Search Results (539)

Objective: To investigate the impact of asymptomatic high-risk status for ischemic stroke on patients with abdominal aortic aneurysm undergoing endovascular aortic repair (EVAR). Methods: Eligible patients with abdominal aortic aneurysm who underwent EVAR between January 2011 and December 2021 were enrolled in this retrospective cohort study. Propensity score matching (PSM) was used to balance baseline characteristics between the cerebrovascular high-risk group and the standard control group. The impact of cerebrovascular high-risk status on short- and long-term outcomes was assessed using Cox proportional hazards regression and generalized linear models, with results presented as hazard ratios (HRs), odds ratios (ORs), and corresponding 95% confidence intervals (CIs). Results: A total of 1080 patients were included (299 high-risk, 781 standard). During the 13-year follow-up period, ischemic stroke occurred in 45 patients (15.1%) in the high-risk group (HR, 7.01; 95% CI, 4.11–11.94; p < 0.001). The high-risk group also had a higher incidence of major adverse cardiovascular and cerebrovascular events (MACCEs), which occurred in 129 patients (43.1%) (HR, 1.78; 95% CI, 1.43–2.24; p < 0.001). These findings remained consistent across inverse probability of treatment weighting (IPTW) and propensity score matching combined with multivariable generalized linear model (PSM+MVA-GLM) analyses. Conclusions: Although no significant increase in perioperative cerebrovascular adverse events was observed in asymptomatic patients with a preoperative cerebrovascular high-risk status, their worse long-term prognosis appears to be associated with this risk status. This association highlights the need for rigorous cardiovascular and cerebrovascular risk management in this vulnerable population after surgery. Full article

This study evaluates a disturbance-informed, planning-level workflow for assessing steady-state feeder performance and post-disturbance frequency security in renewable-rich distribution networks. The workflow links feeder operation in DIgSILENT PowerFactory to reduced-order frequency-security screening in OpenModelica and PSAT, with Pandapower used as an independent steady-state cross-check. The IEEE 33-bus feeder includes distributed photovoltaic units, DFIG-based wind generation, and a grid-forming battery energy storage system (BESS). Hourly feeder time-series results are used to identify renewable-output deficits, and each deficit is converted from MW to the common 10 MVA dynamic-system base before being applied as a conservative step disturbance. The steady-state validation gives a maximum voltage mismatch of 0.0155 pu, within the adopted 2% screening limit. The cross-tool frequency benchmark shows close agreement for nadir and settling time, while RoCoF is interpreted conservatively because of its sensitivity to numerical differentiation and event implementation. As renewable penetration increases from 0% to 100%, the minimum bus voltage remains close to 1.0 pu (0.9999–0.9991 pu), the maximum bus voltage rises from 1.0295 pu to 1.0826 pu, and feeder losses increase from 0.0246 MW to 0.1531 MW. The 24 h assessment gives a maximum daily voltage of 1.0755 pu at 100% penetration, while loading remains below thermal limits. For the corrected 75% severe event (0.3048 MW; −0.0305 pu on the 10 MVA base), the 2 MW droop-plus-FFR case improves the nadir from 49.9695 Hz without support to 49.9924 Hz. Voltage therefore becomes the earliest binding screening constraint from 50% penetration onward, whereas thermal loading and supported frequency nadir remain non-binding under the studied conditions. Full article

The doubly fed induction generator (DFIG) dominates the wind energy market, yet its direct stator-to-grid connection makes it vulnerable to grid faults, creating a tension between hardware self-protection and grid-code fault ride-through (FRT) compliance. This paper presents the modelling and FRT analysis of a 9 MW DFIG wind farm combining a 20 MVA Static Synchronous Compensator (STATCOM) with a ten-tier algorithmic protection scheme. A detailed phasor-domain MATLAB/Simulink R2024b model is complemented by physics-based reduced-order models integrated in Python, separating calibration targets, calibration-dependent derived quantities and quantities independent of the DC-link calibration. The aerodynamic model reproduces the power coefficient maximum of 0.48 at a tip–speed ratio of 8.1. The energy-balance model uses two parameters identified per scenario from the detailed DC-link trajectory; its peak-voltage agreement within 0.4% is therefore a calibrated consistency check, while the derived arming times, slopes, chopper sizing and latency budget remain conditional on that calibration. A first-order Thevenin analysis shows that the STATCOM supports a weak 25 kV point of common coupling of order 53 MVA short-circuit level, not the 2500 MVA source. The approximate 0.50-to-0.78 p.u. recovery requires about 29.7 M_var and 1.90 p.u. of STATCOM rated current for 150 ms, conditional on an assumed short-time envelope and adequate converter-voltage headroom; it is not attributable to continuous rated operation. FRT support for the selected recoverable dip is separated from converter survival during a zero-impedance fault, for which a 1700 V chopper pickup with a 1 ms gate delay, not the 10 ms isolation command, is the clamping mechanism. The assessment is explicitly conditional and requires electromagnetic-transient and hardware-in-the-loop confirmation. Full article

