Subsequent Shocks Research Articles

Defibrillation success with a second generation intercostal extravascular ICD lead and commercially available left pectoral pulse generator

Abstract Background/Introduction An investigational intercostal extravascular ICD lead has been developed for compatibility with commercially available pulse generators (PGs) that are placed in a left pectoral position in appropriate patients. This is substantially different from currently available extravascular ICD systems that require a custom PG placed in a left lateral position. Purpose The purpose of this analysis was to evaluate sensing and defibrillation of a second-generation intercostal, extravascular defibrillation lead (EV-ICD Lead) when used with currently available ICD PGs in a traditional left pectoral location. Methods Patients (n=20) undergoing an ICD implant or replacement underwent acute VF EV-ICD Lead connected to a left pectoral pulse generator. Induced VF was sensed and shocked using a 10 J safety margin, with subsequent higher-energy shocks delivered if required. Testing was also conducted in the left lateral pocket for a paired analysis with patients serving as their own control. Results Automatic sensing of acute, induced VF episodes from the left pectoral PG was successful in 19 of 20 patients (95%) whose pre-induction R-waves were greater than 1.0 mV and unsuccessful in one subject with a pre-induction R-wave of 0.3 mV. VF was successfully terminated with a 10 J safety margin in 17 of 20 (83%) patients, a 5 J safety margin in 2 of 20 (10%) patients and failed to convert one patient (BMI 32.9) from the pectoral pocket (however, conversion was successful from a lateral pocket with a 10 J shock, which provides a 30 J safety margin. With a left lateral ICD, 100% of patients demonstrated successful VF termination with ≥10 J safety margin. Conclusion(s) Sensing and defibrillation using a left pectoral PG location is feasible with a new intercostal, extravascular defibrillation lead.

What Mistakes Can Be Made When Performing the Electrical Cardioversion Procedure?-Analysis of Emergency Medical Team Performance during the Championships in Emergency Medicine.

Medical personnel carrying out electrical cardioversion (EC) procedures must remember to have the R-wave sync mode switched on, use the correct energy and maintain personal safety. The defibrillators used by medical response teams most often switch out of cardioversion mode once a shock is delivered. Therefore, this mode must be switched on again before subsequent shocks are delivered. The main aim of the study was to assess the ability of emergency medical teams participating in emergency medicine championships to perform EC. The research was a retrospective observational study and was based on an analysis of the evaluation sheets from two tasks simulating the management of a patient with unstable tachycardia conducted during the International Winter Emergency Medicine Championships. Three-person teams consisting of paramedics and representing the Polish emergency services were included in the study. The team representing the championship organiser and the few foreign teams participating in the competition were excluded from the study. The decision to conduct EC was taken by 36 teams (83.72%) in 2015 and 27 teams (87.10%) in 2019. In both editions of the championships, during consecutive shocks, the percentage of actions performed correctly decreased significantly-switching on synchronisation mode in 2015 (94.4%, 83.33%, 72.22%) and in 2019 (100%, 88.89%, 81.48%); correct energies in 2015 (91.67%, 80.56%, 77.78%) and in 2019 (92.59%, 85.19%, 81.48%); shocks in a safe manner in 2015 (94.44%, 94.44%, 91.67%) and in 2019 (100%, 96.30%, 96.30%). Teams participating in the assessed tasks in a significant majority of cases correctly qualified the patient for EC, and correctly carried out the actions required for this procedure. It is of particular note that with every subsequent shock, the percentage of shocks carried out without the sync mode increased significantly.

