Monitoring Of Function Research Articles

EMPG - a New Concept for Digital Medical Device Instruction

Errors in the use of medical devices are common and pose a threat to patient safety. The field of anaesthesiology is particularly affected by this issue, as many of the medical devices used in this field are directly responsible for the monitoring and maintenance of a patient's vital functions during anaesthesia. To minimize application errors, instruction in the use of medical devices has been legally required since 1985. Inadequate instructions can put the patient as well as the user at risk. Training courses that provide users with information on the safe use of medical devices significantly improve patient safety. The traditional instruction concept has limitations in its ability to adequately train employees on the use of medical devices. The digital device instruction project presented in this article aims to address this issue by providing medical device instructions at any time, thus increasing the safety of the operation of medical devices.

Quantitative Electroencephalography Monitoring in Type A Aortic Dissection Surgery: A Clinical Case Review and Prospective Applications.

This review explores advanced methods for assessing perioperative cerebral function in Type A aortic dissection (TAAD) patients, with a focus on quantitative electroencephalography (QEEG). It highlights the critical issue of cerebral malperfusion, which is associated with higher mortality and poor prognosis during the perioperative phase in TAAD patients. The review centers on the utilization of QEEG as a pivotal tool for the extensive monitoring of brain function at various stages: preoperatively, intraoperatively, and postoperatively. It elaborates on the foundational principles of QEEG, including the mathematical and computational analysis of electroencephalographic signals, enriched with intuitive graphical representations of cerebral functional states. QEEG is presented as an innovative approach for the real-time, noninvasive, and reliable assessment of cerebral function. The review details the application of QEEG in monitoring conditions such as preoperative cerebral malperfusion, intraoperative deep hypothermic circulatory arrest, and postoperative recovery of cerebral function in patients undergoing TAAD treatment. Although QEEG is still in an exploratory phase for TAAD patients, it has shown efficacy in other domains, suggesting its potential in multimodal brain function monitoring. However, its broader application requires further research and technological advancements.

Safe and supportive prescribing in transgender and non-binary patients with cancer.

Global prevalence rates for transgender individuals vary with estimates ranging from 0.3% to 1%, translating to a potential global population of 24.3 million to 81 million. It is estimated that one in two people will develop cancer in their lifetime. Gender-affirming hormone therapy (GAHT) is a common medical intervention for transgender and non-binary individuals. GAHT requires careful consideration for concurrent medical care due to potential drug interactions and physiological changes. A multi-disciplinary team with expertise in transgender health, oncology and pharmacy met to develop a document summarizing current knowledge on the topic for practical use. The team included trans and non-binary authors who shaped the document's language and focus. The document gives a status update on the current understanding of GAHT and how this may intersect with the safe prescribing of systemic anti-cancer therapies (SACT). The document underwent multiple review stages including internal review, review by the British Oncology Pharmacy Association (BOPA) EDI Subcommittee and, finally, BOPA Executive Committee review and final approval. Key recommendations of this document include the use of inclusive and effective communication, vigilant monitoring of kidney function and cardiovascular health, and considerations for hormone receptor-positive cancers. The document also recognizes the multidisciplinary nature of transgender healthcare and where this relates to social prescribing.

Characteristics of altered biventricular hemodynamics after arterial switch operation for patients with d-transposition of the great arteries with preserved ejection fraction: a four-dimensional (4D) flow cardiovascular magnetic resonance (CMR) study.

