Fixed-effects Model Research Articles

Effects of Agricultural Insurance on Water Pollution in China

Water pollution is the most serious environmental problems in China now, water pollution directly affects people's quality of life and the sustainable development of agriculture, and the biggest source of water pollution is agricultural non-point source pollution, so we need to pay more attention to the environmental impact of agricultural production and reduce agricultural non-point source pollution. This paper examines the environmental impact of agricultural insurance on water pollution. Using annual data from 30 provinces across China between 2011 and 2019, this paper employs a two-way fixed-effects model to examine the correlation between agricultural insurance development and agricultural pollutant emissions. Additionally, it takes agricultural carbon emissions and agricultural output value as dependent variables to comprehensively investigate the environmental and economic impacts of agricultural insurance. The research results indicate that the development of agricultural insurance has a significant effect on reducing agricultural water pollution and carbon emissions. The pollutant reduction effect is more significant in the major grain-producing areas. The positive environmental effect of agricultural insurance is based on the fact that the development of agricultural insurance is conducive to reducing the use of pesticides and chemical fertilisers and does not come at the expense of increased agricultural output.

Enterprise digitization and marine economic performance: An empirical study of listed enterprises in China's maritime economy.

The scale and connectivity of marine resources make them more complex than land resource management. Although digitization has been recognized as an organizational change process that can effectively improve resource efficiency and enhance network resilience, however, gaps remain in establishing the theoretical links between digitization and marine economic performance. Based on a panel fixed-effects model, this study evaluates the interrelationships and potential mechanisms of different firms with data from annual reports of listed firms in the marine economy in the eastern coastal region of China. The results indicate that there is a 'U-shaped' relationship between digitalization and enterprise efficiency in the maritime sector, and significant heterogeneity exists in the characteristics of these enterprises. Notably, firms' technological innovation capability can modulate the 'U-shaped' relationship through the interaction of economies of scale and economies of scope. This paper highlights how digitization mitigates the fragmentation and sectionalization of marine information and addresses the digital overload and productivity paradox that firms may face in the early stages of digitization. The study suggests that institutional diversity shapes resilience. Governments need to promote top-down regulation and industry collaboration, while marine enterprises need to coevolve collaboratively with them through bottom-up internal communication and external interaction to enhance the value chain of marine enterprises.

Studying the impact of profitability, bankruptcy risk, and pandemic on narrative tone in annual reports in an emerging market in the East

The purpose of this paper is to investigate whether the narrative tone of annual reports is influenced by profitability, bankruptcy risk, and pandemic in the context of Vietnam. The study applies the necessary regression analysis steps such as ordinary least squares (OLS), random effects model (REM), fixed effects model (FEM), and feasible generalized least squares (FGLS). Bootstrapping and System Generalized Method of Moments (SGMM) methods are used to test the robustness and address endogeneity and dynamic relationships in the data. The findings show that net tones increase while negative tones decrease in companies with high profitability. Companies at risk of bankruptcy use more negative tone and less net tone than companies that are not at risk of bankruptcy. The study also affirms that bankruptcy risk moderates the relationship between profitability and negative tone. During the COVID-19 pandemic, companies used more positive and negative tones than they did before the pandemic. After the COVID-19 situation stabilized, positive tones were used more, and negative tones were used less than during the outbreak. The research results also recognized that companies do not intend to hide information through impression management when faced with difficult economic conditions. This study has practical implications for investors and information users when considering management disclosures through the narrative tone of annual reports. To our knowledge, this is the first study (1) in an emerging market in the East—where there are fundamental cultural and linguistic differences compared to Western countries, (2) to build a list of Vietnamese words and phrases expressing emotional nuances used in finance and accounting, and (3) refers to the narrative tone of annual reports across different groups of companies.

Board diversity and firm performance in Chinese manufacturing firms: Moderating role of CEO duality

This study explores the relationship between board diversity and firm performance, with a focus on the moderating role of CEO duality in Chinese manufacturing firms. This study applies panel fixed-effect regression models for the period 2008–2022, and findings show that board diversity is positively associated with firm performance, and CEO duality negatively moderates the relationship. However, the findings also show that a highly diversified board can minimize the negative effect of CEO duality and increase the firm’s performance. Furthermore, the findings broaden the understanding of board attributes, showing that the education index is more evident among other board attributes for firm performance. This study verifies its results using the two-step system generalized method of moments approach and different board attributes in robust tests. The findings suggest that strategic efforts to promote board diversity may increase the board’s monitoring function and control managerial opportunism, ultimately improving firm performance in the Chinese business landscape. JEL CLASSIFICATIONS: G30; G34; L25

