Search Results (4,486)

This study investigates the influence of blockchain-enabled supply chain traceability (BESCT) on sustainable supply chain practices (SSCP) in the context of small and medium-sized enterprises (SMEs) in the Turkish manufacturing sector. Grounded in the Resource-Based View (RBV), the research further examines the mediating roles of perceived information transparency (PIT) and supply chain collaboration (SCC) and the moderating effect of environmental orientation (EO). The study employs a quantitative research design using data collected from 652 managers representing various manufacturing SMEs. Structural equation modeling via SmartPLS 4.0 is applied to test a moderated mediation model and assess the relationships among the constructs. The results indicate that BESCT is positively associated with SSCP both directly and through PIT and SCC as mediating mechanisms. PIT is linked to improved visibility and information integrity, while SCC is associated with joint sustainability efforts across supply chain partners. Moreover, EO strengthens the positive associations between BESCT and PIT with SSCP, while its effect on collaboration is more nuanced. Given the cross-sectional design, these findings should be interpreted as associative rather than causal. In addition, the use of a non-probability convenience sampling approach may limit generalizability, and the results should be interpreted with caution. This study contributes to the RBV literature by conceptualizing blockchain as a traceability-enabled dynamic capability that supports sustainability-oriented practices in SMEs. Full article

Inflammatory bowel diseases (IBDs), including ulcerative colitis (UC) and Crohn’s disease (CD), are consistently associated with alterations in gut microbial communities, although the extent and characteristics of these alterations vary across studies, supporting a potential role of the microbiota in disease pathogenesis and therapeutic modulation. We conducted a systematic review to synthesize current evidence on microbiota alterations in IBD and the clinical application of fecal microbiota transplantation (FMT). A total of 118 studies were included (76 focused on microbiota profiling and 42 evaluated FMT as therapy). Across heterogeneous study designs and microbial characterization methods, reduced microbial diversity was the most consistently reported alteration, generally more pronounced in CD than in UC. Depletion of Faecalibacterium prausnitzii—a key butyrate producer with anti-inflammatory properties—was commonly reported, often accompanied by functional impairment in short-chain fatty acid production. Microbial patterns were frequently associated with mucosal inflammation and varied across disease phenotypes; these patterns have been increasingly explored as predictors of treatment response and relapse, although mechanistic interpretation remains limited and causal relationships are difficult to establish. Evidence from randomized controlled trials suggests potential efficacy of FMT in UC, particularly with intensive or repeated protocols, whereas data in CD remain limited and heterogeneous, with signals of benefit often appearing transient. FMT was generally well tolerated, but long-term safety data remain scarce. Emerging multi-omic approaches are reshaping the field by integrating taxonomic and functional insights, with potential implications for risk stratification, diagnosis, prognosis, and therapeutic optimization. Further standardized, longitudinal, and mechanistically oriented studies are required to translate microbiome research into clinically actionable strategies in IBD. Full article

Background: The Middle East and North Africa (MENA) region faces a high cardiovascular disease (CVD) burden alongside endemic serum 25(OH)D (vitamin D) deficiency. This systematic review examines the relationship between vitamin D deficiency and CVD risk factors in MENA populations. Methods: PubMed, Cochrane Library, and Scopus were searched from inception to 18 October 2024, for observational studies in the MENA region examining vitamin D deficiency and cardiovascular risk factors in adults. Independent data extraction was conducted. Study quality was appraised using the Joanna Briggs Institute tool and the Newcastle–Ottawa Scale, with risk of bias visualized using Robvis. Weighted mean differences in cholesterol, body mass index (BMI), and HbA1c between those with and without vitamin D deficiency were computed with random-effects meta-analysis. The protocol was registered in PROSPERO (ID: CRD42025615188) and funded by the Royal College of Surgeons in Ireland—Medical University of Bahrain. Results: Seventeen studies from nine MENA countries were included, predominantly cross-sectional, involving community-based and disease-specific cohorts. Vitamin D deficiency was highly prevalent and consistently associated with higher adiposity and central obesity. Several studies reported significant links between deficiency and poor glycemic control, particularly in obese and prediabetic groups. Meta-analysis demonstrated significantly higher total cholesterol (MD = 0.32; 95% CI = 0.11 to 0.52, p < 0.001), BMI (MD = 1.81; 95% CI = 0.68 to 2.94, p < 0.001), and HbA1c levels (MD = 0.31; 95% CI = 0.06 to 0.57, p = 0.02) in vitamin D deficient individuals, with notable heterogeneity. Conclusions: Vitamin D deficiency is highly prevalent in the MENA region and consistently associated with adiposity-related risk factors. Despite heterogeneity, findings underscore the need for public health strategies and further research to clarify causal pathways and population-specific interventions. Full article