The long-term monitoring of biventricular function is essential to identify potential functional decline in patients following the arterial switch operation (ASO). The underlying pathophysiological mechanisms responsible for altered biventricular hemodynamics in ASO patients are not yet well understood. This study sought to: (I) compare the biventricular kinetic energy (KE) and vorticity of ASO patients and age- and sex-matched controls; (II) investigate the associations of four-dimensional (4D) flow biventricular hemodynamics parameters and neo-aortic root dilation, supravalvular pulmonary stenosis, and pulmonary artery transvalvular pressure difference. A total of 34 patients with dextro-transposition of the great arteries (D-TGA) who underwent ASO, and 17 age- and gender-matched healthy controls were prospectively recruited for this study. All the subjects underwent cine and 4D flow and late gadolinium enhancement scans, and all the patients underwent echocardiography within two weeks of cardiovascular magnetic resonance (CMR) imaging. The following four flow components were analyzed: direct flow, retained inflow, delayed ejection flow, and residual volume. In addition, the following six phasic blood flow KE parameters, normalized to the end-diastolic volume (EDV) and vorticity, were analyzed for both the left ventricle (LV) and right ventricle (RV): peak systolic phase, average systolic phase, peak diastolic phase, average diastolic phase, peak E-wave phase, and peak A-wave phase. The independent sample Student's t-test, Mann-Whitney U-test, univariable and multivariable stepwise regression analyses, intra and inter-observer variability analyses were used to compare patients and controls. In relation to the LV, the D-TGA patients had significantly decreased average vorticity, peak systolic vorticity, systolic vorticity, diastolic vorticity, and peak A-wave vorticity compared to the controls (all P<0.01). In relation to the RV, the pulmonary stenosis group had significantly increased peak E- and A-wave kinetic energy normalized to the end-diastolic volume (KEiEDV), and peak and average vorticity compared to the non-pulmonary stenosis group (all P<0.05). in the multivariable logistic regression model analysis, diastolic KEiEDV, peak E-wave KEiEDV peak A-wave KEiEDV, and average vorticity were associated a with transvalvular pressure difference (β=13.54, P<0.001 for diastolic KEiEDV; β=105.26, P<0.001 for peak E-wave KEiEDV; β=-49.36, P=0.027 for peak A-wave KEiEDV; and β=-56.37, P<0.001 for average vorticity). We found that 4D flow biventricular hemodynamics were more sensitive markers than the ejection fraction in the postoperative D-TGA patients. The RV diastolic KEiEDV parameters and average vorticity were risk factors for pulmonary artery obstruction in the multivariable model.

Bioinspired Artificial Intelligent Nociceptive Alarm System Based on Fibrous Biomemristors.

With the advancement of modern medical and brain-computer interface devices, flexible artificial nociceptors with tactile perception hold significant scientific importance and exhibit great potential in the fields of wearable electronic devices and biomimetic robots. Here, a bioinspired artificial intelligent nociceptive alarm system integrating sensing monitoring and transmission functions is constructed using a silk fibroin (SF) fibrous memristor. This memristor demonstrates high stability, low operating power, and the capability to simulate synaptic plasticity. As a result, an artificial pressure nociceptor based on the SF fibrous memristor can detect both fast and chronic pain and provide a timely alarm in the event of a fall or prolonged immobility of the carrier. Further, an array of artificial pressure nociceptors not only monitors the pressure distribution across various parts of the carrier but also provides direct feedback on the extent of long-term pressure to the carrier. This work holds significant implications for medical support in biological carriers or targeted maintenance of electronic carriers.

Design, Analysis, and Application of a Discrete Error Redefinition Neural Network for Time-Varying Quadratic Programming.

Time-varying quadratic programming (TV-QP) is widely used in artificial intelligence, robotics, and many other fields. To solve this important problem, a novel discrete error redefinition neural network (D-ERNN) is proposed. By redefining the error monitoring function and discretization, the proposed neural network is superior to some traditional neural networks in terms of convergence speed, robustness, and overshoot. Compared with the continuous ERNN, the proposed discrete neural network is more suitable for computer implementation. Unlike continuous neural networks, this article also analyzes and proves how to select the parameters and step size of the proposed neural networks to ensure the reliability of the network. Moreover, how to achieve the discretization of the ERNN is presented and discussed. The convergence of the proposed neural network without disturbance is proven, and bounded time-varying disturbances can be resisted in theory. Furthermore, the comparison results with other related neural networks show that the proposed D-ERNN has a faster convergence speed, better antidisturbance ability, and lower overshoot.

