Search Results (314)

Considering rising global uncertainties and intensifying resource and environmental pressures, it has become an inevitable trend to add more ecologically green factors to the traditional industrial chain resilience system and build a system of green industrial chain resilience (GICR). To address the inherent tension between security and green goals, this study develops a novel two-dimensional analytical framework encompassing fracture repair capacity and development regeneration capacity. This framework provides the theoretical foundation for constructing a pioneering city-level evaluation system for GICR. Employing this system and a suite of spatial econometric methods, we empirically analyze the spatiotemporal evolution, convergence, and driving mechanisms of GICR across 245 Chinese cities. The main findings are threefold. First, the proposed framework effectively captures the complexity of GICR, revealing an overall upward trend but significantly widening regional disparities, with a persistent core-periphery spatial pattern. Second, convergence analysis uncovers a club convergence dynamic nationwide, characterized by a notable “high-level equilibrium lock-in” in the advanced eastern region, in contrast to the catch-up convergence observed in central, western, and northeastern China. Third, geographical detector analysis identifies talent agglomeration as the paramount driver, with its interaction with other factors producing nonlinear enhancement effects. These findings underscore that enhancing GICR requires regionally differentiated strategies: policies must break the innovation lock-in in the east, embed resilience standards into industrial transfer in the central and western regions, and prioritize talent as the core lever for synergistic capacity building. Full article

Introduction: The COVID-19 pandemic disrupted immunization services in Togo, resulting in 69,672 “zero-dose” and 24,846 “under-vaccinated” children by the end of 2023. This study assessed the effectiveness, acceptability, and feasibility of a social marketing approach deployed during the 2025 Big Catch-Up initiative in Togo. Methods: A convergent mixed-methods study was conducted in 17 priority health districts. The quantitative component compared vaccination coverage before and after the intervention using administrative data. Chi-squared test for linear trend compared district-level coverages, and statistical significance was set at p < 0.05 for all tests. The qualitative component used in-depth interviews with key informants to collect data, followed by thematic content analysis. The intervention was grounded on the social marketing framework with 4 pillars (4Ps): Product, Price, Place, and Promotion. Results: Coverage increased dramatically: Penta1 from 1% to 64%, Penta3 from 1% to 45%, MR1 from 4% to 50%, and MR2 from 6% to 49% (all p < 0.001). Togo ranked 3rd out of 24 African countries for Penta1 progress. The approach demonstrated high community acceptability, with Vaccination Monitoring Committees praised as being culturally appropriate. Key concerns included sustainability and resource constraints. Conclusions: Social marketing was associated with increased community adherence and immunization coverage improvement. However, long-term sustainability requires the institutionalization of community structures with domestic funding and continued health system strengthening. Full article

Technology enterprises are leveraging artificial intelligence (AI) to foster disruptive innovation, aiming to seize first-mover advantages in technological catch-up and strategic transformation. Most existing studies adopt static research methods such as empirical analysis to explore corporate disruptive innovation from the dimensions of technology, market, organization and value creation. However, few scholars dynamically investigate the impacts of multi-stakeholder interactions on the disruptive innovation of AI enterprises from the perspective of innovation ecosystem by employing evolutionary game theory. Against this backdrop, this paper adopts the evolutionary game approach to explore how the bounded rational strategic interactions among AI enterprises, incumbent enterprises and governments in the innovation ecosystem affect the evolutionary dynamics of AI enterprises’ disruptive innovation behaviors. It also examines under what conditions of benefits, costs, risks and policies the system can evolve toward a stable strategic equilibrium. The findings reveal that the sustainable advancement of disruptive innovation by AI enterprises is not merely driven by the unilateral willingness of individual firms. Instead, it is jointly shaped by the innovation investment of AI enterprises, cooperative responses of incumbent enterprises, and regulatory and supportive policies of governments, as well as comprehensively influenced by base benefits, R&D investment pressure, technology spillover effects and niche competition risks. This research provides theoretical references for improving the innovation governance and policy support system of the AI industry. Future research can further analyze the influence of strategic interactions among more heterogeneous stakeholders on the evolutionary process of disruptive innovation of AI enterprises. Full article

