Search Results (442)

This paper examines the impact of agent banking activities, a recent FinTech development, influencing the profitability and financial outcomes of commercial banks operating in Bangladesh, as agent banking has been receiving significant global attention due to its technology-driven approach, cost-effectiveness and easy accessibility, and broader coverage of the unbanked population. Through the application of penal data regression methods, the study estimates a random-effect model using panel data comprising quarterly observations from nine Bangladeshi commercial banks that maintained uninterrupted agent banking activities, covering both deposit mobilization and lending during the period from 2018Q1 to 2024Q4. The empirical findings indicate that credit disbursement by agent banks has a positive and statistically significant impact on bank profitability measures, return on assets (ROA), and return on equity (ROE). Similarly, the expansion of agent banking outlets positively and significantly influences ROA. Therefore, an appropriate agent banking policy aimed at increasing agent banking outlets using digital platforms based on FinTech is vital for ensuring positive growth in credit disbursement to achieve improved financial outcomes for the banking sector in a developing country like Bangladesh. Full article

Heart failure (HF) is a major global health challenge, characterized by high morbidity, mortality, and frequent hospital readmissions. Despite the advent of guideline-directed medical therapies (GDMTs), the burden of HF continues to grow, necessitating a shift toward comprehensive, multidisciplinary care models. Heart Failure Disease Management Programs (HF-DMPs) have emerged as structured frameworks that integrate evidence-based medical therapy, patient education, telemonitoring, and support for social determinants of health to optimize outcomes and reduce healthcare costs. This review outlines the key components of HF-DMPs, including patient identification and risk stratification, pharmacologic optimization, team-based care, transitional follow-up, remote monitoring, performance metrics, and social support systems. Incorporating tools such as artificial intelligence, pharmacist-led titration, and community health worker support, HF-DMPs represent a scalable approach to improving care delivery. The success of these programs depends on tailored interventions, interdisciplinary collaboration, and health equity-driven strategies. Full article

We introduce a novel portfolio optimization framework—Distributionally Robust Multivariate Stochastic Cone Order (DR-MSCO)—which integrates partial orders on random vectors with Wasserstein-metric ambiguity sets and adaptive cone structures to model multivariate investor preferences under distributional uncertainty. Grounded in measure theory and convex analysis, DR-MSCO employs data-driven cone selection calibrated to market regimes, along with coherent tail-risk operators that generalize Conditional Value-at-Risk to the multivariate setting. We derive a tractable second-order cone programming reformulation and demonstrate statistical consistency under empirical ambiguity sets. Empirically, we apply DR-MSCO to 23 Borsa Istanbul equities from 2021–2024, using a rolling estimation window and realistic transaction costs. Compared to classical mean–variance and standard distributionally robust benchmarks, DR-MSCO achieves higher overall and crisis-period Sharpe ratios (2.18 vs. 2.09 full sample; 0.95 vs. 0.69 during crises), reduces maximum drawdown by 10%, and yields endogenous diversification without exogenous constraints. Our results underscore the practical benefits of combining multivariate preference modeling with distributional robustness, offering institutional investors a tractable tool for resilient portfolio construction in volatile emerging markets. Full article