Pulmonary Function in Pediatric Stem Cell Transplantation

BackgroundPediatric hematopoietic stem cell transplantation often results in pulmonary complications, yet limited data exist on pulmonary function in Thailand. This study aims to assess pulmonary function, investigating associated complications and identifying clinical factors linked to pre- and post-transplant pulmonary function defects. MethodsIn this retrospective cohort study, we focused on children aged 6-18 years who underwent hematopoietic stem cell transplantation between 1999 and 2020, ensuring accessible pulmonary function tests results. ResultsAmong 48 patients, abnormal pulmonary function pre- and post-transplant (2-8 years) included a diffusion defect in 16.7% and 18.8%, a restrictive defect in 20.8% and 8.3%, and an obstructive defect in 4.2% and 10.4%, respectively. Pulmonary complications occurred in 16 patients (33.3%), including 15 infections and 1 case of bronchiolitis obliterans. While pre-transplant pulmonary function defects were not significantly associated with specific characteristics, post-transplant pulmonary complications correlated with post-transplant pulmonary function defects (aOR=4.11, 95% CI=1.23-13.64, p=0.02). Among the 6 patients with pre- and post-transplant follow-up, those with pulmonary complications showed a discernible decline in pulmonary function over time, while those without pulmonary complications remained stable or improved. However, the differences between these groups did not reach statistical significance (p=0.13-0.76). ConclusionsPrevalent pulmonary function defects and complications in pediatric hematopoietic stem cell transplantation highlight the importance of close pulmonary function monitoring. Post-transplant pulmonary complications are associated with defects, suggesting a potential trend of a subsequent decline in lung function, warranting further prospective validation.

Therapeutic hypothermia: A descriptive, cohort study conducted over 10 years at a tertiary care public hospital.

Introduction. Therapeutic hypothermia (TH) reduces the risk of death or disability in children with moderate to severe hypoxic ischemic encephalopathy (HIE). Objective. To describe a population of patients with HIE that required TH and their course until discharge. Population and methods. Retrospective, descriptive, cohort study. All patients admitted to TH between 2013 and 2022 were studied. Epidemiological, clinical, monitoring, and treatment data were assessed, together with supplementary tests and condition at discharge. Risk factors were compared between deceased patients and survivors; and, among the latter, those requiring special healthcare needs (SHCN) at discharge. Results. A total of 247 patients were included. Mortality: 11%. Most common sentinel event: prolonged second stage of labor (39%). Treatment initiation: median of 5 hours of life. Seizures: 57%. Intravenous erythropoietin: 66.7%. Abnormal pattern in brain function monitoring: 52%. Normalization of monitoring: median of 24 hours. Pathological magnetic resonance imaging: 42%. Predictor variables of mortality: severe Sarnat and Sarnat staging and pathological ultrasound upon admission. Conclusion. The overall mortality rate was 11%. Referrals increased more markedly since 2018. The time of TH initiation was later than in previous reports. Severe neurological signs as per the Sarnat and Sarnat staging and a pathological baseline cranial ultrasound were independent predictors of mortality at discharge. Patients with SHCN at discharge showed a normalized tracing in the amplitude-integrated electroencephalography performed later. The most common finding in the magnetic resonance imaging was basal ganglia involvement. No statistically significant differences were observed in terms of clinical characteristics or complications among patients who received erythropoietin.