With the increasing integration of large-scale renewable energy sources (RESs), modern power grids are evolving into low-inertia and weak-damping networks, creating challenges for transient power-angle stability. Conventional grid-following (GFL) control strategies present a lagging synchronization response under weak grid conditions due to their reliance on phase-locked loops (PLLs). Although grid-forming (GFM) control via virtual synchronous generators (VSGs) provides standalone voltage source properties, conventional fixed-parameter VSGs exhibit an inherent design trade-off between first-swing angular suppression and post-fault oscillation damping during severe short-circuit disturbances. To resolve these vulnerabilities, this paper proposes an adaptive VSG control strategy designed to improve the transient power-angle response of the investigated system. By establishing a parametric judgment framework based on real-time frequency deviations and acceleration rates, the virtual inertia $J\left(t\right)$ and damping coefficient $D\left(t\right)$ are adaptively adjusted within predefined limits. Furthermore, a current-limiting mechanism is incorporated into the parameter adaptation loops to prevent converter overcurrent tripping. To evaluate the proposed method, an aggregated grid-connected benchmark system comprising a 5 MVA PMSG-based wind farm, a conventional synchronous generator, and an external grid is implemented in MATLAB/Simulink. The simulation results under continuous ambient operational fluctuations and severe three-phase short-circuit faults demonstrate that the proposed strategy reduces the first-swing power-angle peak by approximately 31% compared with the conventional fixed-parameter VSG, and the response settles within approximately 0.4 s in the investigated fault case. These results indicate the simulation-based feasibility of the proposed bounded adaptive strategy. Further real-time, hardware-in-the-loop, and experimental validation is required before practical implementation. Full article

In this paper, the nonlinear vibration (NV) response of carbon nanotube-reinforced composite (CNTRC) marine panels (MPs) fitted with symmetric multi-vibration absorbers (MVAs) subjected to steady, velocity-dependent hydrodynamic loads is investigated. To model actual marine conditions more realistically, the lift and drag forces varying with flow velocity were taken into account using experimentally supported Matveev-based formulations for a specific ship. Within the shell, three carbon nanotube (CNT) distribution schemes are considered: one uniformly distributed (UD) CNT configuration and two functionally graded (FG) CNT patterns, namely FG-V and FG-X. The analytical framework is further constructed using classical shell theory (CST) by incorporating geometric nonlinear terms, and the Galerkin technique is employed to obtain a reduced-order model. Thereafter, the NV response of the CNTRC-MPs is predicted through the P-T method, which relies on the joint application of the piecewise constant argument and Taylor series expansion. The results indicate that symmetric MVAs can effectively suppress NV behavior and significantly decrease the maximum NV amplitude of the panel. Moreover, the effectiveness of the proposed configuration is shown to depend on both the absorber characteristics and the reinforcement pattern of CNTs. The study demonstrates that the use of symmetric absorber systems offers a practical and efficient passive vibration-control solution for advanced marine composite panels. Full article