The Impact of Oil Prices on the GDP of V4 Countries

This study is concerned with forecasts of GDP growth for the Visegrad countries (V4-hereafter) and oil prices simultaneously. The series for GDP and Oil prices are quarterly, covering the period from December 1, 2000, to October 1, 2023. Neural network techniques were performed to generate individual forecasts. The forecasts for oil prices maintain higher accuracy than the GDP ones due to autoregressive lags. In other words, current oil prices absorb significant influence from past prices. The GDP forecasts for the V4 group indicate tremendous shock and moving growth to a lower steady state. The lower growth observed by the end of the period under review can be attributed to two subsequent non-economic shocks: the Russia-Ukraine war and the COVID-19 pandemic. The V4 countries faced difficulties after the outbreak of COVID-19, mainly due to the stringency measures. In addition to accelerating inflation, the war also disrupted energy commodities within supply chains. These and other facts justify the low growth that awaits these countries until 2028. Ultimately, the oil price until 2028 is estimated to oscillate between $60 and $90 per barrel.

Optimizing Energy Delivery in Cardioversion: A Randomized PROTOCOLENERGYTrial of 2 Different Algorithms in Patients With Atrial Fibrillation

BackgroundThe optimal energy protocol for direct current cardioversion of atrial fibrillation remains uncertain. The Rational vs Maximum Fixed Energy (PROTOCOLENERGY) randomized trial compared a stepwise escalating energy algorithm (RaA, 150 J, 360 J, and 360 J) with a maximum fixed energy algorithm (MfA, 3 x 360 J). MethodsIn a 1:1 randomized trial, 300 patients with atrial fibrillation received biphasic discharges via hand-held paddles in the anterolateral position. Primary endpoints were sinus rhythm at 1 minute and neurologic complications at 2 hours; secondary endpoints included sinus rhythm at 2 hours, skin changes and chest discomfort at 24 hours. ResultsSinus rhythm at 1 minute was achieved in 92.7% of RaA and 94.0% of MfA patients (P = 0.643) and maintained at 2 hours in 91.3% of both groups. There were no neurologic complications. The protocols differed significantly after the first shock (72.7% in RaA vs 83.3% in MfA; P = 0.026) but equalized after subsequent maximum energy shocks. Fewer RaA patients experienced skin redness compared with MfA patients (19.3% vs 36.0%, P = 0.001), which was attributed to the lower initial 150-J shock and total energy delivered (r = 0.243, P < 0.0001). Chest discomfort at 24 hours was not different between groups (P = 0.378). In multivariate analysis, lower body mass index (P < 0.001, cutoff 29 to 34 kg/m2) was associated with cardioversion success after the initial 150-J shock. ConclusionsBoth protocols showed similar high cumulative efficacy, but RaA with the initial 150-J shock proved to be beneficial in patients with body mass index less than 29 to 34 kg/m2 because of fewer skin complications. Clinical Trial Registration NoNCT05148923

The impact of alternate defibrillation strategies on shock-refractory and recurrent ventricular fibrillation: A secondary analysis of the DOSE VF cluster randomized controlled trial

BackgroundThe DOSE VF randomized controlled trial (RCT) employed a pragmatic definition of refractory ventricular fibrillation (VF after three successive shocks). However, it remains unclear whether the underlying rhythm during the first three shocks was shock-refractory or recurrent VF. ObjectiveTo explore the relationship between alternate defibrillation strategies employed during the DOSE VF RCT and the type of VF, either shock-refractory VF or recurrent VF, on patient outcomes. MethodsWe performed a secondary analysis of the DOSE VF RCT. We categorized cases as shock-refractory or recurrent VF based on pre-randomization shocks (shocks 1–3). We then analyzed all subsequent (post-randomization) shocks to assess the impact of standard, vector change (VC) or double sequential external defibrillation (DSED) shocks on clinical outcomes employing logistic regression adjusted for Utstein variables, antiarrhythmics, and epinephrine. ResultsWe included 345 patients; 60 (17%) shock-refractory VF, and 285 (83%) recurrent VF. Patients in recurrent VF had greater survival than shock-refractory VF (OR: 2.76 95% CI [1.04, 7.27]). DSED was superior to standard defibrillation for survival overall, and for patients with shock-refractory VF (28.6% vs 0%, p = 0.041) but not for those in recurrent VF. DSED was superior to standard defibrillation for return of spontaneous circulation (ROSC) and neurologic survival for shock-refractory and recurrent VF. VC defibrillation was not superior for survival or ROSC overall, for shock-refractory, or recurrent VF groups, but was superior for VF termination across all groups. ConclusionDSED appears to be the superior defibrillation strategy in the DOSE VF trial, irrespective of whether the preceding VF is shock-refractory or recurrent.