Functional hemodynamic monitoring

Critically ill patients in the intensive care unit require intensified monitoring to control the treatment with volume and/or vasoactive substances. What role does functional hemodynamic monitoring play in controlling treatment and what techniques are used to manage this? Review of the current literature. Precise knowledge of the physiology of the cardiovascular system as well as the pathophysiology of individual clinical pictures and the possibilities of invasive and noninvasive monitoring are the prerequisites for the indications, implementation and interpretation of functional hemodynamic monitoring. An understanding of the heart-lung interaction and the influence of invasive ventilation on the volumetric target parameters, such as stroke volume variation, systolic pressure variation and pulse pressure variation as well as sonography of the inferior vena cava are indispensable prerequisites for the question of volume responsiveness. Other maneuvers, such as the passive leg raising test, can be very helpful when deciding on volume administration in everyday clinical practice. Static parameters such as central venous pressure generally play no role and if any only a subordinate one.

Effects of Ventricular Extrasystoles on Right Ventricle Functions (a Speckle Tracking Study). VES and RV Strain Imaging.

The adverse effects of ventricular extrasystoles (VES) on the heart, such as induced dyssynchrony, irregular heart rate, and atrioventricular dissociation, have been demonstrated. The aim of this study was to investigate the effects of VES on the right ventricle (RV) using strain imaging. Fifty patients with 5000 or more VES detected during 24hr Holterrhythm monitoring between April 2022 and September 2022 in the cardiology outpatient clinic were included in this study.A volunteer control group of 50 individuals matching the patients' age and demographic characteristics was selected. Right heart function parameters were compared echocardiographically between the two groups. In the VES group, both RV free wall strain (22.03±3.67, 29.52±3.01; p&lt;0.001) and RV four-chamber strain (19.37±2.95, 22.34±2.11; p&lt;0.001) were lower compared to the control groupIn the univariate regression analysis for decreased RV four-chamber strain, the presence of VES (p&lt;0.001) was identified as a predictor, whereaas in the multivariate regression analysis, it was not considered to be an independent predictor. When evaluating the characteristics of the VES patients, the number of VES detected during Holter monitoring and delta QRS were observed as negative predictors of RV strain. This study demonstrated the adverse effects of VES on the right ventricle, as it is on the left ventricle.Therefore, regular monitoring of RV function with echocardiography is important in the follow-up of patients with VES.

The Movement: Reproductive Health and Rights in 2024

Women’s sexual and reproductive health (SRH) encompasses several topics, including but not limited to sexual expression, pregnancy, childbirth, contraception, and diseases of the reproductive system. The use of legal authority and power, as well as political influence, have long been factors used to regulate women’s SRH. In the United States (U.S.), examples of state and national legislation have been undertaken to impact SRH and medical treatment and decision-making related to SRH. Several national and international organizations engage in sexual and reproductive health rights (SRHR) activities. The activities of these national and international organizations in SRH often include policy formulation, data collection, monitoring, reporting, and other functions. While definitions of sexual and reproductive health rights vary, there are commonalities and core issues that can be identified. These include issues related to the LGBTQ population, immigration, and reproductive health rights among minoritized groups, which are leading topics wrapped around SRHR and of debate in recent history. This article aims to discuss sexual and reproductive health in promoting population health and societal well-being, recent policy decisions impacting SRH, and the role nurses play in shaping research, practice, and policies. For this paper, sexual and reproductive health rights (SRHR) are defined as an extension of human rights relating to an individual’s autonomy, sexuality, sexual expression, reproduction, and access to information and resources on SRH. SRHR also includes freedom from violence, discrimination, and mistreatment. While a comprehensive review of these areas is beyond this article's scope, historical and recent examples are illustrated.