Exploring the Influence of Digital Economy Growth on Carbon Emission Intensity Through the Lens of Energy Consumption

Exploring the impact of new economic forms such as the digital economy (DE) on carbon emissions is crucial for China’s “dual carbon” goals. This paper assesses the impact of the DE on carbon emission intensity (CI) from a 2011–2021 perspective on energy consumption in 30 provinces (Hong Kong, Macao, Taiwan, and Tibet are excluded) by using a double fixed-effects model for evaluating the DE. Based on the results from 2011 to 2021, (1) China’s DE and CI differ spatially and temporally. In contrast to CI, DE shows a pattern of low in the northwest and high in the southeast. The changes are similar to Hu Huanyong’s line, with considerable changes in the southeast, especially the coastal region. (2) Chinese DE’s carbon control effects (−0.027) vary by region. A significant negative effect is seen in both the eastern and western regions, with the western region having the greatest negative effect (−0.030), and a positive but insignificant impact in the central region. (3) Total energy consumption (TEC), structure (EC) and efficiency (EI) are all pathways of its influence. Path changes in China are mainly dominated by dual paths (Accounting for over 47%), with fewer single and multiple paths. Among them, the main dual path types are TEC and EC in the east and central regions, TEC and EC, and EC and EI in the western regions; meanwhile, the paths are unchanged in most of the provinces in China, and the changed provinces are mainly in the west. Based on these findings, DE development policies based on regional energy consumption differentiation are crucial to reducing carbon emissions.

Association of sleep duration with obesity in older adults: A systematic review and meta-analysis.

Research on sleep duration and obesity is extensive in children and young individuals but limited and inconsistent for older adults. Our study aims to clarify the current status of this association in the elderly population. We searched six English and four Chinese databases up to January 25, 2024, for observational studies on sleep duration and obesity in older adults. Two researchers independently conducted the literature search and data extraction. Study quality was assessed using the Newcastle-Ottawa Scale for cohort studies and the Agency for Healthcare Research and Quality for cross-sectional studies. Meta-analyses were performed using Stata 15.0 software, using both random-effects and fixed-effects models to calculate pooled odds ratios with 95% confidence intervals (CIs). The meta-analysis of 15 studies found a correlation between short sleep duration and obesity in older individuals (pooled odds ratio, 1.40 [95% CI: 1.12-1.73]; P = 0.003). However, no significant correlation was found between long sleep duration and obesity among the elderly (pooled odds ratio, 1.04 [95% CI, 0.95-1.13]; P = 0.426). Short sleep duration in the elderly was associated with obesity. More prospective studies need to be included in the future to improve the reliability of the conclusions. Geriatr Gerontol Int ••; ••: ••-•• Geriatr Gerontol Int 2024; ••: ••-••.

Cardiovascular prevention with GLP1 agonists in high or very-high cardiovascular risk irrespective of diabetes

Abstract Introduction Patients with established cardiovascular disease have an increased risk of stroke and myocardial infarction, even in the absence of atrial fibrillation. Several trials have analyzed the effect of glucagon-like peptide-1 receptor (GLP1) agonists in patients with high cardiovascular risk and lately this effect has been studied even in the absence of diabetes. Methods A meta-analysis of randomized clinical trials (RCT) comparing GLP1 agonists with placebo was performed. The primary objective of the study was to analyze the composite endpoint of cardiovascular death, non-fatal myocardial infarction and non-fatal stroke (MACE). As secondary objectives, cardiovascular death, non-fatal myocardial infarction and non-fatal stroke have been studied separately. The meta-analysis was performed using the inverse variance method, using the fixed effects model when there was no heterogeneity and the random effects model when heterogeneity is significant. In the case of significant heterogeneity in the primary objective, a stratified analysis with exposure time have been performed to explain this outcome. Results A sum of 9 randomized controlled trials were included where a GLP1 agonist such as albiglutide, dulaglutide, exenatide, liraglutide, lixinatide or semaglutide was compared with placebo. 77684 patients were incorporated, while 39497 were treated with a GLP1 agonist. The mean age was of 63.7 years (SD ± 1.97 years), 60080 (77.3%) suffered from diabetes and 60552 (77.9%) from cardiovascular disease. As showed in figure 1, the GLP1 agonists showed a reduction of 13% of the MACE (RR: 0.87, 95% CI 0.81-0.92; p<0.001). Heterogeneity could be explained by exposure time and concentration in the blood, considering that it disappears within each group when applying this condition. Treatment with GLP1 agonist also reduced cardiovascular death by 12% (RR: 0.88, 95% CI 0.82-0.94; p<0.001), non-fatal strokes by 14% (RR: 0.86, 95%CI 0.79-0.95; p<0.001) and non-fatal miocardial infarction by 13% (RR: 0.87, 95% CI 0.78-0.97; p<0.001). Conclusion Treatment with a GLP1 agonist reduced the incidence of the MACE by 13% and cardiovascular death by 12%, as well as it decreased the incidence of nonfatal stroke by 14% and of nonfatal myocardial infarction by 13% in different RCTs involving patients with high or very-high cardiovascular risk with or without diabetes.

