Search Results (792)

Background/Objectives: The gut–liver axis is central to sepsis, but assessing mesenteric perfusion remains challenging. Indocyanine green (ICG) clearance reflects hepatic blood flow. Since portal flow is derived from mesenteric circulation and supplies most of the liver, reduced ICG clearance may indicate mesenteric hypoperfusion, which can lead to enteral feeding intolerance (EFI). This study examines whether reduced ICG clearance in septic patients without overt liver injury is associated with EFI. Methods: This study is a secondary analysis of a prospective cohort study (March–May 2024, 20-bed ICU). Septic patients without sepsis-related liver injury or recent abdominal surgery were included. ICG plasma disappearance rate (ICG-PDR) was measured at admission; patients were grouped by ICG-PDR (≤18%/min vs. >18%/min). The primary outcome was EFI within 7 days. Multivariate logistic regression and correlation analyses were performed. Results: Among 77 patients (44 with ICG-PDR > 18%/min, 33 with ≤18%/min), the decreased ICG-PDR group had higher SOFA scores (8.4 ± 4.2 vs. 5.4 ± 3.5, p = 0.001) and higher EFI rates (66.7% vs. 43.1%, p = 0.041). Univariate analysis showed ICG-PDR ≤ 18%/min associated with EFI (OR = 2.632, p = 0.043), but this was attenuated after SOFA adjustment (OR = 2.247, p = 0.171). Reduced ICG-PDR correlated with central venous pressure (CVP) (r = 0.626, p < 0.001) but not with mean arterial pressure (r = −0.175, p = 0.129). Conclusions: In septic patients with preserved hepatocyte function, reduced ICG clearance is associated with EFI, but this relationship is largely explained by disease severity (SOFA). Reduced ICG clearance correlates with CVP; however, ICG-PDR cannot distinguish between portal venous and arterial inflow components. The exact mechanism remains speculative. Full article

The past few years has witnessed the rapid development of China’s logistics industry. However, the industry still faces problems such as uneven regional development, low-cost efficiency, insufficient technology application, and pressure for green transformation. To support more effective policy and strategic planning, this study used composite location entropy, spatial autocorrelation analysis, and kernel density estimation to analyze the spatiotemporal evolution of logistics industry agglomeration based on China’s city-level panel data from 2010 to 2023. Geographic detectors and geographically weighted regression were used to explore its driving mechanisms from multiple perspectives. The results indicated that (1) China’s logistics industry agglomeration exhibited a decreasing gradient from east to west and the regional disparities gradually narrowed down over time. (2) China’s logistics industry showed significantly positive spatial autocorrelation, characterized mainly by high-high and low-low clusters. Northeastern China experienced the most active and tortuous local spatial evolution of logistics agglomeration, while Eastern China exhibited high tortuosity but stable spatial structure. Western China showed a smooth evolution, and Central China followed a relatively independent evolutionary path. Spatially, China’s logistics industry presented a pattern of high concentration in the southeast and sparse distribution in the northwest, with high-value zones expanding toward the central and western regions. (3) Transportation accessibility was the primary factor influencing logistics industry agglomeration, and the interaction among factors was stronger than the effect of individual factors. Specifically, the degree of openness exhibited a driving pattern centered on coastal areas and decreasing towards inland regions; the level of commercial development showed a positive correlation in the west and a negative correlation in the east; the spatial pattern of transportation capacity shifted from a pronounced east–west polarization to a more fragmented multi-cluster distribution; and transportation accessibility demonstrated spatial heterogeneity, with positive correlation in the southeast coastal areas and negative correlation in the west. Full article

Background/Objectives: More than half of all pregnant women in the United States exceed gestational weight gain (GWG) recommendations, which is associated with negative maternal and child health outcomes. The aim of this study was to examine the relationship between prenatal diet quality, measured with the Healthy Eating Index (HEI)-2020, and odds of excessive GWG among a predominantly Latina sample living in the US. Methods: This was a secondary data analysis from a longitudinal study and included 118 pregnant women between the ages of 18 and 45. Logistic regression models were used to investigate if higher scores of the HEI components were associated with a reduced risk for excessive GWG. Results: About 17% of the sample was classified with inadequate GWG, 22% with adequate GWG, and 61% with excessive GWG. The mean total HEI score for the total sample was 54.1 out of 100. (Higher total HEI scores suggest better dietary quality.) When compared with the scores of the inadequate and excessive GWG groups, the adequate GWG group had significantly higher total HEI scores (58.4) (p < 0.05), as well as specific HEI component scores: Greens and Beans (3.5) and Seafood and Plant Proteins (3.5) (p < 0.01). A higher score on these HEI components was associated with a lower risk of excessive GWG. Conclusions: Meeting the recommended daily servings of greens and beans, as well as seafood and plant proteins, may help reduce the risk of excessive GWG. Full article