Association of diaphragmatic dysfunction with duration of mechanical ventilation in patients in the pediatric intensive care unit: a prospective cohort study

BackgroundMechanical ventilation (MV) can cause diaphragmatic injury and ventilator induced diaphragmatic dysfunction (VIDD). Diaphragm ultrasonography (DU) is increasingly used to assess diaphragmatic anatomy, function and pathology of patients receiving MV in the pediatric intensive care unit (PICU). We report the poor contractile ability of diaphragm during ventilation of critically ill patients in our PICU and the association to prolonged length of MV and PICU stay.MethodsPatients who received MV within 24 h of admission to the PICU, expected to undergo continuous MV for more than 48 h and succeeded to extubate were included in the study. DU monitoring was performed daily after the initiation of MV until extubation. Diaphragm thickening fraction (DTF) measured by DU was used as an indicator of diaphragmatic contractile activity. Patients with bilateral DTF = 0% during DU assessment were allocated into the severe VIDD group (n = 26) and the rest were into non-severe VIDD group (n = 29). The association of severe VIDD with individual length of MV, hospitalization and PICU stay were analyzed.ResultsWith daily DU assessment, severe VIDD occurred on 2.9 ± 1.2 days after the initiation of MV, and lasted for 1.9 ± 1.7 days. Values of DTF of all patients recovered to > 10% before extubation. The severe VIDD group had a significantly longer duration (days) of MV [12.0 (8.0-19.3) vs. 5.0 (3.5–7.5), p < 0.001] and PICU stay (days) [30.5 (14.9–44.5) vs. 13.0 (7.0-24.5), p < 0.001]. The occurrence of severe VIDD, first day of severe VIDD and length of severe VIDD were significantly positively associated with the duration of MV and PICU stay. The occurrence of severe VIDD on the second and third days after initiation of MV significantly associated to longer PICU stay (days) [43.0 (9.0–70.0) vs. 13.0 (3.0–40.0), p = 0.009; 36.0 (17.0-208.0) vs. 13.0 (3.0–40.0), p = 0.005, respectively], and the length of MV (days) was significantly longer in those with severe VIDD on the third day after initiation of MV [16.5 (7.0–29.0) vs. 5.0 (2.0–22.0), p = 0.003].ConclusionsDaily monitoring of diaphragmatic function with bedside ultrasonography after initiation of MV is necessary in critically ill patients in PICU and the influences and risk factors of severe VIDD need to be further studied. (355 words)

Research progress on key technologies of flexible wearable electronic devices

Flexible wearable device is an innovative technology product, using soft, lightweight material design, can fit the curve of the human body, providing a comfortable wearing experience. These devices typically integrate a variety of sensors, batteries, and connectivity technologies to enable biometric monitoring, motion tracking, communication, and other intelligent functions. Traditional electronic products tend to give a "stiff" impression that they cannot withstand bending, twisting and stretching. In recent years, under the background of the integration of electronic technology and modern material science technology, the emerging flexible electronic wearable device has become a research hotspot with its more flexible material, more sensitive and accurate signal transmission, and more extensive monitoring range. The development of flexible electronic technology has greatly improved the user's wearing experience and is more suitable for the free movement of the human body. This paper summarizes the basic principle and classification of key technologies of wearable electronic devices, and introduces the research progress and research trend.

A scoping review of remote and unsupervised digital cognitive assessments in preclinical Alzheimer's disease.

Subtle cognitive changes in preclinical Alzheimer's disease (AD) are difficult to detect using traditional pen-and-paper neuropsychological assessments. Remote and unsupervised digital assessments can improve scalability, measurement reliability, and ecological validity, enabling the detection and monitoring of subtle cognitive change. Here, we evaluate such tools deployed in preclinical AD samples, defined as cognitively unimpaired individuals with abnormal levels of amyloid-β (Aβ), or Aβ and tau. In this scoping review, we screened 1,680 unique reports for studies using remote and unsupervised cognitive assessment tools in preclinical AD samples; 23 tools were found. We describe each tool's usability, validity, and reported metrics of reliability. Construct and criterion validity according to associations with established neuropsychological assessments and measures of Aβ and tau are reported. With this review, we aim to present a necessary update to a rapidly evolving field, following a previous review by Öhman and colleagues (2021; Alzheimers Dement. Diagn. Assess. Dis. Monit ) and addressing the open questions of feasibility and reliability of remote testing in the target population. We discuss future directions for using remote and unsupervised digital cognitive assessments in preclinical AD and how such tools may be used for longitudinal monitoring of cognitive function, scalable case finding, and individualized prognostics in both clinical trials and healthcare contexts.