Background: Artificial intelligence (AI) and machine learning (ML) have been reshaping maternal, fetal, neonatal, and reproductive healthcare by enhancing risk prediction, diagnostic accuracy, and operational efficiency across the perinatal continuum. However, no comprehensive synthesis has yet been published. Objective: To conduct a scoping review of reviews of AI/ML applications spanning reproductive, prenatal, postpartum, neonatal, and early child-development care. Methods: We searched PubMed, Embase, the Cochrane Library, Web of Science, and Scopus through April 2025. Two reviewers independently screened records, extracted data, and assessed methodological quality using AMSTAR 2 for systematic reviews, ROBIS for bias assessment, SANRA for narrative reviews, and JBI guidance for scoping reviews. Results: Thirty-nine reviews met our inclusion criteria. In preconception and fertility treatment, convolutional neural network-based platforms can identify viable embryos and key sperm parameters with over 90 percent accuracy, and machine-learning models can personalize follicle-stimulating hormone regimens to boost mature oocyte yield while reducing overall medication use. Digital sexual-health chatbots have enhanced patient education, pre-exposure prophylaxis adherence, and safer sexual behaviors, although data-privacy safeguards and bias mitigation remain priorities. During pregnancy, advanced deep-learning models can segment fetal anatomy on ultrasound images with more than 90 percent overlap compared to expert annotations and can detect anomalies with sensitivity exceeding 93 percent. Predictive biometric tools can estimate gestational age within one week with accuracy and fetal weight within approximately 190 g. In the postpartum period, AI-driven decision-support systems and conversational agents can facilitate early screening for depression and can guide follow-up care. Wearable sensors enable remote monitoring of maternal blood pressure and heart rate to support timely clinical intervention. Within neonatal care, the Heart Rate Observation (HeRO) system has reduced mortality among very low-birth-weight infants by roughly 20 percent, and additional AI models can predict neonatal sepsis, retinopathy of prematurity, and necrotizing enterocolitis with area-under-the-curve values above 0.80. From an operational standpoint, automated ultrasound workflows deliver biometric measurements at about 14 milliseconds per frame, and dynamic scheduling in IVF laboratories lowers staff workload and per-cycle costs. Home-monitoring platforms for pregnant women are associated with 7–11 percent reductions in maternal mortality and preeclampsia incidence. Despite these advances, most evidence derives from retrospective, single-center studies with limited external validation. Low-resource settings, especially in Sub-Saharan Africa, remain under-represented, and few AI solutions are fully embedded in electronic health records. Conclusions: AI holds transformative promise for perinatal care but will require prospective multicenter validation, equity-centered design, robust governance, transparent fairness audits, and seamless electronic health record integration to translate these innovations into routine practice and improve maternal and neonatal outcomes. Full article

The global rise in urban-related health issues poses significant challenges to public health, particularly in cities facing socio-economic crises. In Lebanon, 70% of the population is experiencing financial hardship, and healthcare costs have surged by 172%, exacerbating the strain on medical services. Given these conditions, improving the quality and accessibility of green spaces offers a promising avenue for alleviating mental health issues in urban areas. This study investigates the psychological impact of nine urban public spaces in Beirut through a comprehensive survey methodology, involving 297 participants (locals and tourists) who rated these spaces using Likert-scale measures. The findings reveal location-specific barriers, with Saanayeh Park rated highest in quality and Martyr’s Square rated lowest. The analysis identifies facility quality as the most significant factor influencing space quality, contributing 73.6% to the overall assessment, while activity factors have a lesser impact. The study further highlights a moderate positive association (Spearman’s rho = 0.30) between public space quality and mental well-being in Beirut. This study employs a hybrid methodology combining Research for Design (RfD) and Research Through Designing (RTD). Empirical data informed spatial strategies, while iterative design served as a tool for generating context-specific knowledge. Design enhancements—such as sensory plantings, shading systems, and social nodes—aim to improve well-being through better public space quality. The proposed interventions support mental health, life satisfaction, climate resilience, and urban inclusivity. The findings offer actionable insights for cities facing public health and spatial equity challenges in crisis contexts. Full article

Society’s adaptation to shared mobility services is a growing topic that requires detailed understanding of the local circumstances of potential and current users. This paper focuses on analyzing barriers to the adoption of urban bike-sharing systems in post-industrial cities, using a case study of the Silesian agglomeration in Poland. Methodologically, the article integrates quantitative survey methods with multivariate statistical analysis to analyze the demographic, socioeconomic, and motivational factors that underline the adoption of shared micromobility. The study highlights a detailed segmentation of users by income, age, professional status, and gender, as well as the observation of profound disparities in access and perceived usefulness. Of note is the study’s identification of a highly concentrated segment of young, low-income users (mostly students), which largely accounts for the general perception of economic and infrastructural barriers. These include the use of factor analysis and regression to plot the interaction patterns between individual user characteristics and certain system-level constraints, such as cost, infrastructure coverage, weather, and health. The study’s findings prioritize problem-specific interventions in urban mobility planning: bridging equity gaps between user groups. This research contributes to the current literature by providing detailed insights into the heterogeneity of user mobility behavior, offering evidence-based recommendations for inclusive and adaptive options for shared transportation infrastructure in a changing urban context. Full article

