Limited Experience Research Articles

Long-term clinical outcomes of acute myocardial infarction based on a center's experience with IVUS in the contemporary drug-eluting stent era

Abstract Introduction Intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) is recognized for improving patient prognosis. However, how a center's experience with IVUS affects clinical outcomes remains unclear. Purpose This study aims to elucidate the impact of a center's expertise in IVUS on clinical outcomes, emphasizing the value of institutional experience. Methods In this retrospective cohort study from the Korean AMI Registry (KAMIR), we analyzed 9,752 patients diagnosed with acute myocardial infarction (AMI) who underwent intervention with second-generation drug-eluting stents. The primary outcome was major adverse cardiovascular events (MACE) at 3 years, defined as the composite of all-cause deaths, any myocardial infarction, and any coronary revascularization. The secondary outcome was target-lesion failure (TLF), defined as the composite endpoint of all cardiac deaths, target vessel myocardial infarction, and ischemia-driven target lesion revascularization at 3 years. Results In this study, the median frequency of IVUS usage across 20 institutions was 10.3%. Hospitals were categorized as centers with extensive experience in IVUS or those with limited experience, based on the median frequency of IVUS usage. In centers with extensive experience in IVUS, IVUS-guided PCI consistently showed a reduction in MACE (18.5% vs. 15.3%, p=0.016) and TLF (8.3% vs. 6.3%, p=0.039) within propensity-score matched populations. Furthermore, multivariate Cox regression analysis revealed that IVUS-guided PCI was associated with decreased risks of MACE (HR 0.80, 95% CI [0.69-0.93], p=0.003) and TLF (HR 0.75, 95% CI [0.59-0.95], p=0.01). However, from propensity matched population in centers with limited experience in IVUS, there were no significant reductions in the incidences of MACE (18.6% versus 15.7%, p=0.422) and TLF (10.4% versus 8.9%, p=0.644). Conclusion This comprehensive, nationwide cohort study shows that outcomes of IVUS-guided PCI are more favorable in centers with extensive IVUS experience compared to those with limited experience. These results indicate that the clinical advantages of IVUS-guided PCI are more pronounced in centers with extensive experience than in those with limited experience.

Equity and diversity maturity matrix for structured diversity inclusion in the EU JACARDI project

Abstract Issue There is increasing awareness on the importance of integration of cultural and ethnic diversity perspectives to reduce prevailing health inequities effectively and sustainably. There is, however, limited experience and practical tools for systematic integration of these perspectives in public health. Description of the problem The EU Joint Action for Cardiovascular Diseases and Diabetes (JACARDI) project, conducted 11/2023-10/2027 has developed a structured and systematic approach for integrating equity and diversity perspectives in all its 142 pilots across 21 European countries. Results Equity and diversity perspectives are embedded in the harmonized stepwise methodology for pilots, supported with a practical Equity and diversity maturity matrix. The maturity matrix is based on the JACARDI 4Cs Equity and diversity explanatory framework (Critical reflection; Context and data; Co-design; inclusive and accessible Communications). The content of the matrix is divided into concrete steps related to pilot’s planning and implementation, each with three levels of maturity that aim at gauging how equity and diversity perspectives are applied in practice: Approaching, Meeting, Exceeding. Pilots are encouraged to strive for any of these three levels, considering their available resources and previous experiences in diversity inclusion. Lessons Effective and sustainable change toward more equitable and diversity inclusive practice requires seamless integration of these perspectives in other routine activities. Training and continued practical and motivational support are key for adherence to novel approaches. In addition to being a practical tool, the Equity and diversity matrix acts as a structured self-evaluation tool to monitor how equity and diversity principles are translated into practice.