Multifactor evaluation method of smart meter

As an important terminal of smart grid, smart meter has the functions of equipment health monitoring and power metering. However, it is difficult to quantify the impact of factors such as ex-factory parameters, historical failure rates, electromagnetic interference when conducting an operational condition assessment. Therefore, in view of the large number of influencing factors and the difficulty in quantifying the degree of influence, an improved multifactor evaluation model for the operating status of smart meters is constructed. Firstly, a multifactor index system for evaluating the operating state of smart meters is constructed by analyzing the working mechanism and operating characteristics of smart meters. Then, an improved combinatorial weighting method is proposed by combining the subjective weight and the objective weight. The combinatorial weighting method is used to estimate the weight of factors in the health status evaluation of smart meters, and the improved multifactor evaluation method is presented to evaluate the health status of smart meters. Finally, an example is given to verify and analyze the proposed method. Compared with the other three methods, this method can provide effective evaluation results, and help guide targeted maintenance or replacement to improve the efficiency of smart meter detection.

Breast cancer and cardiovascular health.

Modern cancer therapies greatly improve clinical outcomes for both early and advanced breast cancer patients. However, these advances have raised concerns about potential short- and long-term toxicities, including cardiovascular toxicities. Therefore, understanding the common risk factors and underlying pathophysiological mechanisms contributing to cardiovascular toxicity is essential to ensure best breast cancer outcomes. While cardio-oncology has emerged as a sub-speciality to address these challenges, it is essential that all cardiologists recognize and understand the cardiovascular consequences of cancer therapy. This review aims to provide a comprehensive overview of the potential adverse cardiovascular effects associated with modern breast cancer therapies. A preventive, diagnostic, and therapeutic workflow to minimize the impact of cardiovascular toxicity on patient outcomes is presented. Key aspects of this workflow include regular monitoring of cardiovascular function, early detection and management of cancer therapy-related cardiovascular toxicities, and optimization of cardiovascular risk factor control. By highlighting the gaps in knowledge in some areas, this review aims to emphasize the critical role of cardio-oncology research in ensuring the holistic well-being of patients with breast cancer.

A uniformly convergent analysis for multiple scale parabolic singularly perturbed convection-diffusion coupled systems: Optimal accuracy with less computational time

This study addresses time-dependent multiple-scale reaction-convection-diffusion initial boundary value systems characterized by strong coupling in the reaction matrix and weak coupling in the convection terms for a locally optimal accurate solution. The discrete problem, which typically loses its tridiagonal structure, expands its bandwidth to four in such coupled systems, resulting in a substantial computational load. Our objective is to mitigate this computational burden through a splitting approach that transforms the non-tridiagonal matrix into a tridiagonal form while maintaining the consistency, local optimal accuracy in space, and stability of the numerical scheme. We employ equidistributed non-uniform grids, guided by a carefully chosen monitor function, to approximate the continuous space domain. The discretization strategy targets local optimal linear accuracy across space and time on the domain's interior points. In addition, we have also provided the global convergence analysis of the present splitting approach, mathematically. The mathematical evidence is also obtained from the numerical experiments by comparing the splitting approach (either diagonal or triangular forms) of the reaction matrix to its coupled form. The results strongly confirm the effectiveness of this approach in delivering uniform linear accuracy, based on the present problem discretizations while significantly reducing the computational costs.

Insights into renal and urological complications of inflammatory bowel disease.