Specialized, Refined, Unique and Novel (SRUN) listed firms are pivotal to the high-quality development of China’s real economy, and their growth quality underpins the security of industrial and supply chains. This study empirically examines the relationship between R&D investment persistence and growth quality of Chinese A-share SRUN listed firms from 2006 to 2024, with technology conversion efficiency as the mediating variable. R&D investment persistence is measured from the dual dimensions of investment intensity and stability, and firm growth quality is a comprehensive indicator constructed via principal component analysis (PCA) from revenue growth, profitability and risk resilience. Panel data regression models, combined with mechanism, endogeneity, robustness and heterogeneity tests, are adopted for empirical analysis. The results show a significantly positive correlation between R&D investment persistence and SRUN firms’ growth quality, with the regression coefficient of R&D investment persistence on growth quality reaching 0.189 (p < 0.01); both investment intensity and stability exert significant positive effects on all dimensions of growth quality, with their regression coefficients on growth quality being 0.156 and 0.132 (both p < 0.01) respectively. Technology conversion efficiency plays a partial mediating role in this relationship, with the mediating effect ratio of R&D investment persistence on growth quality through technology conversion efficiency at 34.2%, as R&D investment persistence indirectly improves growth quality by enhancing patent output and new product conversion efficiency. Heterogeneity analysis indicates that this positive correlation is more pronounced in high-tech industries, small and medium-sized enterprises (SMEs) and eastern China-based firms, driven by differences in industrial R&D dependence, resource endowments and financing frictions. Though endogeneity is mitigated by instrumental variables, propensity score matching (PSM) and difference-in-differences (DID), strict causal identification is constrained by data availability. This study enriches the theories of R&D investment and firm growth, and provides empirical insights for SRUN firms to optimize their R&D strategies and for the government to formulate targeted support policies, so as to promote the high-quality development of SRUN firms and the transformation of China’s manufacturing industry. Full article

Oncology nursing is one of healthcare’s most emotionally demanding specialties, characterized by sustained exposure to patient suffering and mortality. While global burnout rates reach 40–60%, emotional intelligence (EI) is a potential protective resource that remains underexamined in Middle Eastern contexts. Despite growing global evidence, little is known about these relationships in Middle Eastern healthcare systems, where cultural norms and workforce structures may shape emotional processes differently. This study examined whether EI was significantly associated with lower burnout across personal, work-related, and client-related dimensions among oncology nurses in Saudi Arabia. Methods: A cross-sectional correlational study enrolled 172 oncology nurses from three tertiary hospitals in Riyadh. Participants completed validated Arabic versions of the Schutte Self-Report Emotional Intelligence Test (SSEIT) and the Copenhagen Burnout Inventory (CBI). Hierarchical regression analyses examined predictive relationships while controlling for age and experience. Results: EI demonstrated significant inverse correlations with personal (r = −0.41), work-related (r = −0.38), and client-related burnout (r = −0.33, p < 0.001). In hierarchical models, EI emerged as a significant predictor of lower scores across all dimensions, explaining 11–17% of unique variance beyond demographic factors. The strongest association was with personal burnout. Causality cannot be inferred from this cross-sectional design. Conclusion: EI functions as a significant protective factor against burnout. Healthcare organizations should integrate EI development into professional training to strengthen workforce resilience and sustain care quality. Full article

The sponge city pilot policy (SCP) is a green infrastructure initiative that integrates ecological stormwater management, land-use planning, and urban sustainability goals. This study employs the super-efficiency slack-based measure (SBM) model to evaluate the green total factor productivity (GFP) of 278 prefecture-level and above cities in China from 2010 to 2022. It then applies a difference-in-differences (DID) model to identify the causal effect of the SCP on urban GFP while further examining transmission mechanisms and heterogeneous policy effects. The empirical findings show that: (1) the SCP significantly enhances urban GFP, with pilot cities exhibiting an average increase of approximately 6.08% relative to non-pilot cities, indicating broader medium- to long-term ecological–economic co-benefits beyond the policy’s immediate hydrological objectives; (2) the policy effect is more pronounced in cities with stronger economic foundations, larger urban scales, greater environmental governance pressure, weaker resource dependence, and more favorable locational conditions; and (3) the SCP promotes industrial structure transformation (IST) and green technological innovation (GTI), which jointly mediate the relationship between ecological infrastructure and green productivity. Drawing on ecological modernization theory and structural change theory, this study explains how ecological infrastructure, as a techno-structural reform mechanism, can internalize environmental externalities, stimulate innovation, and facilitate sustainable urban transformation. These findings provide evidence that green infrastructure policies can generate both ecological and economic co-benefits, offering useful insights for climate-resilient and sustainable urban planning. Full article