Beyond Digital Literacy: Exploring Factors Affecting Digital Performance of University Staff

Digital literacy is essential but doesn’t guarantee digital performance. Many researchers consider factors such as attitude, cultural environment, or institutional setting in their frameworks when researching digital literacy. Yet, their significance often gets lost in a catalog of required skills and knowledge. Here we develop a model outlining factors influencing university personnel’s digital performance across diverse tasks, and we discuss associated challenges. The model derives from literature and insights from 20 qualitative interviews with academic staff in teaching, research, or consulting roles. Results show that institutional settings and employee empowerment are pivotal in shaping openness to digital tools. Intentions fail due to resource constraints and lack of recognition, leading to limited experience with digital opportunities. Well-being significantly influences willingness to embrace digital resources amidst the balancing act of anticipating future efficiency against investing time and resources. Maintaining a team atmosphere often results in alignment with the least digitally competent. With appropriate conditions, time resources, and support, staff could efficiently utilize digital resources, even with only basic skills, which fosters the integration of all workforces. We argue for comprehensive assessments of university employees’ digital performances, considering context and holistic aspects beyond personal skills and knowledge. Our model encompasses digital literacy, openness to digital developments, digital culture, primary conditions, services/empowerment offerings, and mindfulness.

Validation of a hand-held ultrasound device in the evaluation of aortic stenosis

Abstract Introduction Hand-held Ultrasound devices (HHUD) are increasingly used in routine clinical practice, although until recently they did not have continuous Doppler. There is no evidence on the usefulness of an HHUD for the assessment of aortic stenosis (AS) in real life. Objective To validate the use of a new HHUD device in a real-life scenario. Material and methods Observational, single-center and prospective study, including patients diagnosed with AS with a previous standard echocardiography. Patients were randomly recruited from a tertiary cardiac imaging laboratory. Immediately after the reference echocardiography performed by an imaging expert, a Cardiology trainee with ASE level II repeated the study blindly with an HHUD. Agreement between the two tests was evaluated by measuring the mean aortic valve gradient (mAG). An intraclass correlation coefficient (ICC) test, linear regression, and Bland-Altman test were performed to compare the two methods. Results 101 patients were recruited. The reference test calculated a mAG of 29 mmHg (19.8 - 42.2) versus a mAG of 27.2 mmHg (16.2 - 43.9) in HHUD. The statistical analysis showed a good correlation between both tests (ICC: 0.87 (95% CI: 0.79 -0.94) and r=0.89 (95% CI: 0.85-0.94) (Figure). The Bland-Altman test showed a non-significant underestimation (1.61 ± 0.9 mmHg; p= 0.09). The HHUD classified 29 cases as severe or major AS compared to 31 in the reference test (kappa= 0.81; 95% CI: 0.68 - 0.94). The HHUD showed an excellent agreement for classification of AS in at least severe AS grade. The kappa analysis had a value of 0.81 (95% CI 0.68 – 0.94) with a global agreement of 92.1%. The positive predictive value was 89.6%. The negative predictive value was 93.1%. Sensitivity and specificity were 83.8% and 95.7%. The rest of the variables evaluated showed poorer agreement. In those patients with obesity, worse acoustic window, atrial fibrillation and critical AS, the agreement was worse. Conclusions The new HHUD evaluated by an operator with limited experience showed good agreement with the reference echocardiographic device in determining the mean aortic gradient.Central picture

Switching from Premixed Insulin to Insulin Degludec/Insulin Aspart for the Management of Type 2 Diabetes Mellitus: Implications of a Real-World Study on Insulin Degludec Dosing.