Background: Although green supply chain management (GSCM) has been widely examined, prior studies have often treated it as a homogeneous construct and have paid limited attention to how different types of GSCM practices operate in logistics firms. This study addresses this gap by distinguishing between technical GSCM practices and behavioral GSCM practices and examining how both dimensions influence organizational performance through green innovation culture (GIC). Methods: Drawing on data from a cross-sectional survey of 426 logistics practitioners involved in supply chain, operations, and sustainability-related functions in Guangzhou, China, the study tested the proposed model using structural equation modeling (SEM). Results: Both technical and behavioral GSCM practices positively influence GIC, with behavioral practices having a stronger effect. GIC significantly improves organizational performance. Technical and behavioral GSCM practices also directly enhance organizational performance, indicating partial mediation. The indirect effect of behavioral GSCM practices through GIC is stronger, suggesting that behavioral governance is especially important for developing an innovation-oriented green culture. Conclusions: The study advances GSCM and green innovation literature and suggests logistics firms can achieve more sustainable performance improvements by combining technological upgrading with leadership support, employee involvement, stakeholder collaboration, and an innovation-oriented green culture. Full article

Background: Circular logistics translates circular economy principles into practical supply chain processes, but its adoption varies across firms because organizations differ in sustainability commitment, circular supply chain motivation, shared circular identity, and digital traceability capability. This study examines how supplier sustainability commitment and circular supply chain motivation influence circular logistics adoption through circular supply chain identity, while also testing the moderating role of digital traceability capability. Methods: Data were collected from 350 supply chain professionals in Saudi Arabia and analyzed using partial least squares structural equation modeling (PLS-SEM). Results: Supplier sustainability commitment and circular supply chain motivation positively influenced both circular logistics adoption and circular supply chain identity. Circular supply chain identity also positively affected circular logistics adoption and partially mediated the effects of both antecedents. Digital traceability capability acted as a selective moderator: it weakened the circular supply chain motivation–identity relationship, did not significantly moderate the supplier sustainability commitment–adoption relationship, but strengthened the circular supply chain identity–adoption relationship. It also moderated the indirect effect of circular supply chain motivation on circular logistics adoption through circular supply chain identity. Conclusions: Circular logistics adoption is driven not only by commitment and motivation, but also by shared circular identity and digitally enabled traceability. Full article

Carbon reduction is an urgent challenge for developing nations that balance socioeconomic development and climate mitigation in global low-carbon control. As a key digital economy means, e-commerce development enables urban low-carbon transition. In this context, drawing on a Chinese panel dataset covering 283 cities during 2006–2022, and taking the National E-commerce Demonstration City Pilot Policy (NEDCP) as a quasi-natural experiment, we use a multi-stage difference-in-differences (DID) strategy to detect how NEDCP affects urban carbon emissions. The results reveal that the NEDCP greatly reduces carbon emissions at an urban scale, which remains robust through a series of robustness tests. Mechanism analysis focuses on three channels, which includes boosting energy efficiency, advancing the digital economy, and promoting green innovation. Heterogeneity tests show that these benefits are more strongly evident in cities with a higher openness, a larger population, better economic conditions, and a stronger innovation capacity. The spatial spillover effect test shows that the NEDCP not only promotes local carbon reduction, but also promotes carbon reduction in neighboring areas. These findings offer theoretical insights for enhancing the NEDCP’s environmental benefits, and a practical guide for differentiated low-carbon development strategies, especially for prioritizing logistics and innovation support and refining green e-commerce standards. Full article

This study evaluates the implications of Egypt’s accession to the BRICS+ bloc by integrating a Poisson Pseudo-Maximum Likelihood gravity model with a comprehensive PESTEL analysis. Using panel data on Egypt’s bilateral trade with BRICS+ from 2005 to 2024, our econometric results reveal that partner-country economic size and cultural proximity are the primary drivers of trade, whereas geographical distance exerts a negligible effect. Furthermore, trade policy variables—specifically tariffs, exchange rate fluctuations, and existing preferential trade agreements—significantly shape trade flows, while logistics performance and general trade openness demonstrate limited short-term impact. Beyond trade mechanics, the PESTEL analysis indicates that while BRICS+ membership enhances Egypt’s strategic autonomy and broadens its political influence, tangible economic gains remain heavily constrained by persistent structural trade imbalances and a lack of export diversification. Although the bloc offers valuable opportunities for human capital development and green infrastructure financing, technological cooperation is hindered by capacity disparities, and the soft-law nature of the alliance limits the enforceability of economic agreements. Ultimately, this study concludes that to maximize the benefits of BRICS+, Egypt must implement sustained structural reforms aimed at upgrading industrial competitiveness, diversifying its export base, strengthening domestic technological capabilities, and embedding itself more deeply within global value chains. Full article