Against the backdrop of China’s “dual carbon” goals, investigating whether market-based environmental regulations can effectively induce technological upgrading is critical for achieving a sustainable low-carbon transition. This study adopts a staggered difference-in-differences (DID) approach within a two-way fixed-effects framework, supplemented by propensity score matching (PSM-DID), to identify the causal impact of the carbon emission trading (CET) pilot policy. The research utilizes a comprehensive panel dataset of A-share listed companies in heavy-polluting industries from 2010 to 2024, incorporating IPC-matched green patent application data to provide a granular assessment of corporate innovation performance. The empirical findings reveal a structural divergence: while the CET policy promotes green innovation in state-owned enterprises (SOEs), it exhibits a potential “crowding-out” effect on private enterprises, a relationship further explained by the mechanisms of carbon information disclosure and financing constraints. These results suggest that the “Porter Effect” in emerging markets is highly conditional on institutional resource endowments, implying that policymakers must complement market incentives with differentiated financial support and enhanced transparency standards to foster a more equitable innovation ecosystem. Full article

Background: Healthcare systems contribute significantly to environmental pollution, energy consumption, and resource depletion, making sustainability an increasingly important environmental and public health priority. Nurses, as frontline healthcare professionals, play a critical role in promoting environmentally responsible practices and advocating for sustainable healthcare within clinical settings. Objective: The study aimed to examine the associations between nurses’ sustainability consciousness, green advocacy, and work grit in hospital settings. Methods: A descriptive cross-sectional correlational study was conducted among 377 nurses working in two university-affiliated hospitals in Egypt. Data were collected using validated instruments assessing sustainability consciousness, green advocacy, and work grit. Descriptive statistics were calculated to summarize participant characteristics and study variables. Associations among sustainability consciousness, green advocacy, and work grit were examined using Pearson correlation analysis. Multiple linear regression analysis was conducted to identify significant predictors of green advocacy, while noting that the study design allows for identification of associations rather than causal relationships. Results: The findings indicated generally high levels of sustainability consciousness among nurses. Significant positive associations were observed between sustainability consciousness, green advocacy, and work grit (p < 0.01). Multiple linear regression analysis identified sustainability consciousness and work grit as significant predictors of green advocacy, explaining 34.2% of its variance. Conclusions: These findings highlight the interconnected roles of sustainability awareness, advocacy behaviors, and psychological resilience in promoting environmentally sustainable healthcare practices. Strengthening nurses’ sustainability consciousness and work grit may enhance green advocacy and contribute to the development of sustainable healthcare systems, supporting global environmental and public health goals aligned with the United Nations Sustainable Development Goals. Full article

Background: Adventist spirituality has been identified as a relevant psychosocial resource for emotional well-being; however, evidence on its relationship with self-control and perceived stress in specific religious populations remains limited. Objective: The aim of this study was to examine the associations between Adventist spirituality, self-control, and perceived stress in a sample of adults belonging to the Seventh-day Adventist Church and residing in coastal regions of Peru. Methods: A cross-sectional study was conducted between December 2025 and January 2026 with 506 Seventh-day Adventist adults who completed an online questionnaire. Adventist spirituality was assessed using the Mission Commitment Questionnaire, which captures religious–spiritual commitment through three dimensions: personal devotion, participation, and witnessing. Self-control and perceived stress were measured using standardized scales. Data were analyzed using partial least squares structural equation modeling. Results: The constructs showed adequate internal consistency, with Cronbach’s alpha values ranging from 0.875 to 0.951 and composite reliability values ranging from 0.906 to 0.956. Adventist spirituality was positively associated with self-control (β = 0.479, p < 0.001) and negatively associated with perceived stress (β = −0.457, p < 0.001). Personal devotion showed the strongest contribution to the higher-order spirituality construct. The model explained 22.9% of the variance in self-control and 20.9% of the variance in perceived stress. Conclusions: Adventist spirituality, particularly personal devotion, was associated with higher self-control and lower perceived stress. Although the cross-sectional design does not allow causal inference, the findings support the relevance of Adventist spirituality as a psychosocial resource linked to emotional well-being in this religious population and justify future longitudinal studies. Full article

