionally managed with packed red blood cell (PRBC) transfusions or erythropoietin-stimulating agents (ESAs) like epoetin alfa; however, transfusions are limited by complications such as alloimmunization and infection risk, which has led to ESAs becoming the preferred standard of care. Additional therapy may include iron supplementation, which potentially causes complications such as iron overload and infection risks in respective patient populations. The introduction of recombinant human erythropoietin (rhEPO) in 1989 improved anemia management but also raised concerns about adverse cardiovascular outcomes in many studies. Current guidelines promote careful ESA use to balance benefits and risks, while alternatives like hypoxia-inducible factor prolyl hydroxylase inhibitors (HIF-PHIs) show promise in reducing such adverse effects. This review explores ESA trends, challenges, and emerging therapies for anemia in CKD and cancer patients and their implications in clinical use.
The literature search for this narrative review was conducted on PubMed in January 2025. The search was restricted to articles published between January 2020 and January 2025, focusing on randomized controlled trials (RCTs), narrative reviews, systematic reviews, and meta-analyses. The initial PubMed search yielded 454 articles, which were subsequently screened according to the inclusion and exclusion criteria, resulting in a final selection of 58 publications that satisfied the eligibility requirements.
Overall, evidence from these studies suggests that ESAs are considerably beneficial in correcting anemia and lowering the need for blood transfusions in adult patients with CKD. However, concerns about adverse cardiovascular outcomes and their effects on optimal hemoglobin targets have indicated the need to shift treatment approaches. These articles have also suggested recent developments, including the advent of HIF-PHIs and sodium-glucose cotransporter-2 (SGLT-2) inhibitors, which have been shown to offer safer and therapeutically promising alternatives in anemia of CKD and cancer-related anemia. Tailored approaches that take patient-specific factors into account are necessary for optimizing outcomes, suggesting that further research is required to evaluate the efficacy and risks of these novel treatments within clinical settings.
The narrative review has summarized the benefits and drawbacks of ESAs as a widely used treatment for anemia of CKD and cancer-related anemia. Studies identified in this review have shown that ESAs are linked to increased risks of adverse cardiovascular events, tumor progression in cancers, and higher mortality rates. The emerging alternative of HIF-PHIs shows promise in mitigating these adverse risks with a similar treatment efficacy to ESAs. However, there is still a lack of long-term safety data on these treatment options, and future research should focus on determining this risk profile as well as potential dosing strategies to potentially guide the use of HIF-PHIs in future clinical practice as a novel therapeutic alternative for anemia of CKD and cancer-related anemia
Influence of Surface Material, Cleaning Frequency and Swab Type on Touch DNA Recovery from Entrance Door Handles: A Simulated Study
No full textTouch DNA has become an increasingly valuable tool in forensic investigations, particularly in the absence of bodily fluids. However, its recovery is highly variable and influenced by multiple factors, including surface type, swabbing technique, and environmental conditions. Understanding how these variables interact is essential for optimizing evidence collection and interpreting complex DNA mixtures. This study systematically evaluated the effects of surface material (brass, stainless steel, plastic, wood), cleaning frequency (none, weekly, daily), swab type (IsoHelix® vs. rayon), and transfer mode (primary vs. secondary contact) on the quantity and composition of touch DNA recovered from door handles. A total of 240 samples were collected using a full factorial design. DNA was extracted, quantified, and profiled using standard forensic workflows, and statistical analyses were used to assess differences in yield and contributor dominance. IsoHelix® swabs consistently outperformed rayon swabs, recovering two to three times more DNA across all surfaces. Wood and plastic handles yielded significantly higher DNA quantities than metal handles, with brass showing the lowest recovery. Increased cleaning frequency substantially reduced DNA yield and elevated the presence of background or unknown contributors. Mixture analysis revealed that the last person to touch a handle was the major contributor in 74% of wood, 71% of plastic, 55% of stainless steel, and 49% of brass samples. Logistic regression confirmed surface material and cleaning regime as significant predictors of contributor dominance, while swab type had a stronger influence on DNA yield than on contributor attribution. Overall, touch DNA recovery is governed by a complex interplay of surface characteristics, sampling tools, and environmental history. While IsoHelix® swabs demonstrated superior performance for door handle sampling, their effectiveness may not generalize to all exhibit types. These findings highlight the importance of selecting context-appropriate swabbing methods, documenting surface hygiene history, and applying probabilistic frameworks when interpreting lowtemplate or mixed DNA profiles. The study provides practical guidance for forensic casework and contributes to the refinement of trace DNA sampling strategies