BRIDGING THE DIGITAL GAP: ANALYSING THE IMPACT OF ICT DIFFUSION ON INCOME INEQUALITY IN INDONESIA

The development of information and communication technology (ICT) has significantly transformed the socio-economic structure of society, particularly in terms of income distribution. This study aims to analyse the impact of ICT development on income inequality across 34 provinces in Indonesia from 2012 to 2020, employing econometric methods based on panel data through a fixed effects model. Empirical findings reveal that ICT readiness and ICT skills tend to exacerbate income inequality, while ICT use and its quadratic form contribute to reducing it. These results suggest that although ICT infrastructure and skills are crucial, their uneven distribution and utilisation can widen income disparities. Consequently, this study highlights the importance of ensuring equitable access to ICT across Indonesia to mitigate economic inequality. The study's recommendations stress the pivotal role of the government in expanding ICT infrastructure, fostering a research and innovation climate conducive to digital transformation, and formulating policies that enhance ICT skills nationwide. These measures would improve digital literacy, upgrade workforce capabilities, and promote inclusive digital economic growth. Ultimately, comprehensive and equitable ICT development can play a critical role in reducing income inequality across Indonesia.

Heart failure and renal outcomes in patient treated with GLP1 agonists

Abstract Introduction Glucagon-like peptide-1 receptor (GLP1) agonists are emerging as a primordial treatment for diabetes and to reduce cardiovascular burden, both of them factors that play an important role in the developing of renal chronic disease and heart failure, and vice versa. The debut of renal chronic disease and the manifestation of acute renal injury/failure can lead to the discontinuation of treatment, which in patients suffering from heart failure who tend to be polymedicated could end up in lessening their survival. Methods A metanalysis of randomized clinical trials (RCT) comparing GLP1 agonists with placebo was performed. The endpoint of the study was to analyze all-cause mortality, hospitalization or urgent medical visit for heart failure, a kidney outcome composite, which is slightly heterogenic depending on the RCT, and the manifestation of acute renal injury/failure as an adverse effect or that lead to the discontinuation of treatment. The meta-analysis was performed using the inverse variance method, using the fixed effects model when there was no heterogeneity and the random effects model when heterogeneity is significant. Results A sum of 9 randomized controlled trial were included where a GLP1 agonists such as albiglutide, dulaglutide, exenatide, liraglutide, lixinatide or semaglutide compared with placebo. 77684 patients were incorporated, while 39497 were treated with a GLP1 agonists. The mean age was of 63.7 years (SD ± 1.97 years), 60080 (77.3%) suffered from diabetes, 60552 (77.9%) from cardiovascular disease and 14367 from chronic heart failure (18.4%). The mean eGFR was 77.3 mL/min (SD ± 3.3 mL/min). As showed in the forest plots, treatment with GLP1 agonists reduced all-cause mortality by 12% (RR: 0.88, 95% CI 0.83-0.92; p<0.001), hospitalization or urgent medical visit for heart failure by 10% (RR: 0.90, 95% CI 0.83-0.98; p<0.001), the kidney composite outcome by 22% (RR: 0.78, 95% CI 0.70-0.87; p<0.001), while it showed no statistical reduction in acute renal injury/failure (RR: 0.89, 95% CI 0.79-1.01; p=0.069). Conclusion Treatment with a GLP1 agonists reduced the incidence of all-cause mortality by 12%. In addition, hospitalization or urgent medical visit for heart failure was decreased by 10%. In terms of renal asessment, the composite of kidney function was reduced by 22%, while the manifestation of acute renal injury/failure, though no statistical signification was accomplished, showed some evidence of beneficial effect but more RCTs are needed to prove it. Hence, GLP1 analogues appear as a possible new pillar of treatment for heart failure and renal disease in determined patients.