This study examines whether financial leverage promotes sustainable agricultural productivity by accounting for the trade-off between profitability and default risk. We construct a risk-adjusted total factor productivity (TFP) measure by incorporating default risk as an undesirable output into a slack-based DEA framework (USBM), with risk estimated via contingent claims analysis (CCA). Using panel data on Chinese listed agricultural firms, we find a robust inverted-U relationship between leverage and TFP, indicating an optimal leverage range. Mechanism analysis reveals a dual-channel effect: leverage improves productivity through profitability and reduced financing constraints at low levels but increases default risk and undermines financial sustainability at high levels. Decomposition results show that leverage promotes efficiency catch-up but inhibits frontier technological progress, implying a trade-off between short-term efficiency gains and long-term sustainability. Substantial heterogeneity across subsectors and market structures further suggests that optimal leverage is context-dependent. This study contributes by developing a risk-adjusted productivity framework, identifying the nonlinear effects of leverage on sustainable TFP, and providing micro-level evidence from agriculture in a developing economy. The findings offer implications for capital structure optimization and sustainable agricultural finance. Full article

Achieving the Sustainable Development Goals (SDGs) requires not only aggregate progress but also more balanced coordination across social, economic, and ecological systems. This issue is especially salient in western China, where development catch-up, ecological fragility, and pronounced intraregional heterogeneity coexist. This study constructs a localized SDG evaluation framework for 12 provincial units of western China from 2000 to 2018, reorganizing the 17 SDGs into social, economic, and ecological subsystems with 106 indicators. The analysis combines entropy-weighted TOPSIS, coupling coordination analysis, regional disparity analysis, spatial autocorrelation analysis, and integrated forecasting. Results show that the composite sustainable development index increased from 0.225 to 0.430, yet subsystem progress was uneven: social sustainability improved fastest, economic sustainability also increased substantially, while ecological sustainability lagged significantly. SDG5, SDG6, SDG10, SDG12, SDG13, and SDG15 emerged as the principal lagging goals. Coupling coordination among the three subsystems improved from near disorder to primary coordination, but economic–ecological and social–ecological links stayed weaker than the social–economic relationship. Provincial disparities were moderate overall but ecological sustainability exhibited greater interprovincial divergence. Spatially, the three subsystems followed distinct trajectories: ecological sustainability shifted from early clustering to a low-level dispersed state, economic sustainability developed an entrenched club-convergence pattern, and social sustainability remained spatially random. Forecasts to 2030 indicate continued social and economic gains alongside persistent ecological lag and subsystem imbalance. These findings indicate that the main sustainability challenge in western China has shifted from general development insufficiency to structural imbalance across goals, subsystems, and provinces, and that regional SDG assessments must move beyond aggregate metrics to identify subsystem coordination, territorial heterogeneity, and spatially differentiated governance pathways. Full article

Background: The COVID-19 pandemic caused disruptions in HPV vaccination and may have severely undermined global cervical cancer prevention, posing long-term risks to controlling cervical cancer and other HPV-related diseases. Objective: We conducted a scoping review to map and synthesize available evidence on how the COVID-19 pandemic has affected human papillomavirus (HPV) vaccination programs in low- and middle-income countries (LMICs) focusing on changes in vaccine delivery and coverage, determinants of uptake, economic and programmatic consequences and vaccine hesitancy. Methods: Inclusion criteria were limited to studies published in the English language between January 2020 to May 2025, and followed JBI and Arksey & O’Malley’s scoping review guidelines. The review proceeded through three stages: database searches, gray literature and citation tracking and used a PRISMA-ScR checklist to guide narrative and tabular synthesis. Results: A total of 1063 records, 57 studies were included in the final analysis, and these were spread out across 37 low- and middle-income countries (LMICs) mainly in Africa, Asia, and Latin America. Our analysis revealed that HPV vaccination coverage declined substantially during the COVID-19 pandemic, with reductions of up to 90% reported across the included studies, in the context of school closures, workforce redeployment, and supply-chain disruptions. Recovery efforts also faced major barriers including vaccine hesitancy, misinformation about COVID-19 vaccines, and travel restrictions. Strategies like digital tools, mobile clinics, and community health workers showed promise alongside integrated school- and facility-based approaches, although there is limited evidence on cost-effectiveness and long-term sustainability of these strategies. Conclusions: HPV vaccination in LMICs was significantly disrupted by the COVID-19 pandemic due to unreliable vaccine supply chains, health-worker shortages, and challenges tied to school-based vaccine delivery. Although recovery methods show potential, longer observation periods are needed to determine their full effectiveness. Full article