Sapindus mukorossi, known as soapberry, is a multipurpose woody species with oil-rich kernels and saponin-rich pulp, and its kernel oil and pulp saponins have important applications in oleochemicals, detergents, cosmetics, pharmaceuticals, and bioenergy. However, the mechanism by which carbohydrate-derived carbon is differentially allocated to kernel oil biosynthesis and pulp saponin biosynthesis within the same fruit remains unclear. In this study, we integrated morphological, physiological, metabolomic, and transcriptomic analyses to investigate the developmental accumulation patterns of oil and saponins and their relationship with carbohydrate metabolism in S. mukorossi fruit. The fruit reached maturity at approximately 130 days after flowering and was divided into four developmental stages: slow growth, rapid expansion, color transition, and maturation. Kernel oil accumulated in a typical S-shaped pattern and increased rapidly during the middle-to-late developmental stages, whereas pulp saponins increased continuously before maturity and remained stable. At maturity, soluble sugars mainly accumulated in the pulp, while starch was relatively enriched in the kernels, indicating different carbohydrate storage and utilization patterns between the two tissues. Integrated transcriptomic and metabolomic analyses revealed tissue-specific metabolic regulation: lipid metabolism was preferentially enriched in kernels, whereas terpenoid and secondary metabolic pathways were more active in pulp. Several genes related to fatty acid assembly and oil accumulation, including SmACC, SmLACS, SmGPAT, and SmLPAT, showed kernel-biased expression, while genes involved in the mevalonate (MVA)-dependent triterpenoid saponin pathway, including SmACCT, SmMVK, SmIDI, SmSQE, and SmLUP2, were closely associated with pulp saponin accumulation. Hormone-related transcription factors, such as GRAS and BES1 in kernels and MYC2 in pulp, may contribute to the coordination between carbohydrate metabolism and oil or saponin biosynthesis. Overall, these findings suggest that oil and saponin accumulation in S. mukorossi fruit are regulated by distinct tissue-specific metabolic programs closely linked to carbohydrate metabolism. This study provides new insights into carbon allocation between kernel oil and pulp saponin biosynthesis and identifies candidate pathways and genes for the genetic improvement and resource utilization of S. mukorossi. Full article

Background: High-risk (HR) prostate cancer has a propensity for local and distant progression with ultimate death, mandating aggressive locoregional and systemic treatment approaches to maximize oncologic outcomes. Although brachytherapy (BT) with supplemental therapies has demonstrated favorable biochemical and quality of life outcomes, improvements in overall survival have been hampered by an excessive incidence of non- prostate cancer deaths. In this HR study, we report on biochemical failure (BF), prostate cancer-specific mortality (PCSM), overall mortality (OM) and patterns of death with recommendations for the mitigation of non-prostate cancer deaths. Materials and Methods: From April 1995 to November 2018, 577 consecutive HR patients were treated with LDR BT (97.9% Pd-103). Patients were stratified into three age cohorts: ≤ 59, 60–69 and ≥70 years. The BT prescription dose was prescribed to the prostate gland with generous peri-prostatic margins and the proximal 10mm of the seminal vesicles. 94.6% received supplemental EBRT (45–50.4 Gy) and 63.3% received androgen deprivation therapy (ADT) (median duration 12 months). Post-implant CT-based dosimetry was performed on day 0. BF was defined as a PSA > 0.40 ng/mL after nadir. The cause of death was determined for each patient. Patients with metastatic prostate cancer or non-metastatic castrate resistant prostate cancer who died of any cause were classified as dead of prostate cancer. All other deaths were attributed to the immediate cause. Multiple clinical, pathologic and treatment were evaluated for impact on patient outcomes. Results: Of the patients, 87.5% (median follow-up 8.9 years) presented with a single HR factor. The day 0 D90 was 122.5%. Overall, the 15-year BF, PCSM and OM were 12.4%, 5.6% and 51.7%. When stratified by age, there was no significant difference in BF or PCSM. The median post- treatment PSA in biochemically controlled patients was <0.01 ng/mL. In all three cohorts, OM increased linearly for the first 10 years and then approximately doubled from years 10 to 15. Moreover, 239 patients died: 10.9% due to prostate cancer, 38.1% from cardiovascular (CV) disease and 28.4% from other malignancies (to include one rectal and three bladder cancers). In MVA, BF was most closely related to percent positive biopsies (p < 0.001, SHR 1.018), PCSM to Gleason score (p = 0.004, SHR 2.884) and percent positive biopsies (p = 0.005, SHR 1.021) and OM to age (p < 0.001, HR 1.075) and tobacco (p < 0.001, HR 2.374). Conclusions: Despite high cancer control rates, overall survival was limited by a preponderance of CV and non-prostate cancer deaths, which were 6 times more likely than prostate cancer deaths. The implementation of a comprehensive multidisciplinary survivorship program will be essential to impact longevity in this patient population. Full article

