Search Results (14,674)

In this study, we examine the impact of mergers and acquisitions (M&As) on firm environmental performance, aiming to address the gap in research and guide firms, investors, and policymakers toward more environmentally conscious decision-making in M&A. Using panel data from Chinese A-share listed firms (2008–2022), we estimate a two-way fixed effect model. The Propensity Score Matching and the instrumental variable method address potential endogeneity concerns, and robustness checks validate the findings. We found that M&As have a significantly positive effect on firm environmental performance, with heterogeneous impacts across regions, industries, and M&A types. The environmental benefits are most pronounced in heavily polluting industries and hybrid M&A deals. Eastern China shows more modest improvements. The results of mechanism tests revealed that M&As enhance environmental performance primarily by boosting total factor productivity and fostering innovation. This study offers a novel perspective by linking M&A activities to environmental sustainability, enriching the literature on both M&As and corporate environmental performance. We show that even conventional M&A deals (not sustainability-focused) can improve environmental performance through operational synergies. Expanding beyond polluting industries, we reveal how sector characteristics shape M&A’s environmental impacts. We identify practical mechanisms through which standard M&A activities can advance sustainability goals, helping firms balance economic and environmental objectives. It provides empirical evidence from China, an emerging market with distinct institutional and regulatory contexts. The findings offer guidance for firms engaging in M&A to strategically improve sustainability performance. Policymakers can leverage these insights to design incentives for M&A in pollution-intensive industries, aligning economic growth with environmental goals. By demonstrating that M&As can enhance environmental outcomes, this study supports the potential for market-driven mechanisms to contribute to broader societal sustainability objectives, such as reduced industrial pollution and greener production practices. Full article

Cardiovascular disease (CVD) remains the leading cause of mortality worldwide, with hypercholesterolemia identified as a major, but modifiable risk factor. This review serves as the second part of a comprehensive analysis of dyslipidemia management. The first installment laid the groundwork by detailing the key pathophysiological mechanisms of lipid metabolism, the development of atherosclerosis, major complications of hyperlipidemia, and the importance of cardiovascular risk assessment in therapeutic decision-making. It also examined non-pharmacological interventions and conventional therapies, with a detailed focus on statins and ezetimibe. Building upon that foundation, the present article focuses exclusively on emerging pharmacological therapies designed to overcome limitations of standard treatment. It explores the mechanisms, clinical applications, safety profiles, and pharmacogenetic aspects of novel agents such as proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors (alirocumab, evolocumab), small interfering RNA (siRNA) therapy (inclisiran), adenosine triphosphate–citrate lyase (ACL) inhibitor (bempedoic acid), microsomal triglyceride transfer protein (MTP) inhibitor (lomitapide), and angiopoietin-like protein 3 (ANGPTL3) inhibitor (evinacumab). These agents offer targeted strategies for patients with high residual cardiovascular risk, familial hypercholesterolemia (FH), or statin intolerance. By integrating the latest advances in precision medicine, this review underscores the expanding therapeutic landscape in dyslipidemia management and the evolving potential for individualized care. Full article

Currently, Poland is witnessing a dynamic development of the offshore wind energy sector, which will be a key component of the national energy mix. While many international studies have addressed wind energy deployment, there is a lack of research that compares the energy and economic performance of both onshore and offshore wind farms under Polish climatic and spatial conditions, especially in relation to turbine spacing optimization. This study addresses that gap by performing a computer-based simulation analysis of three onshore spacing variants (3D, 4D, 5D) and four offshore variants (5D, 6D, 7D, 9D), located in central Poland (Stęszew, Okonek, Gostyń) and the Baltic Sea, respectively. The efficiency of wind farms was assessed in both energy and economic terms, using WAsP Bundle software and standard profitability evaluation metrics (NPV, MNPV, IRR). The results show that the highest NPV and MNPV values among onshore configurations were obtained for the 3D spacing variant, where the energy yield leads to nearly double the annual revenue compared to the 5D variant. IRR values indicate project profitability, averaging 14.5% for onshore and 11.9% for offshore wind farms. Offshore turbines demonstrated higher capacity factors (36–53%) compared to onshore (28–39%), with 4–7 times higher annual energy output. The study provides new insight into wind farm layout optimization under Polish conditions and supports spatial planning and investment decision making in line with national energy policy goals. Full article