The rapid growth of the low-altitude economy and urban air mobility (UAM) is reshaping urban transport and infrastructure systems. However, current planning practices still tend to treat green spaces, stormwater facilities, and drone infrastructure as separate subsystems. This paper proposes a Garden Hydrology UAV collaborative infrastructure framework for resilient urban low-altitude logistics and inspection. Pocket parks and sponge city facilities (rain gardens, detention basins) are redesigned as multi-functional UAV bases that integrate take-off/landing and charging with stormwater retention and recreation. A SWMM-based hydrological model provides time-varying inundation and storage states, which are mapped into dynamic node availability constraints for UAV operations, using EPA SWMM 5.2. A multi-objective optimization model is formulated to minimize logistics operation cost, hydrological risk exposure and noise impact on sensitive receptors, while respecting airspace and battery constraints. A stylized 4 km² high-density district is used to evaluate three scenarios: depot-only operations, garden–UAV integration without hydrological coupling, and the full collaborative framework with SWMM-based node availability and high-precision navigation. Simulation results show that the integrated design reduces makespan by up to 19.7%, energy use by 22.3%, and hydrological risk exposure by 63.4%, while lowering noise exposure by 21.3%, relative to the baseline. The study suggests that garden and sponge city infrastructures can become key physical supports of smart low-altitude networks under the low-altitude economy. Full article

Background: The rapid growth of e-commerce has intensified the tension between customer expectations for fast, convenient delivery and the need for more sustainable last-mile logistics. While existing studies have examined speed, price, sustainability, and convenience as separate delivery attributes, less attention has been given to how these dimensions are combined and presented in consumer-facing delivery options. Methods: This study adopts a mixed-methods approach, combining a systematic literature review with structured analysis of publicly available delivery offers on websites across the UK retail and logistics sectors. Results: The findings show that delivery design remains strongly shaped by speed, price visibility, and convenience, while sustainability signals are rarely embedded at the point of customer choice. Although the literature highlights growing interest in green logistics, observed delivery menus suggest a persistent gap between sustainability commitments and their implementation at checkout. Five delivery strategy archetypes are identified, illustrating how firms configure trade-offs among fast delivery, affordability, sustainability signalling, and convenience. Conclusions: The study contributes a four-pillar choice architecture framework for understanding online delivery design. It highlights the need for clearer sustainability communication, greener default options, and stronger alignment among firm strategy, consumer decision-making, and policy support in last-mile delivery. Full article

Background: This study aims to evaluate the impact of energy and logistics factors on the milk producer price index to support evidence-based policies that maintain price stability at an optimal level. Methods: Annual data for 2000–2023 are used, including the milk producer price index, milk production volume, transport CPI, diesel price, CO₂ emissions from agriculture, and renewable energy consumption (percentage of total energy consumption). A log-linear ARDL model is applied to examine both short- and long-run asymmetric effects of diesel prices, transport costs, and agricultural CO₂ emissions on milk production dynamics. Results: The research results indicate that energy expenses, logistics considerations, and environmental metrics have statistically significant asymmetric influences on milk production. This underscores the varying short-term adjustments and enduring long-term economic effects throughout the supply chain. Conclusions: Energy and cost factors on the supply side significantly influence the stability of milk markets. Therefore, improving transportation efficiency, encouraging the use of renewable energy sources, and addressing environmental impacts can contribute to consistent and sustainable pricing. Specific policies—including investments in transport infrastructure, subsidies for green energy targeting dairy producers, carbon pricing with support tailored to the sector, and digitalization of supply chains—can enhance resilience and ensure price stability. Full article

Power grid technical renovation projects are implemented through project-based supply chains involving equipment procurement, logistics coordination and on-site construction under market, delivery and carbon constraints. Their final cost is jointly affected by engineering quantities, supplier behavior, lead-time uncertainty, material price volatility and sustainability requirements. Existing studies usually emphasize technical parameters and direct expenditure, whereas supplier reliability, green procurement, carbon intensity and procurement contingency effects are only indirectly incorporated. This study develops a dynamic Bayesian model for carbon-adjusted cost forecasting and investment priority support in power grid technical renovation projects. Based on 800 anonymized project-level records, a random forest is first used to identify informative engineering, supply chain and sustainability variables. These variables are then organized in a Bayesian network that links observed evidence, intermediate cost nodes and the carbon-adjusted cost target. A dynamic evidence-weighting mechanism updates posterior cost beliefs as supplier, logistics, market and carbon information become available during implementation. Compared with static Bayesian inference, XGBoost, an improved BPNN and GRA-based benchmarks, the proposed model yields lower MAE and RMSE. Ablation and scenario analyses further show that supply chain and sustainability variables improve both predictive performance and decision interpretability. The results provide a quantitative basis for budget control, green procurement adjustment, contingency allocation and sustainable asset renewal prioritization in energy enterprises. Full article