This study employs k-means clustering to analyze local organizations responsible for land improvement in Greece, identifying four distinct groups with consistent geographic patterns but divergent financial and operational characteristics. By integrating unsupervised machine learning with spatial analysis, the research offers a novel perspective on irrigation water pricing and cost recovery. The findings reveal that organizations located on islands, despite high water costs due to limited rainfall and geographic isolation, tend to achieve relatively strong financial performance, indicating the presence of adaptive mechanisms that could inform broader policy strategies. In contrast, organizations managing extensive irrigable land or large volumes of water frequently show poor cost recovery, challenging assumptions about economies of scale and revealing inefficiencies in pricing or governance structures. The spatial coherence of the clusters underscores the importance of geography in shaping institutional outcomes, reaffirming that environmental and locational factors can offer greater explanatory power than algorithmic models alone. This highlights the need for water management policies that move beyond uniform national strategies and instead reflect regional climatic, infrastructural, and economic variability. The study suggests several policy directions, including targeted infrastructure investment, locally calibrated water pricing models, and performance benchmarking based on successful organizational practices. Although grounded in the Greek context, the methodology and insights are transferable to other European and Mediterranean regions facing similar water governance challenges. Recognizing the limitations of the current analysis—including gaps in data consistency and the exclusion of socio-environmental indicators—the study advocates for future research incorporating broader variables and international comparative approaches. Ultimately, it supports a hybrid policy framework that combines data-driven analysis with spatial intelligence to promote sustainability, equity, and financial viability in agricultural water management. Full article

Background: Adolescents in Ethiopia, particularly in rural areas, face significant barriers to accessing comprehensive sexual and reproductive health (SRH) services, resulting in poor health outcomes. The youth-friendly health services (YFHS) initiative addresses these challenges by training Health Extension Workers (HEWs) to deliver tailored, age-appropriate care at the primary care level. This study evaluates the cost-effectiveness of YFHS implementation in rural health posts in the Jimma Zone, Ethiopia. Methods: Using an ingredient-based costing approach, costs were analyzed across six health posts, three implementing YFHS and three offering routine services. Health outcomes were modeled using disability-adjusted life years (DALYs) averted, and incremental cost-effectiveness ratios (ICERs) were calculated. Results: Results showed that YFHS reached 9854 adolescents annually at a cost of USD 29,680, compared to 2012.5 adolescents and USD 7519 in control sites. The study showed the ICER of USD 25.50 per DALY averted. The intervention improved health outcomes, including a 27% increase in antenatal care uptake, a 34% rise in contraceptive use, and a 0.065% reduction in abortion-related mortality, averting 52.11 DALYs versus 26.42 in controls. Conclusions: The ICER was USD 25.50 per DALY averted, well below Ethiopia’s GDP per capita, making it highly cost-effective by WHO standards. Scaling YFHS through HEWs offers a transformative, cost-effective strategy to advance adolescent SRH equity and achieve universal health coverage in Ethiopia. Full article

The continued migration of physicians from independent practice to affiliation with larger entities has garnered significant scrutiny. These affiliation models include hospitals and health systems, payers and corporate entities, and management services organizations, which may or may not be private equity (PE)-backed. Data on the impact of different physician affiliation models on cost of care is limited. We examined the relationship between provider affiliation model, site of care (SOC), and cost of care for certain high-volume procedures in procedure-intensive specialties for both Medicare and commercial insurance. We found that hospital-affiliated physicians are least likely—and PE-affiliated physicians are most likely—to provide care in lower-cost settings. For both Medicare and commercial insurance, SOC contributes meaningfully to procedure unit price, which is consistently greater in hospital-based settings. These findings suggest that the physician affiliation model and associated SOC cost differentials contribute materially to healthcare expenditures. As the Medicare cost differentials are set by statute and regulations, strategies such as site-neutral payments are needed to mitigate the monetary impact of historical and future physician practice migration. Full article