Background/Objectives: Myelodysplastic syndrome (MDS) is a heterogeneous clonal hematopoietic disorder characterized by ineffective hematopoiesis and leukemic transformation risk. Current therapies show limited efficacy, with ~50% of patients failing hypomethylating agents. This review aims to synthesize recent discoveries through an integrated network model and examine translation into precision therapeutic approaches. Methods: We reviewed breakthrough discoveries from the past three years, analyzing single-cell multi-omics technologies, epitranscriptomics, stem cell architecture analysis, and precision medicine approaches. We examined cell-type-specific splicing aberrations, distinct stem cell architectures, epitranscriptomic modifications, and microenvironmental alterations in MDS pathogenesis. Results: Four interconnected mechanisms drive MDS: genetic alterations (splicing factor mutations), aberrant stem cell architecture (CMP-pattern vs. GMP-pattern), epitranscriptomic dysregulation involving pseudouridine-modified tRNA-derived fragments, and microenvironmental changes. Splicing aberrations show cell-type specificity, with SF3B1 mutations preferentially affecting erythroid lineages. Stem cell architectures predict therapeutic responses, with CMP-pattern MDS achieving superior venetoclax response rates (>70%) versus GMP-pattern MDS (<30%). Epitranscriptomic alterations provide independent prognostic information, while microenvironmental changes mediate treatment resistance. Conclusions: These advances represent a paradigm shift toward personalized MDS medicine, moving from single-biomarker to comprehensive molecular profiling guiding multi-target strategies. While challenges remain in standardizing molecular profiling and developing clinical decision algorithms, this systems-level understanding provides a foundation for precision oncology implementation and overcoming current therapeutic limitations. Full article

The introduction of mobile banking is essential in today’s financial sector, where technological innovation plays a critical role. To remain competitive in the current market, businesses must analyze client attitudes and perspectives, as these influence long-term demand and overall profitability. While previous studies have explored general adoption behaviors, limited research has examined how individual factors such as social influence, lifestyle compatibility, financial technology self-efficacy, and perceived usage cost affect mobile banking adoption among specific generational cohorts. This study addresses that gap by offering insights into these variables, contributing to the growing literature on mobile banking adoption, and presenting actionable recommendations for financial institutions targeting younger market segments. Using a structured questionnaire survey, data were collected from both users and non-users of mobile banking among the Gen Z population in the United States. The regression model significantly predicts mobile banking adoption, with an intercept of $-0.548$ ($p < 0.001$). Among the independent variables, perceived cost of usage has the strongest positive effect on adoption ($B=0.857$, $\beta =0.722$, $p < 0.001$), suggesting that adoption increases when mobile banking is perceived as more affordable. Social influence also has a significant positive impact ($B=0.642$, $\beta =0.643$, $p < 0.001$), indicating that peer influence is a central driver of adoption decisions. However, self-efficacy shows a significant negative relationship ($B=-0.343$, $\beta =-0.339$, $p < 0.001$), and lifestyle compatibility was found to be statistically insignificant ($p=0.615$). These findings suggest that reducing perceived costs, through lower fees, data bundling, or clearer communication about affordability, can directly enhance adoption among Gen Z consumers. Furthermore, leveraging peer influence via referral rewards, Partnerships with influencers, and in-app social features can increase user adoption. Since digital self-efficacy presents a barrier for some, banks should prioritize simplifying user interfaces and offering guided assistance, such as tutorials or chat-based support. Future research may employ longitudinal designs or analyze real-life transaction data for a more objective understanding of behavior. Additional variables like trust, perceived risk, and regulatory policies, not included in this study, should be integrated into future models to offer a more comprehensive analysis. Full article