When switching from premixed insulin to insulin degludec/aspart (IDegAsp), IDegAsp usually starts at the same dose as the premixed insulin according to limited clinical experience or at a dose according to clinician discretion. The dose of insulin degludec used in the real world after switching has been poorly investigated. A retrospective analysis was conducted on patients with type 2 diabetes who switched from premixed insulin to IDegAsp from October 2016 to December 2023. Repeated measures analysis of variance was used to compare changes in insulin dose, glycated hemoglobin (HbA1c), fasting blood glucose (FBG), and postprandial blood glucose (PBG) before and after switching. Sixty-six patients with prior low-ratio premixed insulin and 22 with prior mid-ratio premixed insulin were included. Among the low-ratio insulin users, the total daily dose of insulin degludec (IDeg) decreased by 21.43% and 19.05% at 3 and 6months, respectively, after switching, compared with prior basal insulin dose (both p < 0.001). Conversely, among mid-ratio insulin users, the IDeg daily dose increased by 10.71% and 32.14% at 3 and 6months, respectively, after switching, compared with prior basal insulin dose (both p < 0.001). In all patients, HbA1c levels decreased by 0.70%, FBG decreased by 1.00mmol/l, and PBG decreased by 1.61mmol/l after 6months of switching (all p < 0.05); the total daily insulin dose and injection frequency significantly decreased after switching (both p < 0.05); age and disease duration did not affect IDegAsp effects on HbA1c reduction. In the setting of transition to IDegAsp from premixed insulin, the dose of basal insulin in the premixed formulation can be a valuable reference for adjusting insulin degludec dose. IDegAsp is superior to premixed insulin in blood glucose control with reduced total daily dose and injection frequency. IDegAsp could be the best choice for the management of diabetes in elderly patients.

Experiences and Challenges of Teachers in Handling Learners with Intellectual Disability During Covid-19 Pandemic

This study delved into the list of significant challenges that teachers were experiencing in handling ID learners. It employed a qualitative method in gathering data on teachers-participants’ experiences and challenges. A total of 20 teachers were selected using a convenient purposive sampling as the participants. The findings of this study revealed that teacher participants have observed and experienced multifaceted scenarios and difficulties during the COVID-19 pandemic. The data showed the existence of the challenges based on DepEd support, the lack of governmental provision of devices to aid learning, the limited learning experience, and instructional time that affect the learner’s personality, social orientations, and performance due to the absence of direct instruction. Likewise, the study concluded that the COVID-19 pandemic has affected and brought challenges to teachers and learners and has created the failure of support from the DepEd and the government. It conveyed the importance of parental support without the teacher’s direct instruction. Hence, it is recommended that schools enhance teacher training, prioritize face-to-face instruction, strengthen parental support, increase resource allocation, promote inclusive practices, and conduct further research on effective strategies.

Releasing our model T - chimeric antigen receptor (CAR) T-cells for autoimmune indications.

This review provides an update on the rapidly growing field of engineered cellular therapies for autoimmune disorders, primarily focusing on clinical experience and correlative studies with chimeric antigen receptor (CAR) T-cells. To date, two case series describing treatment with CAR T-cell therapy for systemic lupus erythematosus (SLE) suggest that drug-free remission can be sustained in patients with previously treatment-refractory disease. The outcomes of these studies are similar, despite the use of different CAR constructs and lymphodepletion regimens. Although it is not yet clear whether the patients described have truly been cured, the majority of remissions have remained durable up to last follow-up at 1-2 years from treatment. Meanwhile, mechanistic studies are providing a window into how transient B-cell depletion mediates lasting benefit. With the encouraging data in SLE, CAR T-cells and other novel B-cell-depleting agents (e.g. bispecific T-cell engagers) are now being evaluated as treatment for other autoimmune conditions, with the goal of durable response. Recent reports highlight cellular therapies as a promising strategy for patients with treatment-refractory autoimmune conditions; however, there is still limited experience, and better insight into this therapeutic approach is expected to emerge rapidly.

14 Exploring factors contributing to Secondary Traumatic Stress in residents during a child maltreatment paediatrics rotation