Capecitabine-induced-coronary-vasospasm leading to polymorphic ventricular tachycardia and cardiac arrest

Capecitabine, a pro-drug of 5-fluorouracil, is commonly used in the treatment of breast and colorectal cancer. Its side effects, including nausea, vomiting, diarrhea, fatigue, loss of appetite, and bone marrow suppression, are well recognized. However, coronary vasospasm represents a less commonly recognized but significant complication of fluoropyrimidine-based therapies such as capecitabine. Proposed mechanisms for this adverse effect complication include direct endothelium-independent vasoconstriction, activation of protein kinase C, and activation of the cyclooxygenase pathway. In this report, we present a case of capecitabine-induced coronary vasospasm leading to progressive, focal ST-elevations, myocardial ischemia, and subsequently polymorphic ventricular tachycardia. These events were captured on telemetry, in a male in his early 40s, diagnosed with stage IIIB sigmoid colon cancer. Notably, the patient had no pre-existing coronary artery disease or other cardiovascular risk factors. Upon diagnosis, the patient was initiated on a calcium channel blocker, verapamil, to mitigate further coronary vasospasm events. After thorough discussions that prioritized the patient’s input and values, an implantable cardioverter-defibrillator was placed subcutaneously. Following discharge, the patient restarted capecitabine therapy along with verapamil prophylaxis and did not experience any subsequent shocks from his ICD as assessed during his outpatient follow-up visits. This case emphasizes the need to involve patients in decision-making processes, especially when managing unexpected and serious complications, to ensure treatments align with their quality of life and personal preferences.

Health financing policies during the COVID-19 pandemic and implications for universal health care: a case study of 15 countries

The COVID-19 pandemic was a health emergency requiring rapid fiscal resource mobilisation to support national responses. The use of effective health financing mechanisms and policies, or lack thereof, affected the impact of the pandemic on the population, particularly vulnerable groups and individuals. We provide an overview and illustrative examples of health financing policies adopted in 15 countries during the pandemic, develop a framework for resilient health financing, and use this pandemic to argue a case to move towards universal health coverage (UHC). In this case study, we examined the national health financing policy responses of 15 countries, which were purposefully selected countries to represent all WHO regions and have a range of income levels, UHC index scores, and health system typologies. We did a systematic literature review of peer-reviewed articles, policy documents, technical reports, and publicly available data on policy measures undertaken in response to the pandemic and complemented the data obtained with 61 in-depth interviews with health systems and health financing experts. We did a thematic analysis of our data and organised key themes into a conceptual framework for resilient health financing. Resilient health financing for health emergencies is characterised by two main phases: (1) absorb and recover, where health systems are required to absorb the initial and subsequent shocks brought about by the pandemic and restabilise from them; and (2) sustain, where health systems need to expand and maintain fiscal space for health to move towards UHC while building on resilient health financing structures that can better prepare health systems for future health emergencies. We observed that five key financing policies were implemented across the countries-namely, use of extra-budgetary funds for a swift initial response, repurposing of existing funds, efficient fund disbursement mechanisms to ensure rapid channelisation to the intended personnel and general population, mobilisation of the private sector to mitigate the gaps in public settings, and expansion of service coverage to enhance the protection of vulnerable groups. Accountability and monitoring are needed at every stage to ensure efficient and accountable movement and use of funds, which can be achieved through strong governance and coordination, information technology, and community engagement. Our findings suggest that health systems need to leverage the COVID-19 pandemic as a window of opportunity to make health financing policies robust and need to politically commit to public financing mechanisms that work to prepare for future emergencies and as a lever for UHC. Bill & Melinda Gates Foundation.