Background: Neonatal jaundice is common and can cause severe hyperbilirubinemia if untreated. The early identification of at-risk newborns is challenging despite the existing guidelines. Objective: This study aimed to identify the key maternal and neonatal risk factors for jaundice requiring phototherapy using machine learning. Methods: In this study hospital, phototherapy was administered following the American Academy of Pediatrics (AAP) guidelines when a neonate’s transcutaneous bilirubin level was in the high-risk zone. To identify the risk factors for phototherapy, we retrospectively analyzed the electronic medical records of 8242 neonates admitted between 2017 and 2022. Predictive models were trained using maternal and neonatal data. XGBoost showed the best performance (AUROC = 0.911). SHAP values interpreted the model. Results: Mode of delivery, neonatal feeding indicators (including daily formula intake and breastfeeding frequency), maternal BMI, and maternal white blood cell count were strong predictors. Cesarean delivery and lower birth weight were linked to treatment need. Conclusions: Machine learning models using perinatal data accurately predict the risk of neonatal jaundice requiring phototherapy, potentially aiding early clinical decisions and improving outcomes. Full article

Effective water infrastructure planning and management is key to sustainable water supply globally. This research assesses water infrastructure planning and management in Gauteng, South Africa, amid growing challenges from rapid urbanisation, high water demand, climate change, and resource scarcity. These challenges threaten the achievement of Sustainable Development Goals 6 and 11; hence, an integrated approach is required for water sustainability. The study responds to a gap in the literature, which often treats planning and management separately, by adopting an integrated, multi-institutional approach across the water value chain. A mixed-methods triangulation strategy was employed for data collection whereby surveys provided quantitative data, while two sets of structured interviews were conducted: the first round to determine causal relationships among the critical success factors and the second round to validate the proposed framework. The findings reveal a misalignment between infrastructure planning and implementation, contributing to infrastructure backlogs and a short- to medium-term focus. Infrastructure management is further constrained by inadequate system redundancy, leading to ineffective maintenance. External factors such as delayed adoption of 4IR technologies, lack of climate resilient strategies, and fragmented institutional coordination exacerbate these issues. Using Decision-Making Trial and Evaluation Laboratory (DEMATEL) analysis, the study identified Strategic Alignment and a Value-Driven Approach as the most influential critical success factors in water asset management. The research concludes by proposing an integrated water infrastructure and planning framework that supports sustainable water supply. Full article

In today’s dynamic and highly uncertain environment, organizations, particularly in the aviation sector, face increasing challenges that demand resilient, flexible, and data-driven change management decisions. Responding to the growing need for structured approaches to managing complex uncertainties—geopolitical tensions, economic volatility, social shifts, rapid technological advancements, environmental pressures and regulatory changes—this research proposes a theoretical change management model for aviation service providers, such as airports. Integrating three analytical approaches, the model offers a robust, multi-method approach for supporting sustainable transformation under uncertainty. Normative analysis using Bayesian decision theory identifies influential external environmental factors, capturing probabilistic relationships, and revealing causal links under uncertainty. Prescriptive planning through scenario theory explores alternative future pathways and helps to identify possible predictions, offer descriptive evaluation employing fuzzy comprehensive evaluation, and assess decision quality under vagueness and complexity. The proposed four-stage model—observation, analysis, evaluation, and response—offers a methodology for continuous external environment monitoring, scenario development, and data-driven, proactive change management decision-making, including the impact assessment of change and development. The proposed model contributes to the theoretical advancement of the change management research area under uncertainty and offers practical guidance for aviation organizations (airports) facing a volatile external environment. This framework strengthens aviation organizations’ ability to anticipate, evaluate, and adapt to multifaceted external changes, supporting operational flexibility and adaptability and contributing to the sustainable development of aviation services. Supporting aviation organizations with tools to proactively manage systemic uncertainty, this research directly supports the integration of sustainability principles, such as resilience and adaptability, for long-term value creation through change management decision-making. Full article