The economic impact of health promotion and disease prevention interventions in ageing populations remains debated, as theories of morbidity compression and expansion offer contrasting views on the relationship between life expectancy and duration of morbidity. A MEDLINE search was conducted to identify studies evaluating the economic impact of health promotion or primary or secondary prevention interventions in OECD countries, over a lifetime time horizon. Among the 29 studies included, 16 reported cost-saving interventions (reducing costs while improving health outcomes), 11 reported cost-effective interventions (health gains at an acceptable additional cost based on an established threshold), and two presented cost-ineffective interventions (costs exceeding the threshold for the health benefits achieved). Interventions targeting diabetes and obesity prevention were cost-saving; cancer screening and fall prevention strategies were cost-effective; whereas interventions targeting rare diseases were cost-ineffective. Regulatory interventions were also cost-saving, while most programme-based interventions were cost-effective. Cost-saving or cost-effective interventions generally adopted broader analytical perspectives, while cost-ineffective ones employed narrower perspectives. The four studies that incorporated competing risks—despite using a narrower healthcare sector perspective—still found the interventions to be cost-saving or cost-effective interventions. None of the included studies assessed whether interventions led to morbidity compression or expansion. Only a few studies considered equity impact; those that did reported improved outcomes for disadvantaged groups, in regulatory and community-based interventions. Further research is needed to quantify morbidity outcomes and enhance methodological consistency, particularly with respect to analytical perspectives, the integration of competing risks, and the inclusion of equity analyses. Full article

This article investigates the institutional and informational foundations of water governance in Southern Europe amid escalating climate stress. Focusing on Portugal, Spain, Italy, and Greece, it develops a multi-level analytical framework to explore how information asymmetries and governance fragmentation undermine coordinated responses to water scarcity. Integrating theories of information economics, polycentric governance, and critical institutionalism, this study applies a stylized economic model and comparative institutional analysis to assess how agents—such as farmers, utilities, regulators, and civil society—respond to varying incentives, data access, and coordination structures. Using secondary data, normalized indicators, and scenario-based simulations, the model identifies three key structural parameters—institutional friction (θ_i), information cost (β_i), and incentive strength (α_i)—as levers for governance reform. The simulations are stylized and not empirically calibrated, serving as heuristic tools rather than predictive forecasts. The results show that isolated interventions yield limited improvements, while combined reforms significantly enhance both equity and effectiveness. Climate stress simulations further reveal stark differences in institutional resilience, with Greece and Italy showing systemic fragility and Portugal emerging as comparatively robust. This study contributes a flexible, policy-relevant tool for diagnosing governance capacity and informing reform strategies while also underscoring the need for integrated, equity-oriented approaches to adaptive water governance. Full article

This study conducts a comprehensive systematic review of the economic impact of Digital Twin (DT) technology within the Architecture, Engineering, and Construction (AEC) industry, following the PRISMA methodology. While DT adoption has been accelerated by advancements in Building Information Modelling (BIM), the Internet of Things (IoT), and data analytics, significant challenges persist—most notably, high initial investment costs and integration complexities. Synthesising the literature from 2016 onwards, this review identifies sector-specific barriers, regulatory burdens, and a lack of standardisation as key factors constituting DT implementation costs. Despite these hurdles, DTs demonstrate strong potential for enhancing construction productivity, optimising lifecycle asset management, and enabling predictive maintenance, ultimately reducing operational expenditures and improving long-term financial performance. Case studies reveal cost efficiencies achieved through DTs in modular construction, energy optimisation, and infrastructure management. However, limited financial resources and digital skills continue to constrain the uptake across the sector, with various extents of impact. This paper calls for the development of unified standards, innovative public–private funding mechanisms, and strategic collaborations to unlock and utilise DTs’ full economic value. It also recommends that future research explore theoretical frameworks addressing governance, data infrastructure, and digital equity—particularly through conceptualising DT-related data as public assets or collective goods in the context of smart cities and networked infrastructure systems. Full article