Impact of allogenic Fecal Microbiota Transplantation (FMT) on lipid parameters in patients with metabolic syndrome (MetS): a meta-analysis

Abstract Background Metabolic Syndrome (MetS) has long been considered a formidable global health concern, and impaired lipid metabolism has been one of its crucial clinical manifestations. Fecal Microbiota Transplantation (FMT) has emerged as a potential therapeutic strategy for MetS, nevertheless, prior meta-analyses have not only yielded conflicting outcomes, but as well predominantly centered on glycemic parameters, leaving the potential impact of FMT on lipid metabolism remained unexplored. Purpose This meta-analysis systematically assessed the influence of allogenic FMT on lipid parameters in MetS patients, unraveling its potential as an innovative therapeutic modality for MetS. Methods A meta-analysis was performed to explore the impact of allogenic FMT on lipid parameters (low-density lipoprotein cholesterol [LDL-C], high-density lipoprotein cholesterol [HDL-C], total cholesterol [TCHO] and triglycerides [TG]) in patients with MetS. Terms regarding FMT and metabolic syndrome were searched in PubMed/Medline, EMBASE, Web of Science, the Cochrane Library, and Scopus from the inception of the databases until 31 August 2023. Ten randomized controlled trials (RCTs) were included and mean difference (MD) of parameters were pooled using a fixed effects model. Subgroup analyses according to follow-up durations were performed, and this study was registered in PROSPERO. Results A total of 532 patients in 10 studies were included. Patients undergoing allogenic FMT manifested significantly higher HDL-c level compared with control group (receiving placebo or autologous FMT, pooled MD 0.06 [95% CI: 0.02, 0.10]), and the result remained consistent in the subgroup with 4 to 6 weeks of follow-up (MD 0.07 [95% CI: 0.02, 0.10]). Though overall pooled result did not manifest a significant LDL lowering effect (MD -0.08 [95% CI: -0.21, 0.05]), in subgroup analyses, a significantly lowered LDL level was observed at 12 weeks of follow-up (MD -0.34 [95% CI: -0.60, -0.08]). No significant difference was observed between allogenic FMT and control group concerning TCHO ant TG levels regardless of lengths of follow-up. Conclusions An overall higher level of HDL-C and lowered LDL-C at 12 weeks of follow-up was observed in MetS patients receiving allogenic FMT. The results indicated that gut microbiota from lean, healthy donors may display a beneficial effect on modulating lipid metabolism in patients with MetS. Allogenic FMT manifested promising therapeutic impact and could serve as a viable intervention for MetS patients. Future large-scale RCTs are required for further validation.

Comparative efficacy of colchicine and intensive LDL-C lowering in patients with ASCVD receiving statins: a network meta-analysis of randomised controlled trials

Abstract Background Adding intensive low-density lipoprotein cholesterol (LDL-C) lowering treatments or colchicine to statins resulted in additional cardiovascular benefits. However, the relative efficacy and priority of these agents are unclear. Purpose We aimed to compare the effects of these supplementary agents on cardiovascular outcomes in patients with atherosclerotic cardiovascular diseases (ASCVD) receiving statins. Methods We performed a systematic review and frequentist network meta-analysis on randomized controlled trials. The primary efficacy endpoint was the main adverse cardiovascular event (MACE), and the secondary efficacy endpoints were myocardial infarct, stroke, coronary revascularization, cardiovascular death and all-cause mortality. The safety endpoints were treatment discontinuation and non-cardiovascular death. Colchicine was used as reference treatment. Random-effects model was used in case of high heterogeneity, the fixed-effects model was preferred otherwise. We ranked the comparative effects of all drugs with surface under the cumulative ranking (SUCRA) probabilities. Results 17 trials totaling 85823 participants treated with colchicine, proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor, Niemann-Pick C1-like 1 protein (NPC1L1) inhibitor and ATP citrate lyase (ACL) inhibitor were included. Compared with colchicine, NPC1L1 inhibitor was associated with increased risk of MACE (risk ratio [RR]: 1.39, 1.21-1.59), stroke (RR: 1.81, 1.09-3.00) and coronary revascularization (RR: 1.36, 1.11-1.68), and PCSK9 inhibitor was associated with increased risk of MACE (RR: 1.27, 1.10-1.46). However, NPC1L1 inhibitor (RR: 0.68, 0.48-0.96) and PCSK9 inhibitor (RR: 0.64, 0.44-0.93) were associated with reduced risk of non-cardiovascular death in comparison to colchicine. PCSK9 inhibitors had a lower risk of MACE (RR: 0.91, 95% CI: 0.85-0.98) and coronary revascularization (RR: 0.89, 95% CI: 0.81-0.97) compared with NPC1L1 inhibitor. Although no regimen prolonged survival, colchicine had the lowest rank at non-cardiovascular death and the worse performance on all-cause mortality. Conclusions In patients with ASCVD receiving statins, inflammation-inhibiting with colchicine seems to be superior to intensive LDL-C lowering therapy with PCSK9 inhibitor or NPC1L1 inhibitor in cardiovascular prevention. However, using colchicine as an alternative to intensive lipid-lowering therapy may need to be weighed against the greater cardiovascular benefits and the potential harms of higher non-cardiovascular death. Given the worse performance of colchicine on survival based on current evidence, colchicine may be more appropriate for patients who have been treated with intensive LDL-C-lowering agents but still have recurrent cardiovascular events.Forest plots of included agentsRadar plot of treatments based on SUCRA