Background: Lung cancer remains one of the leading causes of cancer-related mortality worldwide. While most diagnoses occur in outpatient settings, a subset of cases are incidentally identified during emergency department (ED) visits. The clinical characteristics and treatment decisions of these patients, particularly in relation to social background factors such as living situation and access to primary care, remain poorly understood. Methods: We conducted a retrospective study of patients diagnosed with malignancies in the ED of a single institution between April 2018 and December 2021. Patients diagnosed with lung cancer within 60 days of an ED visit were included. Data on demographics, disease status, treatment decisions, and background factors—including whether patients lived alone or had a primary care physician (PCP)—were extracted and analyzed. Results: Among 32,108 patients who visited the ED, 148 were diagnosed with malignancy within 60 days; 23 had lung cancer. Of these, 69.6% had metastatic disease at diagnosis, and 60.9% received active treatment (surgery or chemotherapy). No significant associations were observed between the extent of disease and either living arrangement or PCP status. However, the presence of a PCP was significantly associated with the selection of best supportive care (p = 0.023). No significant difference in treatment decisions was observed based on age (cutoff: 75 years). Conclusions: Although social background factors such as living alone were not significantly associated with cancer stage or treatment choice, the presence of a primary care physician was associated with a higher likelihood of best supportive care being selected. This may indicate that patients with an established PCP have more clearly defined care goals at the end of life. These findings suggest that primary care access may play a role in shaping end-of-life care preferences, highlighting the importance of personalized approaches in acute oncology care. Full article

According to the literature, the advancement of information and communication technology (ICT) has increased individual exposure to scams, turning fraud victimization into a significant concern. While prior research has primarily focused on socio-demographic predictors of fraud victimization, this study adopts a behavioral perspective that is grounded in the Signal Detection Theory (SDT) to investigate the likelihood determinants of individuals becoming fraud victims. Using survey data of 671 Indonesian respondents analyzed with the Partial Least Squares Structural Equation Modeling (PLS-SEM), we explored the roles of vigilance and financial literacy in moderating the relationship between fraud exposure and victimization. Our findings substantiate the notion that higher exposure to fraudulent activity significantly increases the likelihood of victimization. The results also show that vigilance negatively moderates the relationship between fraud exposure and fraud victimization, suggesting that individuals with higher vigilance are better at identifying scams, thereby decreasing their likelihood of becoming fraud victims. Furthermore, financial literacy is positively related to vigilance, indicating that financially literate individuals are more aware of potential scams. However, the predictive power of financial literacy on vigilance is relatively low. Hence, while literacy helps a person sharpen their indicators for detecting fraud, psychological, behavioral, and contextual factors may also affect their vigilance and decision-making. Full article

The prevalence of early non-infectious peritoneal dialysis (PD) catheter complications makes performing PD challenging for patients and difficult for the healthcare team to manage. Three common patient scenarios are presented: catheter flow dysfunction, peri-catheter leaks, and catheter-related abdominal pain. Practice recommendations are integrated into each scenario and tailored to clinical presentation, patient need, and resource availability. The importance of including patients in the decision-making process is emphasized, and examples of how contextual factors modify the proposed approach to complications are given. Full article

Corydalis yanhusuo W. T. Wang, commonly known as Yanhusuo, is an important and rare medicinal plant resource in China. Its habitat integrity is facing severe challenges due to climate change and human activities. Establishing an integrative quality zoning system for this species is of significant practical importance for resource conservation and adaptive management. This study integrates multiple data sources, including 121 valid distribution points, 37 environmental factors, future climate scenarios (SSP126 and SSP585 pathways for the 2050s and 2090s), and measured content of tetrahydropalmatine (THP) from 22 sampling sites. A predictive framework for habitat suitability and spatial distribution of effective components was constructed using a multi-model coupling approach (MaxEnt, ArcGIS spatial analysis, and co-kriging method). The results indicate that the MaxEnt model exhibits high prediction accuracy (AUC > 0.9), with the dominant environmental factors being the precipitation of the wettest quarter (404.8~654.5 mm) and the annual average temperature (11.8~17.4 °C). Under current climatic conditions, areas of high suitability are concentrated in parts of Central and Eastern China, including the Sichuan Basin, the middle–lower Yangtze plains, and coastal areas of Shandong and Liaoning. In future climate scenarios, the center of suitable areas is predicted to shift northwestward. The content of THP is significantly correlated with the mean diurnal temperature range, temperature seasonality, and the mean temperature of the wettest quarter (p < 0.01). A comprehensive assessment identifies the Yangtze River Delta region, Central China, and parts of the Loess Plateau as the optimal integrative quality zones. This research provides a scientific basis and decision-making support for the sustainable utilization of C. yanhusuo and other rare medicinal plants in China. Full article