Toe-in and Toe-Out Walking Patterns and Lateral Wedge Insoles: A Musculoskeletal Simulation and Probabilistic Modelling Assessment of Medial Tibiofemoral Cartilage Mechanics
No full textThis study examined lateral wedge insoles and altered foot progression angles on medial tibiofemoral loading and long-term cartilage failure risk. Fifteen healthy male participants walked under four conditions: neutral gait, lateral wedge insoles, toe-in and toe-out gait. Three-dimensional kinematics were captured using an eight-camera system, and ground reaction forces were measured via a piezoelectric force plate. Musculoskeletal simulation analysis quantified tibiofemoral compressive forces, cartilage stresses, strains, and whole-body metabolic power. Probabilistic modelling was employed to estimate the probability of cartilage failure. Comparisons across the four gait conditions employed linear mixed-effects models with repeated measures. Peak compressive forces, stresses and strains were significantly larger in the neutral (force = 2.68 BW, stress = 2.61 MPa & strain = 0.22), compared to toe-in (force = 2.51 BW, stress 2.47 MPa & strain = 0.21) and toe-out (force = 2.43 BW, stress 2.40 MPa & strain = 0.21) conditions. Medial tibiofemoral cartilage failure probability was also significantly larger in the neutral condition (14.04%) compared to toe-in (10.66%) and toe-out (7.89%) conditions. Whole-body metabolic power was also significantly greater in the toe-out (9.74 W/kg) condition compared to neutral (9.32 W/kg) and lateral insoles (9.36 W/kg). The findings suggest that toe-in or toe-out walking may reduce medial tibiofemoral osteoarthritis risk. However, the greater metabolic demand of toe-out walking may limit its long-term feasibility and practicality as a preventive intervention
Gastric Motility Disorders Post Organ Transplantation—A Comprehensive Review
No full textMotility disorders, particularly gastroparesis, are prevalent complications following solid organ transplantation, significantly impacting quality of life, nutritional status, graft survival, and mortality. This comprehensive review synthesises evidence from PubMed, Scopus, and Embase databases on pathophysiology, clinical manifestations, diagnosis, management, and prognostic factors across transplant types. Mechanisms include vagal nerve injury (highest in lung transplants, prevalence 40–91%), immunosuppressive effects (e.g., tacrolimus accelerates motility; mycophenolate impairs it), surgical trauma, microbiome dysbiosis (reduced Firmicutes/Bacteroidetes ratio), and metabolic factors like post-transplant diabetes (OR 5.17 in kidney recipients). Pediatric and thoracic recipients face the highest risks, with lung transplant gastroparesis conferring a 2.7-fold increased mortality/retransplantation hazard (p < 0.05). Diagnosis relies on gastric emptying scintigraphy (gold standard, sensitivity 85–95%) and wireless motility capsules (100% sensitivity for delay), while management encompasses prokinetics (60–80% response), endoscopic G-POEM (85% success), gastric electrical stimulation (100% quality-of-life improvement in series), and nutritional support. Prognostic factors include younger age (better intervention response), aetiology (anatomical worse than metabolic), and early therapy success. Outcomes vary: lung recipients experience severe impacts on chronic allograft dysfunction (83% oesophageal motility abnormalities correlate with 66–67% rejection). Future directions emphasise microbiome therapies, AI predictive models (AUC 0.85), and wearables for continuous monitoring. Multidisciplinary approaches are essential to balance immunosuppression with GI management, addressing ethical dilemmas like drug interactions and access disparities. Ultimately, early screening and personalised interventions can mitigate complications, enhancing long-term transplant success
Tailoring midwifery care to women's needs in early labour: The cultivation of relational care in free-standing birth centres
Get PDFAim
To understand and interpret the lived experience of newly qualified midwives in their first year in a free standing birth centre caring for women in early labour.
Background
Women who present in hospital labour wards in early labour are encouraged by hospital staff to go home. This leaves women to navigate early labour without professional care, leaving them on their own to manage the transition from early to active labour. However, some women request care for this transition.
Design
This is a Heideggerian hermeneutic phenomenology study.
Methods
Three unstructured interviews were conducted with 15 newly qualified midwives in their first year working in a free-standing birth centre. This paper focuses on the research participants’ lived experience offering care to women in early labour. The study was conducted from 2021-2024.
Findings
Three themes were revealed in analysis: “Paving the way into labour”: Tailoring care to women's needs in early labour; “Perhaps it was intuition.”: Experiencing deeper knowing as a newly qualified midwife; and “She locked the door and wouldn't let me in.”: Navigating uncomfortable situations in early labour.
Conclusions
The lived experience of newly qualified midwives offering care in early labour shows potential for midwives to build trusting relationships with women in this phase.
Relevance to clinical practice
Prioritizing relational care over interventions in early labor can enhance trust and confidence between midwives and birthing women, particularly in settings where policies discourage early admissions.