The role of anticoagulation in atrial high-rate episodes: a meta-analysis

Abstract Background The role of anticoagulation in patients with atrial high-rate episodes (AHRE), who have no prior history of atrial fibrillation or atrial flutter, is being extensively studied. Purpose Given the increased thrombo-embolic risk in patients who have atrial high-rate episodes, our aim was to evaluate whether anticoagulation leads to enhanced clinical outcomes compared to no anticoagulation (1). Methods We searched PubMed, EMBASE, and the Cochrane Library, through February 2024, for studies evaluating outcomes in patients with atrial high-rate episodes managed with oral anticoagulation (OAC) compared to those not managed with oral anticoagulation. Outcomes assessed were ischemic stroke, thromboembolic events, major bleeding, and all-cause mortality. A fixed-effects model was used to calculate pooled risk risk ratios (RR) and their 95% confidence intervals (CI). Results A total of 4 studies comprising 6788 patients were included. Anticoagulation was associated with a significant reduction in the risks of ischemic stroke (RR 0.66; 95% CI 0.49 - 0.90; P = 0.0084) and thromboembolic events (RR 0.70; 95% CI 0.55 - 0.89; P = 0.0037). Compared to atrial high-rate episodes not managed with anticoagulation, there was a significantly increased risk of major bleeding with anticoagulation (RR 1.57; 95% CI 1.23 - 2.00; P = 0.0002), while the risk of all-cause mortality was similar (RR 1.07; 95% CI 0.95 - 1.21; P = 0.2437). Conclusion Our study suggests that anticoagulation in patients with atrial high-rate episodes decreases the risks of ischemic stroke and thromboembolic events, while increasing the risk of major bleeding, compared patients not managed with anticoagulation. Our study does not show a mortality benefit with the use of anticoagulation in patients with atrial high-rate episodes. Further studies are needed to confirm the safety and efficacy of anticoagulation in atrial high-rate episodes.Forest Plots of Outcomes Assessed

Clinical outcomes of atrial high-rate episodes: an updated meta-analysis

Abstract Background Atrial high-rate episodes (AHRE) are commonly detected in individuals with cardiac implantable electronic devices. Outcomes of atrial high-rate episodes remain unclear in those without a prior history of atrial fibrillation. Purpose This study aims to evaluate clinical outcomes of atrial high-rate episodes in patients who have no prior history of atrial fibrillation. Methods PubMed, EMBASE, and Cochrane databases were searched through February 2024 for studies evaluating clinical outcomes in individuals with cardiac implantable electronic devices who experienced atrial high-rate episodes, compared to those who did not. Individuals who had a prior history of atrial fibrillation were excluded. Outcomes assessed were clinical atrial fibrillation, thromboembolic events, and all-cause mortality. A fixed-effects model was used to calculate risk ratios (RRs) with 95% confidence intervals (CI). A subgroup analysis of thromboembolic events was conducted based on the duration of atrial high-rate episodes. Results A total of 9 studies met inclusion criteria with a combined enrollment of 7440 patients. Compared to those who did not experience atrial high-rate episodes, those who did had significantly increased risks of clinical atrial fibrillation (RR 3.33; 95% CI 1.99 - 5.57; P < 0.0001) and thromboembolic events (RR 2.21; 95% CI 1.72 -2.85; P < 0.0001). The risk of all-cause mortality was similar between both groups (RR 1.19; 95% CI 0.95 – 1.49; P = 0.13). Subgroup analysis revealed an increased risk of thromboembolic events among atrial high-rate episodes ≥ 24 hours (RR 12.34; 95% CI 2.70 – 56.36) while atrial high-rate episodes lasting < 24 hours were insignificantly associated with thromboembolic events (RR 0.83; 95% CI 0.12 – 5.58). Conclusions Our study indicates a heightened risk of clinical atrial fibrillation and thromboembolic events among patients with atrial high-rate episodes, with no observed increase in mortality risk. Furthermore, our findings suggest that the duration of atrial high-rate episodes influences the risk of thromboembolism. Further studies are warranted to confirm our findings.