The integration of artificial intelligence (AI), big data analytics, and blockchain technologies within the digital economy presents transformative opportunities for promoting low-carbon urban development. However, a systematic understanding of how these digital innovations influence urban carbon mitigation remains limited. This study addresses this gap by proposing two research questions (RQs): (1) What are the key success factors for artificial intelligence, big data, and blockchain in urban carbon emission reduction? (2) How do these technologies interact and support the transition to low-carbon cities? To answer these questions, the study employs a hybrid methodological framework combining the decision-making trial and evaluation laboratory (DEMATEL) and interpretive structural modeling (ISM) techniques. The data were collected through structured expert questionnaires, enabling the identification and hierarchical analysis of twelve critical success factors (CSFs). Grounded in sustainability transitions theory and institutional theory, the CSFs are categorized into three dimensions: (1) digital infrastructure and technological applications; (2) digital transformation of industry and economy; (3) sustainable urban governance. The results reveal that e-commerce and sustainable logistics, the adoption of the circular economy, and cross-sector collaboration are the most influential drivers of digital-enabled decarbonization, while foundational elements such as smart energy systems and digital infrastructure act as key enablers. The DEMATEL-ISM approach facilitates a system-level understanding of the causal relationships and strategic priorities among the CSFs, offering actionable insights for urban planners, policymakers, and stakeholders committed to sustainable digital transformation and carbon neutrality. Full article

This study developed a model to predict ships with high deficiency risk under Port State Control (PSC) through machine learning techniques, particularly the Random Forest algorithm. The study utilized actual ship inspection data from the Port of Singapore, comprehensively considering various operational and safety indicators of ships, including but not limited to flag state, ship age, past deficiencies, and detention history. By analyzing these factors in depth, this research enhances the efficiency and accuracy of PSC inspections, provides decision support for port authorities, and offers strategic guidance for shipping companies to comply with international safety standards. During the research process, I first conducted detailed data preprocessing, including data cleaning and feature selection, to ensure the effectiveness of model training. Using the Random Forest algorithm, I identified key factors influencing the detention risk of ships and established a risk prediction model accordingly. The model validation results indicated that factors such as ship age, tonnage, company performance, and flag state significantly affect whether a ship exhibits a high deficiency rate. In addition, this study explored the potential and limitations of applying the Random Forest model in predicting high deficiency risk under PSC, and proposed future research directions, including further model optimization and the development of real-time prediction systems. By achieving these goals, I hope to provide valuable experience for other global shipping hubs, promote higher international maritime safety standards, and contribute to the sustainable development of the global shipping industry. This research not only highlights the importance of machine learning in the maritime domain but also demonstrates the potential of data-driven decision-making in improving ship safety management and port inspection efficiency. It is hoped that this study will inspire more maritime practitioners and researchers to explore advanced data analytics techniques to address the increasingly complex challenges of global shipping. Full article

Cardiogenic shock (CS) in the setting of severe aortic stenosis (AS) presents a critical and high-risk scenario with limited therapeutic options and poor prognosis. Transcatheter aortic valve implantation (TAVI), initially reserved for inoperable or high-risk surgical candidates, is increasingly being considered in patients with CS due to improvements in device technology, operator experience, and supportive care. This review synthesizes current evidence from large registries, observational studies, and meta-analyses that support the feasibility, safety, and potential survival benefit of urgent or emergent TAVI in selected CS patients. Procedural success is high, and early intervention appears to confer improved short-term and mid-term outcomes compared to balloon aortic valvuloplasty or medical therapy alone. Critical factors influencing prognosis include lactate levels, left ventricular ejection fraction, renal function, and timing of intervention. The absence of formal guidelines, logistical constraints, and ethical concerns complicate decision-making in this unstable population. A multidisciplinary Heart Team/Shock Team approach is essential to identify appropriate candidates, manage procedural risk, and guide post-intervention care. Further studies and the development of TAVI-specific risk models in CS are anticipated to refine patient selection and therapeutic strategies. TAVI may represent a transformative option for stabilizing hemodynamics and improving outcomes in this otherwise high-mortality group. Full article