Background/Objectives: Multiple sclerosis (MS) commonly impairs information processing speed, which is not well captured by conventional disability metrics. Oculomotor paradigms engage neural circuits frequently affected in MS and may provide objective cognitive correlates. We investigated whether baseline oculomotor parameters are prospectively associated with processing speed at ~6-year follow-up. Methods: Forty-four patients with MS underwent a standardized oculomotor battery (visually guided saccades, antisaccades, and sinusoidal smooth pursuit). The Symbol Digit Modalities Test (SDMT) was reassessed after a mean of 5.7 years. Age-adjusted Spearman partial correlations were computed between 30 baseline oculomotor parameters and follow-up SDMT, applying false discovery rate (FDR) correction. Sensitivity analyses included Cook’s distance. Results: Three parameters survived FDR correction: reflexive saccade duration (i.e., erroneous fixation duration—the dwell time at the erroneous target location before corrective antisaccade initiation; ρ = −0.59, q = 0.0011), catch-up saccades (ρ = −0.52, q = 0.0055), and reflexive saccade latency (ρ = −0.44, q = 0.033). Results remained stable after excluding influential observations. In multivariable analysis (adjusted R² = 0.60), reflexive saccade duration (p < 0.001) and catch-up saccades (p = 0.019) were independently associated with lower SDMT. Conclusions: Baseline antisaccade reflexive saccade duration and smooth-pursuit catch-up saccades were prospectively associated with worse cognitive processing speed at long-term follow-up, suggesting eye-tracking-derived metrics as candidate objective correlates warranting prospective validation in MS. Full article

Elderly psoriasis patients (≥65 years) demonstrate mainly preserved but substantially delayed therapeutic responses to IL-17 and IL-23 inhibitors, achieving lower PASI90 rates at early time-points with eventual “catch-up” by week 52, alongside increased adverse-event-driven discontinuation. This review synthesizes clinical efficacy data from real-world studies with emerging mechanistic evidence on immunosenescence and cellular senescence to propose the “Inflammatory Noise Floor” hypothesis. We postulate that senescent keratinocytes and fibroblasts constitutively secrete SASP cytokines (IL-6, IL-8, TNF-α) through pathways partially independent of IL-23/IL-17, potentially establishing a persistent baseline inflammation that IL-23/IL-17 blockade might not suppress. Concurrently, immunosenescence, characterized by CD8⁺CD28⁻ T-cell accumulation, exhaustion marker upregulation, and Treg dysfunction, is hypothesized to impair adaptive immune re-equilibration. This dual mechanism represents one plausible, albeit theoretical, explanatory framework for the temporal lag, PASI plateau effects, and infection risk observed in elderly patients. Optimizing outcomes in the elderly may require a pragmatic approach: accepting stable PASI 75-90 as a successful endpoint and prospectively validating extended assessment timelines. While a direct correlation remains to be proven, this framework identifies cellular and immunosenescence as potential targets for future senotherapeutic interventions. Full article

Background/Objectives: Glycogen storage disease type IX (GSD IX) is an inherited metabolic disorder characterized by marked clinical heterogeneity and variable severity. Dietary therapy is considered the cornerstone of management, but evidence on treatment strategies, efficacy, and safety remains limited. This study aimed to systematically synthesize available data on therapeutic approaches and clinical outcomes in GSD IX. Methods: A focused analysis of treatment-related data was conducted from a previously performed PRISMA-based systematic review. Clinical studies reporting treatment and follow-up data in genetically confirmed GSD IX patients were included. Results: Among 400 patients identified in the original review, 129 from 26 studies had treatment and follow-up data available. Dietary management combined with uncooked cornstarch (UCCS) was the most common approach (96.1%), with highly heterogeneous protocols. Hepatic manifestations improved in 59/129 (45.7%) of patients, and hypoglycemia in 45/129 (34.9%). Growth outcomes were variable, with catch-up growth in 14.0% and persistent impairment in 19.4%, although data were often missing. Muscle involvement was rarely assessed. No treatment-related adverse events were reported. However, disease-related complications were described, including liver cirrhosis, neurological involvement, osteopenia/osteoporosis, and two deaths in GSD IXa patients. Conclusions: Dietary therapy combined with UCCS remains the mainstay of treatment in GSD IX and is associated with improvement in key clinical domains. However, evidence is limited, heterogeneous, and largely based on small studies. Data on modified cornstarch formulations, such as Glycosade^®, are scarce. Prospective studies and standardized treatment protocols are needed to support evidence-based management. Full article