Background/Objectives: Reliable biomarkers for longitudinal surveillance of neuroendocrine tumors (NETs) remain an unmet clinical need. Chromogranin A (CgA), the most widely used circulating biomarker, is limited by low sensitivity, substantial biologic variability, and poor concordance with radiologic progression. NETest2.0^® is a blood-based multigene transcriptomic liquid biopsy designed to dynamically assess NET biologic activity. This study compared serial NETest2.0^® measurements with CgA for monitoring disease progression in a real-world registry cohort. Methods: Patients with histologically confirmed NETs enrolled in the RegisterNET program (NCT02270567) who had paired blood samples and contemporaneous clinical assessment were included. NETest2.0^® scores were derived from quantitative RT-PCR analysis of a 51-gene transcript panel and expressed on a 0–100 scale. Serum CgA levels were measured using standard clinical immunoassays. Imaging-based disease assessment was performed using CT, MRI, and/or ⁶⁸Ga-somatostatin receptor PET/CT with RECIST 1.1 criteria applied where appropriate. Longitudinal percentage changes (Δ) between sequential measurements were evaluated using predefined NETest2.0^® thresholds and compared with the conventional CgA threshold (>50%). NETest2.0 Δ thresholds of >0% and >5% were evaluated a priori: >0% as a high-sensitivity threshold capturing any upward transcriptomic drift, and >5% as a more conservative threshold intended to reduce minor biological or analytical fluctuation. Receiver operating characteristic (ROC) analysis, operating characteristics, multivariable analysis (MVA), and logistic regression analysis (LRA) were performed. Results: A total of 191 patients were analyzed. Exploratory ROC analysis demonstrated superior discrimination for progression using serial NETest2.0^® changes compared with changes in CgA (AUC: 0.893 vs. 0.538; p < 0.0001). In the primary surveillance analysis, NETest2.0^® thresholds of >0% and >5% achieved AUCs of 0.860 (95% CI: 0.803–0.906) and 0.822 (95% CI: 0.760–0.873), respectively, both significantly superior to CgA (AUC: 0.553, 95% CI: 0.480–0.625; both p < 0.0001). NETest2.0^® >0% demonstrated the highest sensitivity (86.4%), whereas NETest2.0^® >5% achieved the optimal balance of sensitivity (70.5%), specificity (93.9%), and overall accuracy (88.5%). In multivariable and logistic regression analyses, changes in NETest2.0^® were the strongest independent predictor of progression (all p < 0.0001; odds ratios: 52.99–61.26), whereas CgA did not significantly contribute to progression prediction. Conclusions: Serial NETest2.0^® assessment significantly outperformed CgA for monitoring NET disease activity and progression. These findings support the integration of NETest2.0^® into molecularly informed surveillance strategies to complement imaging and improve longitudinal monitoring of patients with NETs. Full article

The mevalonate (MVA) pathway is a central metabolic route responsible for the biosynthesis of isoprenoids with broad biological and biotechnological relevance. Due to its importance, the MVA pathway has attracted increasing interest in studies of enzymatic regulation, structural biology, metabolic engineering, and synthetic biology, particularly in fungi. This review provides a comprehensive overview of the MVA pathway, addressing its distribution across different domains of life, evolutionary aspects, and metabolic organization, with emphasis in fungi. Special attention is given to the biochemical and structural characterization of MVA-pathway enzymes, including catalytic mechanisms, structural features, and regulatory processes. The methylerythritol phosphate pathway is also presented as an alternative route for isoprenoid precursor biosynthesis and discussed in terms of its taxonomic distribution and metabolic significance. Recent advances in synthetic biology, enzyme regulation, and pathway engineering are highlighted, emphasizing their contributions to metabolic engineering and synthetic biology. Special emphasis is given to fungi, in which the MVA pathway plays a central role in ergosterol biosynthesis, protein prenylation, and secondary metabolite production. Advances in the engineering of fungal cells, including Saccharomyces cerevisiae and other emerging fungal species, are discussed in the context of sustainable isoprenoid production. Finally, strategies for optimizing microbial production are presented, highlighting the importance of fungal synthetic biology in advancing biotechnological applications. Full article