Inflammatory bowel disease (IBD) is a chronic condition characterized by immune-mediated inflammation in the gastrointestinal tract, which follows a relapsing and remitting course. Apart from affecting the gastrointestinal tract, IBD also has extra-intestinal manifestations (EIMs). While the etiology of extraintestinal manifestation remains unclear, it is theorized to be based on immunological responses influenced by genetic factors. Renal involvement is one of the EIMs observed in ulcerative colitis and Crohn's disease. The renal manifestations in IBD patients encompass a range of conditions including nephrolithiasis, amyloidosis, tubulointerstitial nephritis, glomerulonephritis (GN), obstructive pathologies, and chronic kidney disease (CKD). The incidence of CKD in IBD patients varies from 5%-15%. The decline in renal function can stem from various factors such as direct inflammatory damage to the kidneys leading to glomerular or tubular injury, or from complications like recurrent stones, amyloidosis, or GN. Additionally, nephrotoxic medications used in treating IBD, such as TNF-α inhibitors, calcineurin inhibitors, and aminosalicylates, can exacerbate the decline in renal function. Currently, there is a lack of consensus regarding these patients' screening and renal function monitoring. This review aims to assess the existing literature on the different renal complications among individuals with IBD, shedding light on their pathophysiology and management.

CARDIOMIOPATIA INDUZIDA POR QUIMIOTERAPIA: UMA REVISÃO INTEGRATIVA SOBRE MECANISMOS, DIAGNÓSTICO E TRATAMENTO

Chemotherapy-induced cardiomyopathy is a significant complication associated with the use of chemotherapeutic agents, particularly anthracyclines such as doxorubicin. This condition adversely affects cardiac function and can limit cancer treatment due to the increased risk of cardiac side effects. Studies have shown that doxorubicin and other agents, such as paclitaxel, are effective in cancer treatment but also present a high risk of cardiac toxicity. Mechanisms of cardiotoxicity include oxidative stress, mitochondrial dysfunction, and cellular signaling alterations. Prevention and management of cardiotoxicity have evolved, with the use of cardiac protectors such as dexrazoxane and carvedilol, as well as ACE inhibitors like captopril and enalapril. Clinical guidelines recommend rigorous monitoring of cardiac function using echocardiography and magnetic resonance imaging for early detection of toxicity. This integrative review examines the mechanisms, diagnosis, and treatment options for chemotherapy-induced cardiomyopathy, highlighting the importance of preventive strategies and therapeutic interventions to improve the management of this condition.

Ownership structure, board composition and CEO dominance: what does really matters to corporate deleveraging policies?

Purpose The role played by corporate governance mechanisms on corporate deleveraging policies has not been clarified. Empirical evidence is confined to developed economies, even with conflicting and inconclusive results. This paper aims to examine the role of corporate governance mechanisms, such as ownership structure, board composition and CEO dominance, in explaining corporate deleveraging policies. Design/methodology/approach Using a sample of listed Pakistani firms between 2010 and 2022, this study resorts to binary response models to examine the effects of governance mechanisms on firms’ decision to go debt-free. Findings A greater ownership concentration, institutional ownership and family ownership increase the propensity for zero leverage. Board gender diversity decreases the propensity for deleveraging policies, which seems to indicate that the presence of females reinforces the monitoring function of the board. Finally, lower managerial ownership or CEO dominance decreases the propensity toward zero leverage (interest convergence hypothesis), but higher managerial ownership or CEO dominance increases the propensity toward zero leverage (managerial entrenchment hypothesis). Practical implications Risk-averse managers who prefer to control a firm using little or no debt will find it easier to implement these financing policies in firms with greater ownership concentration and where institutional holders have a substantial stake. For shareholders, this study suggests that investing in firms with females on board reduces the risk of corporate deleveraging policies being adopted for entrenched reasons. Social implications The presence of females on board seems to decrease the propensity of managers to adopt opportunistic actions and may also contribute to enhancing human welfare and society in developing countries. Originality/value To the best of the authors’ knowledge, this is the first study considering the effect of board diversity on zero leverage. Another singularity is that this study exhibits a nonlinear relationship between managerial ownership and corporate deleveraging policy.