Background: Treatment with recombinant human growth hormone (rhGH) is approved for children born small for gestational age (SGA) who fail to show postnatal catch-up growth; however, optimizing its efficacy remains a challenge. Aim: to evaluate the impact of rhGH therapy on growth trajectory (GT) and adult height (AH) in SGA children and to identify factors influencing height gain (HG). Methods: A total of 49 SGA children (24 males, 25 females) without postnatal growth recovery and treated with rhGH were enrolled. Clinical and anthropometric data were collected at treatment initiation (T0), after 1 (T1) and 2 years (T2) of therapy, at pubertal onset (P0), during the first (P1) and second year (P2) of puberty, and at attainment of AH. Parameters included age, bone age, H, weight, BMI (all expressed as SDS), HG, and the difference between H and target height (Δ H-TH). Results: a significant increase in HG at all evaluated stages was observed (p < 0.05). The H–TH difference progressively decreased from T0, particularly until the first two years of puberty. Nevertheless, mean AH was −1.75 ± 0.63 SDS, and it was found to fall within the TH range in 86% of cases. Univariate and multivariate regression analysis revealed that age and H at T0 were independent predictors of HG. Conclusions: rhGH treatment has a positive impact on GT in children born SGA. Pubertal growth has a limited contribution in influencing AH of these patients. H and timing of treatment initiation significantly influence HG in SGA children. Early selection of patients for rhGH therapy could further improve their GT. Full article

The low-carbon transition (LCT) of manufacturing clusters is a critical pathway to addressing bottlenecks in global climate governance and promoting sustainable economic development in developing countries. Accurately measuring the level of this transition and clarifying its dynamic trends are of great significance. Drawing on the economic rationale of a low-carbon economy, this study constructs a comprehensive evaluation indicator system and employs the entropy-weighted CRITIC-grey relational TOPSIS method to measure the LCT levels of China’s four major industrial bases from 2013 to 2023. Combined with convergence analysis, the Theil index, mechanism analysis, and policy scenario simulation, it systematically analyzes the characteristics of disparities and the underlying mechanisms. The study’s results show that low-carbon technology is the core driver of the LCT of the four major industrial bases. The LCT levels of the four major industrial bases have generally increased, with some bases exhibiting a catch-up effect internally. The overall disparity among the four major industrial bases has widened, primarily driven by intra-base differences. Specifically, the Beijing–Tianjin–Tangshan industrial base displays polarization characteristics, while the Central-Southern Liaoning industrial base shows a relatively low-level equilibrium. The transition of resource-based cities lags, mainly constrained by rigid industrial structures and insufficient investment in technology. Industrial structure optimization plays a certain role in improving resource-based regions, whereas technological innovation has a more pronounced effect in developed regions. This study constructs a comprehensive analytical framework of “measurement–evolution–mechanism–simulation,” which refines the quantitative evaluation system for the LCT of manufacturing clusters. The findings provide empirical support for formulating differentiated low-carbon policies for manufacturing clusters and optimizing coordinated emission reduction pathways, while also offering a reference paradigm for similar research in other developing countries. Full article

The transition to low-emission road transport in Europe depends not only on the growth of plug-in electric vehicle (PEV) uptake, but also on the timely expansion of publicly accessible charging infrastructure. This article provides a descriptive and diagnostic assessment of the relationship between electrification dynamics and public charging infrastructure development in Europe. The analysis combines a long-run descriptive window (2015–2024, with 2025 treated separately as a scenario observation) and a core diagnostic window (2020–2024) for which a consistent proxy of potential infrastructure strain—plug-in vehicles per public recharging point (VPP)—is available. The results show a strong increase in PEV share in new registrations, from 1.0% in 2015 to 20.92% in 2024, while the number of public recharging points rose from 67,064 to 900,000 over the same period. In the core sample, VPP declined from 15.24 in 2020 to 13.92 in 2024, which is consistent with a catch-up phase in infrastructure deployment after 2021. At the same time, the short-window relationship between PEV share, infrastructure scale and average CO₂ emissions of newly registered cars remains weak and unstable, indicating the role of additional structural factors. The article contributes a transparent, replicable indicator-based framework for describing infrastructure strain in aggregate European data. In policy terms, the findings support a shift from simple point-count targets toward functionally and spatially differentiated infrastructure planning, including interoperability, power structure, and accessibility in underserved areas. Full article