Abstract Background Secondary Traumatic Stress (STS) refers to the distress and emotional disruption experienced by individuals caring for those who have experienced trauma. STS is increasingly recognised in child serving professions, especially in medical trainees and clinicians working in Child Maltreatment Paediatrics (CMP). Paediatric resident physicians are typically of younger age, work long hours in stressful conditions, and have limited CMP experience. This makes them particularly vulnerable to experiencing STS. In addition to affecting the wellbeing of trainees, STS can impede performance at work and affect patient care. Thus, it is important to understand and mitigate the development of STS among paediatric trainees during their CMP rotation. Objectives This study aims to identify key factors contributing to STS among medical residents at a tertiary care paediatric hospital during a CMP rotation. Design/Methods Qualitative interviews and focus groups were conducted to explore the experiences and perceptions of CMP trainees, staff physicians, and psychologists. Quality Improvement methods including a Fishbone diagram (figure 1), 5-whys analysis, and Pareto analysis (figure 2) were used to analyze the factors that contribute to residents developing STS symptoms. Results Our analysis revealed the following themes contributing to STS symptoms in paediatric residents: (1) limited awareness and education on STS symptoms, (2) lack of planned case debriefing, (3) residency-related burn out, (4) limited experience in CMP, (5) hidden curriculum of residency, and (6) limited opportunity to discuss STS symptoms. Conclusion Our study identified factors related to both limited knowledge around STS, and limited opportunities to debrief cases that may contribute to the development of STS among residents. These factors can, in part, be addressed on a program level. This aligns with existing STS literature which emphasizes implementing program level strategies to support professionals in addition to prioritizing self-care. Next steps involve implementing targeted interventions within the rotation to help mitigate STS effects on trainees.

Investigation of drive mechanisms in fractured oil reservoirs with tight matrix: a case study of an Iranian reservoir

ABSTRACT Tight matrix oil reservoirs pose significant challenges for oil recovery due to their low permeability and intricate fracture networks. Effective reservoir development strategies require a thorough understanding of the recovery mechanisms; otherwise, it is difficult to maximize production rates and optimize the oil recovery factor. The reservoir examined in this study contains black oil within a tight matrix, complicating the planning and selection of appropriate recovery methods. Despite strong bottom water influence and high water-cut issues, the fractures in the reservoir facilitate economical extraction. However, the reservoir’s complexity, coupled with limited knowledge and experience in this area, further complicates recovery efforts. In this study, we investigated the multi-mechanistic flow dynamics within the porous media. Simulation results indicate that during the first month of production, the dominant recovery mechanism is rock expansion drive. Beyond this period, the water drive mechanism prevails. Over a ten-year period, oil recovery is distributed as follows: 13.1% from bottom water drive, 1.0% from gas cap drive, 0.2% from rock expansion, and 0.6% from oil expansion drive.

Unveiling Therapeutic Challenges: A Unique Case of Intracranial Myroides odoratimimus Infection Following Hemorrhagic Stroke.

Intracranial infections post-neurosurgical procedure pose substantial morbidity and mortality risks. Myroides odoratimimus, an opportunistic gram-negative pathogen, represents a real challenge because of limited clinical experience. This article details the second reported case of intracranial M. odoratimimus infection associated with external ventricular drains in an immunocompetent adult. Treatment involved a 21-day course of intravenous antibiotherapy using meropenem and vancomycin. This case underscores the complexity of managing rare complications, providing insights into therapeutic strategies for this challenging condition.

Combination Dornase and Alteplase for Intra-abdominal Drain, Abscess, and Hematoma Clearance: A Retrospective Case Series

Background: Since the advent of the MIST2 trial, the combined instillation of dornase and alteplase has become an effective nonsurgical treatment option for empyema and pleural fluid collection. Percutaneous drainage of abdominal abscesses and fluid collections, rather than open surgical treatment, also has become commonplace. The are several case reports and studies on the use of fibrinolytics to drain abdominal fluid collections but no literature reporting use of both alteplase and dornase for abdominal administration. Objective: We present a case series from an academic medical center where dornase therapy was added to fibrinolytic therapy to treat intra-abdominal fluid collections, hematoma, and abdominal drainage catheters with low output. Methods: This is an institutional review board-approved retrospective case series of 13 patients who underwent combination use of alteplase and dornase via intra-abdominal route. The primary objective was to assess for increased drain output, reduction in size of the fluid collection, and adverse events. Results: Many patients had improved drain output after dornase-alteplase therapy. One patient had significant bleeding complications. Conclusions: All patients were discharged alive from the hospital. Clinical success was difficult to define due to variable goals of therapy. Further data are needed to establish the safety and efficacy of this practice, especially compared with intra-abdominal alteplase alone. Patients in our series generally received larger doses of alteplase than in prior studies due to use of dosing modeled on the MIST2 trial. Based on the limited experience of our study, we recommend holding therapeutic anticoagulation during the administration of intra-abdominal dornase-alteplase.