The objective of this study is to develop a methodological approach to the integral assessment of the investment attractiveness of metallurgical enterprises to improve the efficiency of investment activities and the implementation of projects and ensure sustainable development. The metallurgy industry faces the challenge of balancing efficiency goals and sustainable objectives (ESG) and risks. Our approach takes into account the relationship between investment potential, realized opportunities, and the level of risk. Based on a systematic analysis of theoretical approaches, an integral investment attractiveness index is proposed that aggregates investment potential (consisting of seven sub-potentials), an assessment of the results of project implementation, and an aggregated risk index. Assessing investment attractiveness is important for ensuring the sustainable implementation of effective projects and determining their priority. A panel dataset was constructed using data from two metallurgy companies. The relationship between investment attractiveness and classical indicators (ROIC, EVA, MVA, Tobin’s Q, and P/BV) is examined through panel regression with fixed effects, cross-correlation analysis of the temporal structure of relationships, a CUSUM test for model stability, and decomposition of investment attractiveness changes. Decomposition of investment attractiveness changes makes it possible to quantify the contribution of potential, opportunities, and risk to the dynamics of investment attractiveness across various periods, including crisis and post-crisis ones describing the specifics of the metallurgic industry. The presented methodology is relevant for increasing the efficiency of project implementation within the framework of an integral company policy and contributes to the acceleration of industrial implementation of sustainable projects in the metallurgy sector. Full article

Background/Objectives: Ebola Virus Disease (EVD) remains a public health threat in sub-Saharan Africa. The 10th Ebola outbreak in the Democratic Republic of the Congo (DRC) in 2018–2020 led the Rwanda Ministry of Health to launch a large-scale Ebola vaccination campaign using the two-dose Ad26.ZEBOV and MVA-BN-Filo regimen. The campaign was implemented by local organizations, the Center for Family Health Research and Rinda Ubuzima, in partnership with the Rwanda Biomedical Center. Methods: The campaign targeted those who live near or routinely cross the Rwanda/DRC border and unvaccinated first responders. Children <2 years and pregnant women were excluded. Results: Between December 2019 and September 2021, 219,775 individuals attended vaccination sites and 216,108 received the first dose. Of those, 110,699 (51.2%) were adults (≥18 years) and 105,409 (48.8%) were children aged 2–17 years. A total of 118,048 (54.6%) were women and 98,060 (45.4%) were men. Of all first-dose clients, 203,303 (94.1%) received the second dose. Participants who were older, male, in Rubavu district, and urban were more likely (p < 0.05) to be lost between the first and second dose. Most individuals who were ineligible for the second dose were women who fell pregnant after the first dose. Conclusions: Findings highlight that a large-scale vaccination campaign, including remote areas, is feasible with high adherence despite the concurrent COVID-19 pandemic. Early stakeholder engagement and local leadership were critical to success. Future studies of reasons for non-adherence, as well as strategies to integrate family planning into campaign activities to reduce ineligibility due to pregnancy, are warranted. Full article

This manuscript will present an advancement of transformative research that has been conducted at Oak Ridge National Laboratory (ORNL) over a 25-year period (2000–2025) on a variety of environmental and biological matrices. These investigations derived a fundamental understanding of how elemental detection and analysis of these matrices led to the knowledge and discovery of natural processes in plants and the environment. Each project led to the initiation of a new research area which unearthed awesome and novel breakthroughs. Highlights are listed below: 1. The preliminary research at ORNL centered on the detection of aerosols utilizing Laser-induced Breakdown Spectroscopy (LIBS) technology. The Clean Air Act Amendment (CAAA) of 1990 highlighted the importance of identifying hazardous air pollutants (HAPs) due to their impact on environmental and human health, thereby underscoring the need to detect various toxic elements. Research in aerosol chemistry aimed to identify these harmful elements released by factories during periods of increased emissions in their manufacturing processes. LIBS emerged as the most effective method for real-time, in situ measurements of metal species in both gaseous and aerosol phases. 2. An understanding of the presence of total carbon in soils gives perspective on how to develop carbon sequestration strategies. The recognition that carbon sinks can evolve back to carbon sources to emit back to the atmosphere was an important consideration. Also, the concentration of carbon in soil indicates the health of land areas for growing crops successfully. 3. The direct detection of most of the elements in a wood sample in a single emission spectrum, without sample preparation, encouraged the research to use the LIBS technique for preservative treated wood coupled with use of multivariate statistical methodology. Additionally, it encouraged the researchers to try to differentiate natural woods from different parts of the country, and it was successfully demonstrated that LIBS coupled with MVA analysis could differentiate wood of different species from each other and of similar species grown in different environments based on their elemental spectra. This was a breakthrough since it revealed a systematic approach to connect elemental scarcity and abundance to either drought or typical rainfall conditions for the hardwood trees grown in specific areas. 4. Furthermore, the research progressed to reveal physiological and developmental processes contributing to biomass production such that the variation in leaf elemental composition increases our understanding of terrestrial nutrient cycles, as well as tracking the transfer of toxic elements from soils to living organisms. 5. Recently another breakthrough viz., ionomics initiated the correlation of elements to specific genes, uncovering the function that the element performed in the plant. More recently, this has been extended from plants to fungi as well as fungi growing in symbiotic relations with plants. Full article