Failure to defibrillate or cardiovert due to premature truncation of biphasic shocks from implantable defibrillators

BackgroundIn 2022 and 2023, Medtronic recalled implantable defibrillators because they may deliver less than full-energy shocks. The 2022 problem truncates the second phase of the waveform (SCP-T2), resulting in ∼32-J shocks, and is mitigated by downloadable software. The 2023 malfunction truncates the first phase of the waveform, resulting in 0- to 12-J shocks due to a glassed feedthrough problem (GFT-T1) that might be avoided by programming B>AX shock polarity. ObjectiveThe purpose of this study was to assess the consequences of GFT-T1 and SCP-T2 shocks in the Food and Drug Administration’s Manufacturers and User Facility Device Experience (MAUDE) database and to estimate the incidences of GFT-T1 and SCP-T2. MethodsWe analyzed MAUDE reports supplemented by Medtronic data; lead failures were excluded. The incidences of SCP-T2 and GFT-T1 were estimated using USA volumes for devices with glassed feedthroughs. ResultsOne hundred thirty-two devices delivered truncated shocks: 27 (20.5%) were GFT-T1; 103 (78.0%) were SCP-T2; and 2 (1.5%) truncated both phases (BOTH-T1&2). Of 54 ventricular fibrillation (VF) patients, 21 (38.9%) were not defibrillated by truncated shocks: 8 (38.1%) received GFT-T1 shocks, 12 (57.1%) received SCP-T2 shocks, and 1 received a BOTH-T1&2 shock; 2 patients suffered unrelated deaths; 1 was externally rescued; 1 outcome was unknown; the others were defibrillated by subsequent shocks or terminated spontaneously. The majority of patients (79.1%) shocked for ventricular tachycardia (VT) were converted, primarily (94.1%) by SCP-T2 shocks. Estimated incidences of GFT-T1 and SCP-T2 were 0.0078%–0.0088% and 0.1062%–0.1110%. ConclusionGFT-T1 and SCP-T2 shocks can result in failure to terminate VF/VT, but they may be preventable. Although the incidences of these truncated shocks are very low, heightened surveillance is warranted.

Abstract 14731: T-wave Oversensing Secondary to an Inappropriate ICD Shock Resulting in Subsequent Unnecessary Shocks

Introduction: Inappropriate ICD shocks commonly result from persistent atrial arrhythmias or oversensing. We report a scenario where an ICD shock for a rapid, sustained atrial tachycardia (AT) resulted in T-wave oversensing (TWO), triggering further inappropriate shocks. Presentation: A 69-year-old woman with secondary prevention dual chamber ICD underwent pulmonary vein isolation for symptomatic paroxysmal atrial fibrillation (AF). The patient remained free of AT/AF off antiarrhythmics for 3 months after the procedure when she was admitted with four consecutive ICD shocks. Electrolytes were within normal limits. Device interrogation showed that the first shock was triggered by a rapid, sustained AT (cycle length: 270 msec) detected in the VF zone (single zone device; 280 msec cut-off) and failed ATP. Following the first shock, an irregular AT ensued, with cycle length ranging from 280-370 msec, but now with high amplitude T-waves in the RV channel, resulting in TWO and three subsequent inappropriate shocks (Figure). She received IV metoprolol and digoxin with subsequent resolution of AT and TWO. Beta-blocker dosing was increased and she has remained free of AT/AF at 6 month follow-up. Conclusions: ICD shocks can trigger marked repolarization changes in near-field intracardiac RV electrograms resulting in TWO and subsequent appropriate shocks. Further studies are warranted to understand the mechanism underlying this phenomenon and potential risk for these events.