The impact of perceived knowledge on marketing agility in the context of big data: role of deployment level

PurposeAgainst the backdrop of dynamic capabilities theory, this research examines the relationship between knowledge and marketing agility in the context of big data marketing analytics (BDMA). The relevant knowledge constructs under investigation are business/marketing, relational, technological and technology management. The level of BDMA deployment is also examined to determine its impact on these relationships.Design/methodology/approachA survey was used to gather data from marketing professionals working in firms with at least limited experience in big data (BD) deployment in the United States and Canada. The results were analyzed using partial least squares structural equation modeling (PLS-SEM) with a sample of 236 responses.FindingsThe results indicate that marketing professionals perceived the knowledge and marketing agility constructs differently than the previous research on IT professionals. The knowledge construct was perceived as a two-dimensional construct consisting of broad knowledge skills and specific technical knowledge skills. Only the broad knowledge skills construct was significantly related to the marketing agility construct, with progressively high predictive validity and relevance when the deployment of BDMA progresses.Originality/valueThe paper's originality stems from the different conceptualizations of the knowledge and marketing agility constructs due to the use of a novel sample of marketing professionals in this study. The research also contributes to the dynamic capabilities theory by emphasizing the critical role of vital knowledge when aiming to enhance marketing agility.

Prevalence, Risk Factors, and Impact of Long COVID Among Adults in South Korea.

This study aimed to identify the prevalence, risk factors, and impact of long COVID in a community-based representative sample of patients with COVID-19 aged 19-64 years. A total of 975 participants completed online or telephone surveys at 1 and 3 months post-diagnosis, covering persistent symptoms, daily activity limitations, vaccination status, and underlying diseases. Long COVID, as defined by the WHO criteria, had a prevalence of 19.7-24.9% in females and 12.7% in males. Logistic regression revealed that the odds of having long COVID symptoms were higher among females compared to males (OR, 2.43; 95% CI, 1.53-3.87), and higher in those aged ≥ 30 years compared to those aged 19-29 years: 30-39 years (OR, 2.91; 95% CI, 1.59-5.33), 40-49 years (OR, 2.72; 95% CI, 1.51-4.89), and 50-64 years (OR, 1.96; 95% CI, 1.10-3.49). Additionally, patients with underlying diseases had higher odds of long COVID symptoms compared to those without underlying diseases (OR, 1.81; 95% CI, 1.24-2.64). Among those with long COVID, 54.2% experienced daily activity limitations, and 40.6% received treatment. Furthermore, lower income groups faced greater daily activity limitations but had similar treatment rates to higher income groups. These findings emphasize the need for interest in and the development of programs to support these low-income populations.

Unifying Principles of Generalization: Past, Present, and Future.

Generalization, defined as applying limited experiences to novel situations, represents a cornerstone of human intelligence. Our review traces the evolution and continuity of psychological theories of generalization, from its origins in concept learning (categorizing stimuli) and function learning (learning continuous input-output relationships) to domains such as reinforcement learning and latent structure learning. Historically, there have been fierce debates between approaches based on rule-based mechanisms, which rely on explicit hypotheses about environmental structure, and approaches based on similarity-based mechanisms, which leverage comparisons to prior instances. Each approach has unique advantages: Rules support rapid knowledge transfer, while similarity is computationally simple and flexible. Today, these debates have culminated in the development of hybrid models grounded in Bayesian principles, effectively marrying the precision of rules with the flexibility of similarity. The ongoing success of hybrid models not only bridges past dichotomies but also underscores the importance of integrating both rules and similarity for a comprehensive understanding of human generalization.