This study examines how several gender-encoding strategies in Spanish and social factors influence gender perception, reinforcing or mitigating a sexist male bias. Using an experimental design, we tested four linguistic conditions in a job recruitment context: masculine forms (theoretically generic), gender-splits, epicenes, and non-binary neomorpheme “-e”. After reading a profile in one of these conditions, 837 participants (52% women) selected an image of a woman or man. Results show that masculine forms lead to the lowest selection of female candidates, manifesting a male bias. In contrast, gender-fair language (GFL) strategies, particularly the neomorpheme (les candidates), elicited the highest selection of female images. Importantly, not only did linguistic factors and participants’ gender identity influence results—with male participants selecting significantly more men in the masculine condition, but affinity with feminist movements and LGBTQIA+ communities or positive attitudes towards GFL also modulated responses—increasing female selections in GFL, but reinforcing male selections in the masculine. Additionally, no extra cognitive cost was found for GFL strategies compared to masculine expressions. These findings highlight the importance, not only of linguistic forms, but of social and attitudinal factors in shaping gender perception, with implications for reducing gender biases in language use and broader efforts toward social equity. Full article

The building sector remains one of the largest contributors to global energy consumption and CO₂ emissions, yet selecting optimal retrofit strategies is often hindered by inconsistent evaluation practices and limited integration of environmental and social impacts. This review addresses that gap by systematically analyzing how various assessment methods are applied to building retrofits, particularly from a financial and environmental perspective. A structured literature review was conducted across four major scientific databases using predefined keywords, filters, and inclusion/exclusion criteria, resulting in a final sample of 50 studies (green colored citations of this paper). The review focuses on the application of Life Cycle Cost Analysis (LCCA), Cost–Benefit Analysis (CBA), and Life Cycle Assessment (LCA), as well as additional indicators that quantify energy and sustainability performance. Results show that LCCA is the most frequently used method, applied in over 60% of the studies, often in combination with LCA (particularly for long time horizons). CBA appears in fewer than 25% of cases. More than 50% of studies are based in Europe, and over 60% of case studies involve residential buildings. EnergyPlus and DesignBuilder were the most common simulation tools, used in 28% and 16% of the cases, respectively. Risk and uncertainty were typically addressed through Monte Carlo simulations (22%) and sensitivity analysis. Comfort and social impact indicators were underrepresented, with thermal comfort included in only 12% of studies and no formal use of tools like Social-LCA or SROI. The findings highlight the growing sophistication of retrofit assessments post-2020, but also reveal gaps such as geographic imbalance (absence of African case studies), inconsistent treatment of discount rates, and limited integration of social indicators. The study concludes that future research should develop standardized, multidimensional evaluation frameworks that incorporate social equity, stakeholder values, and long-term resilience alongside cost and carbon metrics. Full article

This study explores the spatial and social implications of urban food systems in Quito, Ecuador, focusing on how food access inequalities reflect and reinforce broader urban disparities. The research addresses a critical problem in contemporary urbanization: the disconnection between food provisioning and spatial equity in rapidly growing cities. The objective is to assess and map disparities in food accessibility using a mixed-methods approach that includes field observation, participatory mapping, value chain analysis, and statistical modeling. Five traditional and emerging food markets were studied in diverse districts across the city. A synthetic accessibility function F(x) was constructed to model food access levels, integrating variables such as income, infrastructure, transport availability, and travel time. These variables were subjected to Principal Component Analysis (PCA) and hierarchical clustering to generate three typologies of territorial vulnerability. The results reveal that peripheral areas exhibit lower F(x) values and weaker integration with the formal food system, leading to higher consumer costs and limited fresh food options. In contrast, central districts benefit from multimodal infrastructure and greater diversity of supply. This study concludes that food systems should be treated as critical urban infrastructure. Integrating food equity into land use and mobility planning is essential to promote inclusive, sustainable, and resilient urban development. Full article