Rework continues to be a critical issue in construction projects, contributing to cost escalation, schedule delays, and compromised quality. While earlier studies have identified isolated causes such as design deficiencies, communication failures, and inadequate workmanship, the structural relationships among these factors have not been sufficiently examined. This study investigates the interdependencies among major rework causation domains using Structural Equation Modelling (SEM) based on survey responses from 200 construction professionals. A total of 43 observed variables, identified through an extensive literature review, were grouped into four latent constructs: contractor-related, owner-related, design-related, and resource/workforce-related factors. Confirmatory Factor Analysis (CFA) was conducted to validate the measurement model, followed by structural path analysis to examine causal linkages. The findings reveal that design-related and owner-related factors exert the most significant direct and indirect influence on rework, followed by contractor- and workforce-related factors. The proposed model demonstrates satisfactory goodness-of-fit indices, confirming its reliability and applicability. Compared to conventional ranking and fuzzy-based approaches, SEM provides a more systematic and comprehensive understanding of rework dynamics. The findings provide practical guidance for project managers and decision-makers by identifying the most critical drivers of rework, enabling targeted mitigation strategies and improved resource allocation to enhance overall construction project performance. Full article

Given limited evidence on temporal changes in pathogen detection patterns and hospital-based inflammatory burden across the pandemic transition, this study examined their long-term relationship using respiratory multiplex PCR positivity and concurrent C-reactive protein (CRP) levels. We analyzed 19,002 episodes linking respiratory multiplex PCR (mPCR) results and concurrent CRP from October 2008 to December 2024. Pre-pandemic, pandemic, and post-pandemic changes in monthly testing volume, positivity rate, median CRP, high and extreme inflammation by mPCR status, and the correlation between positivity rate and median CRP were assessed. mPCR positivity decreased from 60.62% (pre-pandemic) to 22.45% (pandemic) and remained low at 25.95% thereafter, whereas the median CRP increased from 0.94 to 3.35 and 5.97 mg/dL, respectively. After January 2020, testing volume and positivity rate decreased, whereas the median CRP increased. High inflammation increased from 13.78% to 27.93% and 38.98% in mPCR-negative episodes, and from 4.61% to 7.20% and 27.66% in mPCR-positive episodes, remaining consistently lower in the latter. Monthly positivity rate was strongly negatively correlated with median CRP. Overall, respiratory virus positivity declined, whereas CRP-based inflammatory burden increased, indicating divergent temporal trends across the pandemic transition. These findings should be interpreted descriptively, not causally, as reflecting divergent temporal trajectories of pathogen detection and inflammatory burden. Full article

Background: Chronic plantar fasciitis refractory to conservative treatment is a frequent cause of persistent heel pain and functional limitation. Although radial extracorporeal shock wave therapy (rESWT) has shown potential benefit, the relationship between clinical improvement and structural ultrasonographic changes remains unclear. The aim of this study was to evaluate the clinical, functional, and ultrasonographic outcomes associated with rESWT in patients with refractory plantar fasciitis. Methods: We conducted a prospective observational single-center study including 287 patients with plantar fasciitis refractory to conservative treatment for at least 6 months and confirmed by ultrasonography (plantar fascia thickness >4 mm). All patients received four weekly sessions of rESWT. Pain intensity (visual analog scale [VAS]), foot function (Foot Function Index [FFI]), quality of life (EQ-5D), and plantar fascia thickness were assessed at baseline and 3 months after treatment. Results: Significant improvements were observed in pain (mean VAS change, −3.73 points), function (mean FFI-disability change, −32.37 points), and quality of life (improvement in at least one EQ-5D dimension in 81.5% of patients) (all p < 0.001). The mean reduction in plantar fascia thickness was 0.14 mm. Most responders (71.8%) showed clinical improvement despite the absence of a relevant structural change, defined as a reduction in plantar fascia thickness <0.5 mm. In multivariate analysis, physically demanding occupations were associated with a lower probability of response (odds ratio, 0.32; 95% confidence interval, 0.17–0.63). The prognostic model showed moderate discrimination (area under the curve, 0.71). Conclusions: In this observational cohort, rESWT was associated with improvements in pain, function, and quality of life in patients with refractory plantar fasciitis. Clinical improvement frequently occurred despite minimal changes in plantar fascia thickness, suggesting that ultrasonographic thickness may not adequately reflect symptomatic evolution. However, the absence of a control group prevents causal interpretation of these findings. Full article