Variations in Personality Traits Among Top Judo Referees from 2018 to 2022 Based on Gender Differences

The personality traits of top judo referees are crucial for fair decision-making in elite competitions, shaping the experience for athletes, coaches, and spectators. This study examines potential differences in personality traits among 63 referees from the World Judo Tour between 1 January 2018 and 31 December 2022. Factors analyzed include completing the IJF Academy course Level 1, elite athlete status, number of officiated events, performance ratings, and participation in the Olympic or Paralympic Games. Our research shows that older referees tend to exhibit greater extraversion, whereas less experienced officials show lower levels of this trait. Referees with limited experience generally demonstrate higher agreeableness than their more experienced counterparts. Female referees and those with top performance ratings display greater conscientiousness than male referees. Completing the IJF Academy course is associated with lower neuroticism, while lower performance ratings are linked to higher neuroticism. Openness tends to decrease with increased officiating experience, with less experienced referees showing higher levels of this trait. In conclusion, competitive experience, training completion, and officiating tenure are associated with specific personality traits among judo referees, highlighting the importance of continuous training for effective officiating. The analysis of personality traits revealed no statistically significant differences between male and female referees in the dimensions measured by the BFI (Big Five Inventory). This indicates that the levels of extraversion, agreeableness, conscientiousness, neuroticism, and openness were similar for both genders, with no significant variation in how these traits were expressed.

Predicting and Understanding Human Action Decisions: Insights from Large Language Models and Cognitive Instance-Based Learning

Large Language Models (LLMs) excel in tasks from translation to complex reasoning. For AI systems to help effectively, understanding and predicting human behavior and biases is essential. However, it remains an open question whether LLMs can achieve this goal. This paper addresses this gap by leveraging the reasoning and generative capabilities of LLMs to predict human behavior in two sequential decision-making tasks. These tasks involve balancing between exploratory and exploitative actions and handling delayed feedback, which is essential for simulating real-life decision processes. We compare the performance of LLMs with a cognitive instance-based learning (IBL) model, which imitates human experiential decision-making. Our findings indicate that LLMs excel at rapidly incorporating feedback to enhance prediction accuracy. In contrast, the IBL model better accounts for human exploratory behaviors and effectively captures loss aversion bias — the tendency to choose a sub-optimal goal with fewer step-cost penalties rather than exploring to find the optimal choice, even with limited experience. The results highlight the benefits of integrating LLMs with cognitive architectures, suggesting that this synergy could enhance the modeling and understanding of complex human decision-making patterns.

The impact of single-port robotic surgery: a survey among urology residents and fellows in the United States.

Our aim was to investigate the perception and future expectations of Single-Port (SP) surgery among urology trainees in the United States. A 34-item online survey was distributed to urological residency and fellowship programs across the US, covering demographic profiles, SP training opportunities, perceived educational impact, and future perspectives. Descriptive analysis and multivariable linear regression were used to assess predictors of SP adoption. 201 surveys were completed (28.6% completion rate). Among institutions with an SP platform, about 50% have used it regularly for over 2 years, though often in less than 50% of procedures. While robotic simulators are commonly available, only 17% offer both multi-port and SP simulators, and structured pre-clinical SP training is limited. Approximately 30% of respondents expressed concerns over limited hands-on experience and a steeper learning curve with SP. Around 40% felt that their robotic surgery exposure was negatively impacted by SP's introduction. SP surgery's benefits are seen mostly in the immediate post-operative period and a significant number of respondents foresee a major role for SP in urology. However, proficiency in SP surgery is not seen as crucial for career advancement or job opportunities. Academic job aspirations, SP platform availability, and SP surgery workload are predictors of future SP implementation. Trainees increasingly recognize the clinical benefits of SP procedures but express concerns about the potential negative impact on hands-on experience. Training programs should more systematically integrate SP technology into curricula. There is a correlation between training in high-volume SP centers and future SP adoption.