Issue
Women presenting in hospital labour wards in early labour who are sent home are often discouraged, feeling that their concerns and embodied experiences have not been heard.
What is already known
When labouring women are admitted to hospitals in early labour, they are prone to receive a cascade of interventions.
What this paper adds
When newly qualified midwives began working in free-standing birth centres, they acquired skills and knowledge to accompany women in early labour who requested care. Relational care in early labour builds women's trust in their ability to give birth and does not rely on interventions to augment labour
Identifying challenges in implementing digital transformation in UK higher education
Get PDFPurpose
The purpose of this study is to systematically dissect strategies against the challenges stalling digital transformation (DT) in the UK higher education (HE) sector. It addresses the challenges impeding DT’s incorporation and offers a blueprint for fostering innovation and efficiency within academic institutions.
Design/methodology/approach
Using a systematic literature review, the research integrates a nuanced literature review with interpretive structural modelling (ISM). Through meticulous ISM analysis, including sensitivity analysis and level partitioning, a robust framework is developed to pinpoint and interrelate DT challenges.
Findings
This investigation delineates a spectrum of impediments to DT in HE, most notably the need for more digital understanding among educators, intensified by inadequate support and resources. The findings reveal that the effective integration of DT is hindered by factors such as insufficient educator digital skills, resistance to technology and the continuous evolution of digital infrastructure.
Practical implications
The study’s findings and the developed level partitioning diagram offer invaluable insight into how DT must be integrated into the curriculum to enhance HE. Additionally, it could further lead to research within digital infrastructure and how learning needs to be facilitated for students in HE.
Originality/value
This study breaks new ground by systematically illuminating the centrality of the educator skill gap. By contributing insights into the educator skill gap, it proposes a unique analytical model that underscores actionable pathways for advancing DT initiatives in HE institutions
Digital Versus Paper-Based Consent from the UK NHS Perspective: A Micro-costing Analysis.
Get PDFThe paper-based consent pathway can be associated with missing information, error, and inadequate patient comprehension. Digital consent addresses some of these limitations. However, limited research has been conducted to understand relative costs and consequences associated with adopting digital consent pathways. The aim of this study was to compare the relative costs of digital consent pathways with paper-based consent pathways in UK National Health Service (NHS) clinical practice. A micro-costing study was conducted from the UK NHS perspective. Multi-stakeholder involvement contributed to understanding how the paper-based consent pathway varies by department and hospital setting. Sensitivity analyses were conducted to identify the key cost drivers and scenario analyses explored the effect of consent timing and hospital digital readiness. Potential advantages and disadvantages of digital consent were also considered, such as possible impacts associated with consent-related litigation. The cost per consent episode is approximately £0.90 more expensive when completed on paper. The ordering or printing of paper consent forms, and the transportation of forms to storage and back to clinic are process steps that would not be necessary with digital consent. Sensitivity and scenario analyses indicated consultation duration had the greatest impact on the relative costs of both pathways. Per litigation claim prevented, an average of £201,590 could be saved. Digital consent is potentially cost saving for the NHS. Consent for elective procedures is recommended in advance of the day of surgery, and digital consent used in this scenario demonstrated the greatest savings. Consultation duration was estimated to have the greatest impact on the relative costs of both pathways, which should be a focus of further investigation. [Abstract copyright: © 2024. The Author(s).
How Conversations can Empower and Involve: Building the evidence for Approved Mental Health Professionals’ Communicative Practices
Get PDFApproved Mental Health Professionals (AMHPs) undertake Mental Health Act (MHA) interviews and they make the ultimate decision, based on doctors’ medical recommendations, to detain an individual in hospital without their consent. AMHPs are required to embed the statutory guiding principle of Empowerment and Involvement as well as to maximise service users’ self-determination and this is part of a broader policy orientation toward principles of participation, involvement, shared decision-making and supported decision-making. Yet there is very little research in this area and AMHP practice takes place in the absence of guidelines or clear evidence base. Consequently, more needs to be understood about effective techniques for communication and involvement. This study was conducted with AMHPs from an AMHP service in England. A qualitative methodology was employed to gather indepth information about AMHPs’ communicative practices. MHA assessments were observed and audio-recorded to enable Conversation Analysis to be used to analyse the content and style of communication within interactions. Findings suggest that at a micro, conversational level, AMHPs worked to address obstacles to communication as well as to maintain, or restore, affiliation and alignment in their relationships with service users. Evidence suggests that communicative techniques form part of AMHPs’ broader coordinating and empowering role. The study concludes that there is a need for a more deliberate and deliberative approach to re-engineer how AMHPs and service users work together, providing original evidence for AMHP practice and supporting future training