What works to reduce regional health inequalities? A case of East vs West Germany post reunification

Abstract Regional inequalities in mortality are rising across the globe. The case of German reunification offers a unique opportunity to explore how such inequalities can be reduced, or even eliminated: following reunification, a long-standing life expectancy gap between East and West Germany was closed for women and markedly reduced for men in a period of less than 15 years. Drawing from theory on health inequalities, we investigate the contribution of material, behavioural and psychosocial factors likely related to the narrowing of the life expectancy gap between East and West Germany following reunification. We used regional data from official national statistics covering the period 1994-2020 for 15 regions in East and West Germany. Using fixed-effects models with an interaction term for regions in the East, we investigated whether within-region changes in key hypothesised factors (social security expenditure, healthcare improvements, changes in alcohol consumption, and life satisfaction), have had differential impacts on life expectancy at birth and at 65 years. We find that increases in social security benefits in the East following reunification has been the most important factor for lowering inequalities between the two parts of Germany: for every standard deviation increase in social security benefits, life expectancy at birth increased by an additional 0.20 [0.07,0.33] years for males and by 0.15 [-0.01,0.31] years for females in East relative to West Germany. We find the protective effect of social security benefits also for women at 65 years (additional 0.14 years [0.006,0.268]) but not for men. Overall, our findings suggest that increasing social security expenditure could be an effective policy-based tool for reducing health disparities across regions with different levels of economic development. This provides additional support for the relevance of the materialist hypothesis and the political economy of root causes of health inequalities. Key messages • Our findings suggest that increasing social security expenditure could be an effective policy-based tool for reducing regional health disparities. • We find support for the materialist and political economy approaches to explaining health inequalities.

Creditor rights and investment sensitivity: evidence from an emerging market

PurposeCreditor rights reduce or increase agency problems in corporations, affecting financial decisions. This study examines the impact of India’s Insolvency and Bankruptcy Code of 2016 (hereinafter referred to as the Code) on firms’ investment and investment sensitivity based on their health, considering this Code as more creditor-friendly than pre-existing bankruptcy laws.Design/methodology/approachThis study uses a quasi-natural experiment that employs the difference-in-differences (DID) and propensity score matching difference-in-differences (PSM DiD) approach by considering the Code as treatment and categorizing the firms into distressed (treated group) and healthy (control group) firms. For the purpose of analysis, a fixed-effect regression model is used.FindingsThis study finds that distressed firms reduce their investment after the Code, but healthy firms do not observe any change. It shows that the reduction in investment of the distressed group is significantly greater than that of the healthy group due to agency conflict and the liquidation bias hypothesis. However, the reduction in investment is not followed by the change in investment sensitivity.Originality/valueThis study adds to the existing studies on the impact of the Insolvency and Bankruptcy Code, 2016 on investment. No study explores the relationship between this Code and investment based on the financial health of the firms. Also, none of the studies explores the impact of the Code on investment sensitivity. The results show that this Code has provided stronger protection to the creditors, which hurts the internal stakeholders’ interests. The study has implications for policymakers and academicians.

Inclusion of unexposed clusters improves the precision of fixed effects analysis of stepped-wedge cluster randomized trials with binary and count outcomes