How 2008 financial crisis legacies impacted future health workforce resilience – a realist review

Abstract The 2008 financial crisis and subsequent recession led many Governments to adopt programmes of austerity. This had a lasting impact on health system functionality, resources, staff (numbers, motivation and morale) and patient outcomes. This study aimed to understand how health system resilience was impacted and how this affects readiness for subsequent shocks. A realist review identified legacies associated with austerity, with a particular focus on workforce resilience. EMBASE, CINAHL, MEDLINE, EconLit and Web of Science were searched (2007- May’21), followed by additional theory-driven searches. Descriptive, inductive, deductive and retroductive realist analysis (utilising excel and Nvivo) aided the development of Context, Mechanism, Outcomes Configurations (CMOCs), alongside stakeholder engagement to confirm, refine or refute emerging results. CMOCs revealed how: 1) priorities influenced by outside agents (e.g. Troika, governmental departments) led to a focus on external transparency and distrust in policy agenda, compounded by poor communication; 2) efficiency driven culture and performance monitoring meant professionals could not recognise their interests and values leading to sense of powerlessness, detachment and professional dissonance; 3) sustained restrictive economic policies that impacted patient care, eroded values, leading to a diminished view of profession; 4) health professionals maintained control by circumventing policy to deliver care - further isolating decision makers; and 5) street-level bureaucracy eventually leads to moral distress resulting in apathy and burn-out. Austerity challenged health system resilience but lessons can be leveraged by policy-makers and management to develop resilient strategies that protect and promote sustainable outcomes for the health workforce. This review reveals the importance of transparent, open communication, in addition to co-produced and value-driven policies.

Iran’s Demographic Transition and Its Potential for Development

: Over the past half-century, Iran has experienced unprecedented demographic transition. With a population over 85 million, Iran’s population growth recently has declined below one per cent per year, compared with nearly four per cent in the 1980s. This phenomenal decline is the result of social developments along with the re-introduction of a family planning program, which progressively brought the total fertility rate (TFR) down to below-replacement level since 2000. That is, from around seven children per woman in the mid-1980s–and despite the reversal of population policies toward pronatalist since 2010–the total fertility rate had decreased to 1.7 children per woman in 2021, partly due to the COVID-19 pandemic and subsequent economic shocks. Life expectancy at birth has tripled in the last century (1920-2020) from 25 to 75 years. There have been important changes in the age structure of Iran’s population, with the under-15 population decreasing from 40 per cent in 1996 to 20 per cent in 2021. In contrast, the working-age population (ages 15 to 64) has increased substantially to over 70%, indicating that Iran has entered a ‘demographic window of opportunity’. Accompanied by rising levels of educational attainment among both men and women, this demographic window has the potential to create socio-economic opportunities for Iran over the next three decades, provided that adequate economic conditions, public policies and youth employment are prepared.

Exploring the impact of COVID-19 on frontline health workers through a photovoice study in Kaduna, Kwara and Ogun States, Nigeria.

Described as the 'backbone of health systems', particularly in low- and middle-income countries, community health workers (CHWs) are a critical cadre on the frontline of any outbreak response. However, it is widely recognised that CHWs are frequently lacking in appropriate support from the health system due to inadequate physical, social and financial resources. Furthermore, despite their critical role in service delivery, the health and well-being of CHWs is seldom considered and the additional emotional and physical burdens that health systems shocks can present are frequently ignored. Thus a critical step in strengthening health systems to manage disease outbreaks or other system shocks is to ensure that CHWs are adequately supported. Within this study we document the experiences of CHWs within Nigeria during the coronavirus disease 2019 (COVID-19) outbreak to understand the impact of the pandemic on CHW well-being with a view to identifying strategies that could support CHWs during COVID-19 and subsequent health system shocks. This study was based in Ogun, Kaduna and Kwara States, Nigeria. We used the creative participatory methodology of photovoice with 30 CHWs (10 in each state). Participants were asked to take photos documenting their experiences of working and living through the pandemic. Participants sent photos with captions to the research team via WhatsApp following one-on-one discussions. Photos were co-analysed among participants in focus group discussions using thematic analysis. Our findings reveal similar experiences of CHWs across Ogun, Kwara and Kaduna States in Nigeria, providing a unique insight into how the Nigerian health system was impacted and how this closely aligns to the performance and well-being of CHWs. CHW experiences related to three overarching themes: major stressors and challenges experienced due to COVID-19 (fear of contracting COVID-19, food insecurity, personal and gendered impacts), the impact of COVID-19 on providing routine care (stigma from community members, heavy workloads and inadequate equipment provision) and motivation and support from the community (pride in their roles and valued support from community leaders). The challenges highlighted through photovoice led to developing recommendations to address some of the challenges. This included training, adequate resource provision, routine supervision and peer support. COVID-19 highlighted the burden health workers often face. Photovoice allowed a space for frontline health workers to come together to share common experiences, particularly the psychosocial impact of working during health system shocks and its impact on performance. This underlines the need to acknowledge mental health and prioritise the well-being of healthcare staff. Sharing stories from the perspectives of health workers provides a platform to share learning and strategies on how to best support health workers holistically, particularly during health system shocks.