The Prevalence and Predictors of Workplace Violence Among Hospital Staff

Background: Workplace violence has always been a serious chal-lenge in health care systems. It reduces employees’ satisfaction and productivity, and increases the potential for adverse medical events. This study aimed to determine the prevalence and predictors of workplace violence among hospital clinical staff. Methods: This cross-sectional study was conducted on 140 hospital care staff including nurses and paramedics in 2022. The standard questionnaire of WHO on workplace violence in health sector was used to collect data. To describe the quantitative variables, the mean and standard deviations were utilized, and for analyzing the data, multiple logistic regression model was used. The analysis was performed using SPSS 26. Results: The results showed that 47.9% of the participants ex-perienced verbal violence at least once in the past year, and 19.3% experienced sexual violence. Regarding the perpetrators of violence, except for physical violence, colleagues accounted for the highest. Most physical violence cases against the clinical staff were perpetrated by one of the patient’s family members. Gender, marital status, and years of work experience were determined as predictors of workplace violence. Married male employees with limited work experience were disproportionately at risk of workplace violence. Conclusion: Hospital clinical staff were exposed to all kinds of violence, especially verbal violence. Training personnel on the management of workplace violence and enhancing their communication skills and determining the scope, and predictors of workplace violence can help healthcare managers reduce the violence and its complications.

Effect of media freedom on liquidity and information asymmetry: evidence from non-U.S. stocks in the NYSE

ABSTRACT While previous studies have mainly explored the impact of media freedom on macroeconomic variables, there is a relative scarcity of research on how media freedom affects stock markets. This paper examines the relationship between media freedom and the liquidity and information asymmetry of non-U.S. stocks listed on the New York Stock Exchange by demonstrating how these factors affect the liquidity dynamics of stocks from countries with varying degrees of media freedom. Ultimately, this study reveals that non-U.S. stocks from countries with limited press freedom experience poorer market liquidity. These conclusions hold even when considering a broader concept, voice and accountability, which includes media freedom, as well as different measures of liquidity and asymmetry, which reaffirms the reliability of the results. Our research illustrates the vital significance of media freedom in enhancing the liquidity of individual company stocks and mitigating market information asymmetry, suggesting that a nation’s press freedom can profoundly influence its stock market performance.

Life cycle assessment and generative design: development of a national LCA tool for exterior walls

PurposeThe promotion of sustainable design is demanded globally. The life cycle assessment (LCA) proved its reliability in this mission, but the difficulty and time required to apply it discouraged designers. This research aims to integrate LCA into the building design process through a software tool, taking advantage of generative design features. This will facilitate decision-making by architects and construction professionals.Design/methodology/approachThe study develops the EGY-LCA (http://egy-lca.com/). This prototype tool suggests exterior wall design alternatives for residential buildings in Egypt, using the environmental impact indicators of LCA data and other criteria related to national codes, materials, construction methods and required thermal resistance. Within a generative design process, the algorithm tests every possible wall method with materials and thickness combinations for each layer in compliance with inputs. The paper begins by explaining the tool’s working method. Afterward, different sets of inputs are examined and the values of the resultant environmental impacts of several suggested wall solutions are statistically analyzed. The application demonstrates the importance of the generative design tool. Proposing several solutions based on a set of inputs facilitates the selection of sustainable choices and allows comparisons between alternatives.FindingsThe prototype experiment confirms the research hypothesis. Unlike the available LCA tools, architects can make decisions with limited LCA experience if the data and equations are integrated into a generative design tool. The prototype proves its applicability for exterior wall alternatives.Research limitations/implicationsThe prototype is the initial step toward a whole-building LCA tool. It includes limited LCA stages and materials for the external wall. Future research is required to expand this parametric tool concept to include all the building components. The framework in Section 5 proposes a visualization.Practical implicationsThe prototype tool: EGY-LCA (http://egy-lca.com/). The value added to the design and construction sectors through the uncomplicated LCA application is fostering sustainable design, generative design tools can achieve this.Originality/valueThe novelty of this work is that it is the first initiative offering a parametric LCA tool. It promotes the application of LCA at the design stage using generative design, which contributes to sustainable development.