BackgroundThe fixed effects model is a useful alternative to the mixed effects model for analyzing stepped-wedge cluster randomized trials (SW-CRTs). It controls for all time-invariant cluster-level confounders and has proper control of type I error when the number of clusters is small. While all clusters in a SW-CRT are typically designed to crossover from the control to receive the intervention, some trials can end with unexposed clusters (clusters that never receive the intervention), such as when a trial is terminated early due to safety concerns. It was previously unclear whether unexposed clusters would contribute to the estimation of the intervention effect in a fixed effects analysis. However, recent work has demonstrated that including an unexposed cluster can improve the precision of the intervention effect estimator in a fixed effects analysis of SW-CRTs with continuous outcomes. Still, SW-CRTs are commonly designed with binary outcomes and it is unknown if those previous results extend to SW-CRTs with non-continuous outcomes.MethodsIn this article, we mathematically prove that the inclusion of unexposed clusters improves the precision of the fixed effects intervention effect estimator for SW-CRTs with binary and count outcomes. We then explore the benefits of including an unexposed cluster in simulated datasets with binary or count outcomes and a real palliative care data example with binary outcomes.ResultsThe simulations show that including unexposed clusters leads to tangible improvements in the precision, power, and root mean square error of the intervention effect estimator. The inclusion of the unexposed cluster in the SW-CRT of a novel palliative care intervention with binary outcomes yielded smaller standard errors and narrower 95% Wald Confidence Intervals.ConclusionsIn this article, we demonstrate that the inclusion of unexposed clusters in the fixed effects analysis can lead to the improvements in precision, power, and RMSE of the fixed effects intervention effect estimator for SW-CRTs with binary or count outcomes.

Which diversity factors influence the attribution of competences and co-operation in nursing teams?

Abstract Background Diversity within nursing teams increases due to staff shortages in Germany, nurse migration and the current academization of the profession. Quality of patient care is associated with intraprofessional teamwork. Little is known about how nurse’s own diversity factors and those of team members impact nurse’s perception and behavior in team situations. Methods A quasi-experimental, cross-sectional study with a factorial online survey with fictional case studies (vignettes) was conducted in two German hospital operators in 2023. Nurses of legal age working in hospitals or nursing homes were eligible to participate. Associations of diversity factors, i.e., gender, age, migration background, and qualification, on the participant and vignette level on perceived competences and willingness to cooperate were preliminary analyzed via multi-level fixed effects models in SPSS. Results N = 684 nurses participated (76% female; mean age: 44.2 years; 88% born in Germany; 75% completed vocational training). Competency of team members in patient’s personal hygiene was rated higher by respondents born in Germany (.36), when fictional colleagues were of middle age (.06) compared to higher age and were from Germany (.22) or France (.08) compared to China. Competency in inserting infusions was rated higher by respondents born in Germany (.56), when fictional colleagues were from Germany (.29) or France (.20) compared to China and when one worked together for months compared to days (-.39). Willingness to swap shifts was affected by the fictional length of collaboration (-.08). All significance levels were p<.02. Conclusions How nurses perceive their colleagues’ competences is mainly influenced by their own and the other’s migration background, while willingness to cooperate is only affected by length of collaboration. Improving the onboarding process of new nurses in teams, and providing the time and space for professional exchange might improve mutual trust and teamwork. Key messages • Diversity in German nursing teams increases due to nurse migration and plurality of qualifications. • Facilitating professional exchange about individual competences might improve team work in nurses.

Ultrasound-guided versus palpation-guided techniques for vessel catheterization in children undergoing cardiac surgery. A systematic review and meta-analysis of randomized controlled trials

Abstract Background Pediatric heart surgery is the first treatment option for congenital heart disease, which is the leading cause of death in Children. Arterial cannulation (AC) and Central venous catheter (CVC) are required in pediatric cardiac surgery for continuous monitoring of the central venous pressure (CVP), replacement of fluid and blood products, close hemodynamic monitoring, and frequent sampling for arterial blood gases (ABG). Purpose We aim to assess the efficacy and safety of the ultra-sound guided technique compared to the traditional palpation-guided technique for vessel catheterization in children undergoing cardiac surgery. Methods A systematic review and meta-analysis synthesizing evidence from randomized controlled trials (RCTs) studies obtained from PubMed, Embase Cochrane, Scopus, and WOS until February 2024. We used the fixed-effects model to report dichotomous outcomes using risk ratio (RR) and continuous outcomes using mean difference (MD) with a 95% confidence interval (CI). Results Thirteen RCTs with 1060 children were included. Regarding arterial cannulation, ultrasound-guided technique was associated with a statistically significant increase in successful cannulation [RR: 1.31 with 95% CI (1.10, 1.56), P< 0.0001], and first-attempt success [RR: 1.88 with 95% CI (1.35, 2.63), P< 0.0001]; however, it was not associated with any statistically significant difference in venous cannulation in both outcomes with [RR: 1.13 with 95% CI (0.98, 1.30), P= 0.10], [RR: 1.53 with 95% CI (0.86, 2.71), P= 0.15] respectively. Moreover, ultrasound-guided technique was associated with a statistically significant decrease in the number of attempts either in arterial cannulation with [MD: -0.73 with 95% CI (-1.00, -0.46), P< 0.0001] or in venous cannulation with [MD: -1.34 with 95% CI (-2.55, -0.12), P= 0.03], and the time of attempted cannulation also either in arterial cannulation with [MD: -2.27 with 95% CI (-3.38, -1.16), P< 0.0001] or in venous cannulation with [MD: -4.13 with 95% CI (-7.06, -1.19), P< 0.0001]. Finally, ultrasound-guided technique was associated with a statistically significant decrease in the incidence of any complications either in arterial cannulation with [RR: 0.36 with 95% CI (0.18, 0.71), P< 0.001] or in venous cannulation with [RR: 0.30 with 95% CI (0.11, 0.84), P= 0.02]. Conclusion Ultrasound-guided arterial catheterization increases the number of successful catheterizations and first-attempt success rate; however, there was no significant difference in venous cannulation, while both arterial and venous cannulation were associated with decreased number of attempts, reduced overall procedure time, and decreased incidence of complications.