The microbiota–gut–brain axis (MGBA) is a complex bidirectional communication network integrating neural, endocrine, immune, and metabolic pathways linking intestinal microbiota to central nervous system function. Increasing evidence indicates that microbiota-derived signals are critical regulators of neurodevelopment and may contribute to vulnerability to neurodegenerative disorders across the lifespan. In this narrative review, we synthesize experimental and clinical evidence to define the key biological mechanisms underlying microbiota–brain interactions. Converging data indicate that immune activation, barrier dysfunction, and microbial metabolites, particularly short-chain fatty acids and tryptophan-derived compounds, represent central mediators linking gut dysbiosis to neuroinflammatory and neurodegenerative processes. Early-life microbial perturbations, driven by factors such as antibiotic exposure, diet, and psychosocial stress, appear to induce long-term immunometabolic programming that may increase susceptibility to neurological disorders later in life. Clinical studies consistently associate dysbiosis with neurodevelopmental conditions and major neurodegenerative diseases, including Alzheimer’s disease and Parkinson’s disease; however, causal relationships remain incompletely defined due to heterogeneity and the predominance of observational data. Overall, the available evidence supports a lifespan model in which microbiota-driven immune and metabolic dysregulation contributes to both early neurodevelopmental trajectories and late-life neurodegeneration. While microbiome-based biomarkers and therapeutic strategies show promise, their clinical translation requires validation in longitudinal and interventional studies. Full article

Background: Depression is highly prevalent among individuals with chronic pain and strongly impacts pain intensity, psychological functioning, and health-related quality of life. Self-efficacy has emerged as a potentially modifiable resilience factor within this interplay, yet large-scale real-world evidence integrating self-efficacy into multidimensional pain–depression models remains limited. Methods: This cross-sectional registry-based analysis evaluated standardized patient-reported measures from chronic pain patients enrolled in the German Pain e-Registry. All variables were directionally harmonized and transformed into standardized deviation scores (hSDSs) relative to patients without depression. Group-level hSDS profiles for five DASS-21 depression severity strata (none, mild, moderate, severe, extreme) were compared across pain intensity, disability, psychological well-being, affective pain processing, quality of life, neuropathic pain features, and pain-related self-efficacy (PSEQ). Correlations and exploratory principal component analysis (PCA) were used to assess multivariate structure. PCA-informed path models were estimated to evaluate directional relationships between pain, function, depression, and self-efficacy. All directional and mediation models represent exploratory, theory-informed statistical frameworks and do not imply causal or mechanistic relationships. Results: Across all domains, hSDS values increased monotonically with depression severity, while self-efficacy showed the strongest inverse gradient. Exploratory PCA revealed a dominant severity component explaining most variance and a secondary affective–self-efficacy axis, supporting the conceptual separation between functional–physical and psychological–affective symptom clusters. In the bottom-up path model (pain → function → self-efficacy → depression), self-efficacy showed the largest indirect statistical contribution within the proposed path models, and the model explained 55% of depression variance (R² = 0.55). In the top-down model (depression → affective pain → self-efficacy → pain), 45% of pain intensity variance was explained (R² = 0.45), again with self-efficacy as a central mediating construct. Associations remained robust after adjustment for age, sex, and BMI, as well as during sensitivity analyses. Conclusions: This large real-world cohort demonstrates a highly coherent pattern of associations across biopsychosocial domains and highlights pain-related self-efficacy as a central statistical construct linking pain, functional impairment, and depressive symptom burden within the applied exploratory models. The findings suggest that self-efficacy occupies a key position in the interplay between pain and mood, and that pharmacological and non-pharmacological treatments traditionally used in chronic pain management may be associated with changes in this construct. Importantly, all directional and mediation analyses are exploratory and do not imply causal or mechanistic relationships. Therapeutic strategies aimed at enhancing self-efficacy may therefore represent promising targets for future research within multimodal pain management frameworks. Full article

This study examines the current account implications of sustainable rural tourism in Türkiye by measuring rural tourism intensity through tourist arrivals in locally embedded and small-scale accommodation structures—including mountain lodges, camping sites, hostels, pensions, motels, village houses, and boutique hotels—collectively referred to as the LESS variable. Using monthly time series data over the period 2000–2025, the trade deficit is modeled as a function of rural accommodation intensity and the real effective exchange rate. The empirical framework employs Johansen cointegration analysis evaluated through the Pantula principle, Vector Error Correction Model-based Granger causality tests, full-sample bootstrap causality tests, and rolling window bootstrap causality analysis to capture time-varying causal dynamics. The findings confirm a long-run cointegration relationship among the variables and reveal that rural tourism intensity exerts a statistically significant causal effect on the trade deficit, with the relationship intensifying during crisis periods such as the 2008 global financial crisis and the COVID-19 shock. Specifically, increases in rural accommodation intensity are found to exert a negative and significant effect on the trade deficit, indicating that locally embedded tourism structures enhance net foreign exchange retention through lower import leakage. These results suggest that tourism structures characterized by stronger local embeddedness and lower import intensity enhance net foreign exchange retention and contribute to external balance stability. Full article