As the foreign direct investment (FDI)-driven catch-up model of eight Central and Eastern European (CEE-8) economies approaches its limits, strengthening the export capacity of small and medium-sized enterprises (SME) may play an important role in sustaining economic convergence within the European Union (EU). Despite deep integration into EU production networks, domestic SME participation in international trade remains limited. In this context, digitalization is increasingly seen as a factor that may reduce information, coordination, and administrative barriers associated with SME cross-border trade. This study examines how different dimensions of digitalization relate to intra-EU export performance of SMEs in the CEE-8, conceptualizing digitalization across three distinct but interacting layers: firm-level digital adoption, societal digital usage, and the institutional digital environment. Using a balanced panel dataset covering 2018–2023, the analysis employs a one-way fixed-effects estimator with wild cluster bootstrap inference to address the small-cluster setting. Results indicate that societal digital usage and digital public services for businesses are strongly and positively associated with SME intra-EU export performance. Firm-level digitalization shows a more complex pattern: internal digital tools display delayed positive associations after a maturation period, while e-commerce participation is consistently negatively associated with aggregate export volumes. Robustness checks using Driscoll-Kraay standard errors and alternative functional forms confirm the stability of the core findings. The results suggest that strengthening digital foundations and reducing cross-border digital frictions can support more effective CEE-8 SME participation in the EU Single Market. Full article

Background: Despite the introduction in 2017 of mandatory vaccination for the hexavalent and the measles–mumps–rubella–varicella vaccines, childhood vaccination coverage in Sicily (Italy) remains below the recommended and safety threshold of 95%. A catch-up vaccination intervention was implemented for the pediatric population of the 2022–2023 birth cohorts residing in a health district of Palermo (Bagheria) where in 2024, 24-month coverage for polio and measles was 77.29% and 77.62%, respectively. Methods: A cross-sectional study with a before–after component was conducted between June 2025 and December 2025, with the aim of evaluating the increase in vaccination coverage. A questionnaire was administered to the parents of non-compliant children to investigate the determinants of infant vaccine hesitancy. Results: Collaboration with primary care pediatricians and the organization of active call sessions and extra vaccination sessions resulted in an increase in vaccination coverage of approximately 10–12 percentage points in both birth cohorts. The investigation of the determinants of vaccination adherence showed some significant associations: “perception of infectious disease risk” (OR: 7.91; p = 0.009) and “expectations of a positive outcome from vaccination” (OR: 8.62; p = 0.003). Vaccine information sources such as the internet and media were associated with refusal of catch-up vaccination (OR: 0.47, p < 0.001; and OR: 0.13, p = 0.026, respectively). Conclusions: Despite methodological limitations, such as the self-reported nature of the survey data, the study demonstrated the usefulness of local strategies aimed at vaccination catch-up, representing a valuable example of local public health practice and effectively contributing to improved vaccination coverage in the pediatric population. Full article

This paper examines economic and institutional convergence between EU Core, EU New, and Western Balkan countries over the period 2004–2023 using a comprehensive panel dataset and multiple convergence frameworks. Evidence of absolute β-convergence is found, although at a slow pace, while conditional specifications show that structural and institutional factors explain growth differences; institutional quality appears to affect growth primarily through direct effects rather than through significant interaction-based β-convergence. A Principal Component Analysis-based Institutional Index (PC1) explains 90% of the variance in institutional quality, highlighting its role in shaping cross-country growth differentials rather than directly influencing convergence speed. Group-specific models reveal heterogeneous convergence paths across European regions. EU Core economies exhibit relatively stable convergence patterns, reflecting their proximity to steady-state income levels. In contrast, EU New and Cohesion Economies do not display statistically significant β-convergence, suggesting that catch-up processes are uneven and not uniformly driven by initial income differences. Western Balkan economies show weak and limited convergence patterns, reflecting persistent structural and institutional constraints. Robustness tests (FE/RE, Hausman, VIF, Breusch–Pagan, residual diagnostics) confirm the validity of the results. Findings suggest an important role of institutional quality in supporting long-term growth and the accession process of the Western Balkans. Policy implications highlight the importance of governance reforms, human capital development, and EU integration mechanisms in accelerating convergence. Full article