Outcomes of bariatric surgery in obese patients with heart failure:a meta-analysis

Abstract Background Patients with heart failure possess an increased risk for adverse outcomes with noncardiac surgery (1). While bariatric surgery is frequently performed in patients with obesity, there remains a limited understanding of the impact of bariatric surgery in obese patients with heart failure. Purpose The purpose of this study was to compare outcomes of bariatric surgery versus nonsurgical management in obese patients with heart failure. Methods We searched PubMed, EMBASE, and the Cochrane Library, through February 2024, for studies evaluating outcomes in obese patients with heart failure who underwent bariatric surgery compared to nonsurgical management. Outcomes assessed were postoperative atrial fibrillation, all-cause mortality, and hospital readmission. We used a fixed-effect model to calculate hazard ratios (HR) with 95% confidence intervals (CI) in R studio for outcomes assessed. In outcomes where significant heterogeneity was found (P< 0.05 and I2 > 60%), a random effects model was used. Results A total of 3 studies were identified, consisting of 260,186 patients. Compared to nonsurgical management, bariatric surgery was associated with a significant reduction in postoperative atrial fibrillation (HR 0.72; 95% CI: 0.62-0.84), all-cause mortality (HR 0.50; 95%CI 0.35-0.72), and hospital readmission (HR 0.73; 95% CI 0.69-0.78) in obese patients with heart failure. Conclusion Our study suggests that bariatric surgery significantly reduces post-operative atrial fibrillation, mortality, and hospital readmission among obese patients with heart failure.Our findings demonstrate that bariatric surgery should be considered as a viable intervention in obese patients with heart failure. Further studies are warranted to confirm our findings.Forest Plots of Outcomes Assessed

Research on Whether Artificial Intelligence Affects Industrial Carbon Emission Intensity Based on the Perspective of Industrial Structure and Government Intervention

Artificial intelligence serves as the fundamental catalyst for a new wave of technological innovation and industrial transformation. It holds vital importance in reaching carbon reduction targets and the objectives of “carbon peak and neutrality”. This factor contributes significantly to the reduction in carbon emissions in the industrial domain. This article utilizes panel data from 30 provinces in China, covering the years 2013 to 2021, to develop an evaluation framework for assessing the progress of artificial intelligence development. Through the use of double fixed-effect models, mediation effect models, and threshold effect models, the empirical analysis examines the industrial carbon reduction effects of artificial intelligence and its operating mechanisms. Research indicates that the advancement of AI can significantly reduce carbon emission intensity within the industrial sector. This conclusion remains valid following comprehensive robustness tests. Furthermore, there exists temporal and regional variability in AI’s impact on industrial carbon reduction, particularly more pronounced after 2016 and in central and western regions. AI influences carbon emission reduction in China’s industrial sector through the advancement and optimization of industrial structures. Here, the increase in senior-level operations acts as a partial masking effect, while optimization serves as a partial mediator. The relationship between AI and industrial carbon emission intensity is non-linear, being influenced by the threshold of government intervention; minimal intervention weakens AI’s effect on carbon intensity reduction. These findings enhance our understanding of the factors influencing industrial carbon emissions and contribute to AI-related research. They also lay a solid empirical groundwork for promoting carbon emission reduction in the industrial domain via AI. Additionally, the results offer valuable insights for formulating policies aimed at the green transformation of industry.