Long-term effects of sectarian politics: evidence from Lebanon

Abstract We examine the effect of sectarian politics in the presence of weak state capacity on long-term economic growth. To this end, we exploit the 1956 civil uprising between Maronite Christian and Sunni Muslim factions in Lebanon to estimate the impact of sectarian political tensions on long-term growth. To isolate the impact of the uprising, we use synthetic control estimator and match Lebanon’s pre-1956 growth and development trajectory with the rest of the world where such uprising did not occur, and estimate the counterfactual growth trajectory in the hypothetical absence of the sectarian conflict. Our evidence indicates large and pervasive negative growth effects of factionalism. Our estimates imply that Lebanon’s per capita income down to the present day is on average 57% lower than that of its pre-1956 synthetic control group without sectarian clashes, and does not seem to be driven by preexisting or subsequent trends and shocks. The negative long-term growth effect of sectarian conflict is robust to a battery of spatial and temporal placebo checks, choice of samples and is not sensitive to the composition of control groups.

Separating the memory of reionisation from cosmology in the Lyα forest power spectrum at the post-reionisation era

ABSTRACTIt has been recently shown that the astrophysics of reionisation can be extracted from the Lyα forest power spectrum by marginalizing the memory of reionisation over cosmological information. This impact of cosmic reionisation on the Lyα forest power spectrum can survive cosmological time-scales because cosmic reionisation, which is inhomogeneous, and subsequent shocks from denser regions can heat the gas in low-density regions to ∼3 × 104 K and compress it to mean-density. Current approach of marginalization over the memory of reionisation, however, is not only model-dependent, based on the assumption of a specific reionisation model, but also computationally expensive. Here, we propose a simple analytical template for the impact of cosmic reionisation, thereby treating it as a broad-band systematic to be marginalized over for Bayesian inference of cosmological information from the Lyα forest in a model-independent manner. This template performs remarkably well with an error of $\le 6~{{\ \rm per\ cent}}$ at large scales k ≈ 0.19 Mpc−1, where the effect of the memory of reionisation is important, and reproduces the broad-band effect of the memory of reionisation in the Lyα forest correlation function, as well as the expected bias of cosmological parameters due to this systematic. The template can successfully recover the morphology of forecast errors in cosmological parameter space as expected when assuming a specific reionisation model for marginalization purposes, with a slight overestimation of tens of per cent for the forecast errors on the cosmological parameters. We further propose a similar template for this systematic on the Lyα forest 1D power spectrum.

Guinea

Following a coup d’état in September 2021 and a year of socio-political tension, the situation has stabilized after the authorities agreed with ECOWAS on a revised, shorter (24-month) transition calendar. While the non-mining sector remains weakened by the subsequent shocks—the pandemic, political uncertainty, the global food and fuel price shock and ensuing food insecurity—overall growth remains buoyant, driven by strong mining production. Inflation hovered around 12 percent for most of 2021 and 2022, despite significant international prices pressures. Food insecurity became increasingly acute during 2022 stemming from the price shock and could be exacerbated next year.