Olive oil represents a precious resource for the agri-food sector, not just economically but also for its health properties due to the presence of bioactive compounds. The aim of this study is to evaluate the Nuclear Magnetic Resonance (¹H NMR)-based metabolomics profiles of monovarietal olive oils from Coratina, Ogliarola garganica and Peranzana, which are typically included in the “Dauno” PDO. Analysis by ¹H NMR metabolic profiling was carried out to develop a strategy for understanding the differences based on cultivar. NMR spectroscopy coupled with multivariate statistical analysis (MVA) revealed significant differences in fatty acid profiles and phenolic compounds according to cultivar. In particular, Coratina oils were higher in squalene, oleic acid and polyphenols than Ogliarola garganica and Peranzana. Conversely, the latter two showed higher contents of polyunsaturated fatty acids and lower levels of phenolic compounds. Furthermore, as the olive oils were influenced by several factors, in addition to cultivar, the effects of tree age on the chemical composition of Peranzana olive oils were investigated. MVA revealed different fatty acid and polyphenol contents between secular and young trees. These results may contribute to expanding the literature data on the ¹H NMR-based chemometric approach as a powerful tool for quality and authenticity control of olive oil. Full article

The digital transformation of tourist facilities requires careful selection of technologies that can provide secure, stable and scalable network infrastructure. Due to the possibility of application in different sectors with different specificities, the focus of the research was placed on the implementation of smart tourist services. A hybrid multi-criteria decision-making model based on PIPRECIA and MVA models was applied for the research. Based on the literature and the opinions of experts in the field, evaluation criteria such as bandwidth, latency, energy efficiency, security and privacy, scalability, costs and interoperability were defined, and internet technologies such as Li-Fi, Wi-Fi 7, Wi-Fi 6, private 5G networks, Ethernet-over-Power (EoP), NB-IoT and LoRaWAN were defined. The results obtained put the security and privacy criterion at the top (0.2253), followed by scalability (0.1952) and bandwidth (0.1624). The obtained results indicate that Wi-Fi 7 achieved the highest weighted score (4.2247), followed closely by Li-Fi (4.2177) and Wi-Fi 6 (4.0771). Wi-Fi 7 demonstrated particularly strong performance in scalability, interoperability and bandwidth, making it highly suitable for environments with high user density. Li-Fi achieved very high scores in security and latency, which makes it particularly appropriate for security-sensitive smart tourism environments. Lower-ranked technologies such as NB-IoT and LoRaWAN proved valuable for supporting IoT and monitoring functions, rather than as primary communication infrastructure. The proposed model has proven to be a flexible, transparent and practical tool for strategic decision-making in the field of smart tourism. In addition to the basic application presented in the paper, the model has the potential to be adapted to different contexts and expanded with additional criteria or new technologies. The proposed hybrid approach can serve as a useful decision-making tool for tourism managers, system engineers and urban planners who are looking for optimal solutions for the development of digital infrastructure. Full article

This study examines how innovation and green management influence business sustainability and firm value in Indonesian healthcare companies. Innovation is measured using Value-Added Intellectual Capital (VAIC) efficiency, green management through Environmental, Social, and Governance (ESG) scores, business sustainability as carbon emission disclosure (CEDI), and firm value as Market Value Added (MVA). The sample consists of 123 firm-year observations from healthcare firms listed on the Indonesia Stock Exchange (2019–2023). Based on the capital-based theory of sustainability and stakeholder theory, hypotheses are tested using fixed-effect panel regression, Baron and Kenny mediation analysis, and Structural Equation Modelling (SEM). The results show that VAIC is the only significant predictor of MVA, with a consistent positive effect across all model specifications. Neither ESG Score nor CEDI shows a significant effect on market value, indicating that sustainability disclosure has not yet translated into measurable financial returns in this context. Within the structural model, ESG governance is the strongest predictor of carbon disclosure, while firms with higher VAIC tend to prioritise value creation over environmental reporting. All mediation hypotheses are rejected. These findings suggest that intellectual capital and sustainability practices currently function as separate strategic priorities in Indonesian healthcare. Intellectual capital produces tangible market value in the short term, while the financial benefits of sustainability disclosure are likely to emerge only as Indonesia’s ESG reporting standards and investor awareness continue to develop. Full article