Financial development and development of renewable energy technologies: A comparison of developing and developed countries

Greenhouse gas emissions are a global concern, and many countries around the world are looking for alternative traditional sources of hydrocarbon energy with economic and environ- mental benefits, including considering the effects of rising oil prices and their subsequent shocks, increasing energy security, and reducing consumption of fossil fuels. The effective role of renewable energy in sustainable development, reducing greenhouse gases and increasing energy security on the one hand, and the necessity of assigning major financial resources to renewable energy projects on the other hand, double the importance of financial improve- ment in the development of renewable energy sources. Due to the importance of this issue, using a panel data model, the present study examines the impact of financial development in the stock market, credit market and total financial markets on the development of renewable energy technology in two groups of selected developed and developing countries during the years 2000-2018. According to the results, financial development has a significant positive impact on the development of renewable energy technology. Due to the nature of this type of energy, it can have multiple environmental benefits as well. Furthermore, in this regard, in the selected developed countries, the improved financial market (credit and stock markets) has a positive effect on the development of the annual installed capacity of renewable energy. How- ever, in the selected developing countries, development in financial market has a positive effect on the deployment of renewable energy as well. Based on the coefficients in two re- gression models, credit market improvement has a greater effect on the development of the installed capacity of renewable energy technologies in developing countries rather than in developed countries. Also, the overall financial index indicates that financial development has a greater effect on deployment of renewable energies in developed countries rather than in developing countries. JEL classification: G2, Q43, C23

Predefibrillation end-tidal CO2 and defibrillation success in out-of-hospital cardiac arrest: an observational cohort study

BackgroundPredefibrillation end-tidal CO2 (ETCO2) may predict defibrillation success and could guide defibrillation timing in ventricular fibrillation (VF) cardiac arrest. This relationship has only been studied using advanced airways. Our aim...

Manufacturing employment and women’s agency: Evidence from Lesotho 2004–2014

This paper examines the impact of manufacturing employment on women’s health and decision-making power within households in Lesotho. Under the US African Growth and Opportunity Act of 2000, the employment of women in ready-made garment (RMG) factories in new industrial zones greatly increased. Subsequent shocks to international demand for textile products created by the phase-out of the Multi-Fibre Agreement and the 2008 Financial Crisis temporarily reduced well-paid RMG work opportunities. Women residing closer to the industrial zones were particularly affected. These changes are exploited for identification of causal impacts. Employment in the RMG sector is found to substantially increase women’s say in decisions about the allocation of household resources and own health.

How does the COVID-19 outbreak affect the causality between gold and the stock market? New evidence from the extreme Granger causality test

The causal relationship between gold and stocks has been widely studied, while their causality and the long- and short-run characteristic of this relationship have not been examined under different shocks. The purpose of this paper is to fill this gap. Meanwhile, considering the impact of the COVID-19 outbreak on gold and stock markets, we also aim to investigate whether the relationship changes after this epidemic. With invoking the time- and frequency-domain extreme Granger causality tests, we find that a significant causality between gold and stock usually comes from extreme shocks, displaying as the long-term causality running from gold shocks to stock shocks while the fickle impact of stock shocks on gold shocks. Besides, empirical results suggest that the causality between gold and stock shocks is greatly promoted after this epidemic. The present study is useful for investors and policymakers, as it has reference significance when dealing with subsequent extreme shocks or events.

Inappropriate shock delivery as a result of electromagnetic interference originating from the faulty electrical installation

We present a case report of a 74‐year‐old male patient with an implantable cardioverter defibrillator who suffered an inappropriate defibrillation shock while bathing in the tub. Insight in the ICD stored electrogram episodes revealed electromagnetic interferences, with a typical 50 Hz electrical artifact mimicking fast ventricular tachycardia as a device misinterpreted. After this event, the maintenance workers investigated the electrical installation in the bathroom and revealed that there was voltage leaking between electrical installation and metal pipes. After the repair was completed without any additional programming, the patient has had no subsequent shocks.