The conducted study examines the environmental impacts of logistics sector operations and possible solutions to reduce them. The main aim is to balance the stability of sustainability principles across economic, social, and environmental indicators by applying green methods. Logistics warehouse operations are also important, because they can also have negative impacts, but this study focuses on environmental pressures. Logistics firms choose to implement green sustainable methods because their major sustainability aim is the protection of the environment. Moreover, by achieving this vision, logistics companies can create better brand image and attract more customers and suppliers. This study included a survey conducted among various professionals to obtain a deep understanding of the topic, with the findings being visualised in charts to improve understanding and generate an interest for this area of study; a table illustration is also provided to clearly present the factors contributing to the environmental footprint of logistics firms and solutions to mitigate them. According to the results given in this article, it can be stated that the modern world shows great interest in the topic of sustainability and takes into strict consideration green methods in order to achieve sustainable operations efficiently. Full article

Background: Thailand is considered a logistics hub in Southeast Asia where the freight forwarding sector is essential for international trade and economic growth. This study aims to explore the relationships between logistics resources, strategic capabilities, competitive advantage, and organizational performance in Thailand’s freight forwarding sector. Methods: A quantitative cross-sectional survey was conducted with 250 management-level respondents from Thai freight forwarding companies. Partial Least Squares Structural Equation Modeling (PLS-SEM) was used to examine direct and mediating relationships among constructs. Results: Logistics resources significantly influenced competitive advantage, while strategic capabilities that integrate dynamic capabilities and green supply chain management exerted a stronger effect. Competitive advantage strongly predicted organizational performance, explaining 53.4% of its variance. Mediation analysis confirmed that competitive advantage mediates the effects of both logistics resources and strategic capabilities on organizational performance. Conclusions: Strategic capabilities exert greater impact on competitive advantage than static logistics resources, underscoring that organizational adaptability is more critical than resource possession alone. Freight forwarding firms should prioritize capability development and embed environmental management as a core competency rather than a compliance obligation. Full article

Despite accounting for less than 0.03% of the world’s greenhouse gas emissions, the Pacific Small Island Developing States (PSIDS) face existential threats to their environment, livelihoods, and regional stability due to their heavy dependence on imported fossil fuels and disproportionate climate vulnerability. To address this “Justice Paradox,” this study utilises a Nexus Mapping framework to qualitatively synthesise the non-linear causal pathways between climate stressors and energy system vulnerabilities. Through an integrative thematic synthesis of literature and regional policy documents, the research identifies systemic bottlenecks, including the “fiscal trap” of post-disaster reconstruction, the “demand-utility paradox” of rising temperatures, and the logistical premiums of archipelagic energy distribution. The analysis suggests that energy decarbonisation represents a strategic opportunity to strengthen climate security across four dimensions: human, national, international, and ecological. To facilitate a secure transition, the study proposes a comprehensive “policy mix” of regulatory standards (sticks), economic de-risking through mechanisms such as Sovereign Green Bonds (carrots), and the institutionalisation of local technical sovereignty (sermons). This research offers an interpretive analytical framework for Pacific policymakers, arguing that decentralised, modular renewables may serve as a strategic shield against climatic instability and support the preservation of regional statehood. Full article

Background/Objectives: Sentinel lymph node biopsy is central to axillary staging in breast cancer, but conventional mapping often relies on radioisotopes and/or blue dye. Indocyanine green fluorescence has emerged as an alternative, although evidence for its use as a sole tracer in routine practice remains limited. This study evaluated the technical feasibility, lymph node yield, nodal metastasis detection, and short-term clinical outcomes of indocyanine green used as the only tracer for axillary staging in a consecutive single-centre cohort. Methods: This retrospective observational cohort study included 260 patients with histologically confirmed breast cancer who underwent axillary surgery at University Hospital Kaspela between 2024 and 2025 under an institutional protocol using indocyanine green as the sole tracer. Indocyanine green-guided mapping was attempted in all patients. For node-focused statistical analyses, a predefined complete-case–cohort of 230 patients was used. Descriptive analyses assessed axillary procedure distribution, lymph node yield, nodal metastasis, and postoperative outcomes. Exploratory multivariable logistic regression was performed to evaluate predictors of nodal metastasis. Results: Mapping was successful in 259/260 patients (99.6%). In the complete-case–cohort, sentinel lymph node biopsy was performed in 166/230 patients (72.2%), targeted axillary dissection in 4/230 (1.7%), and axillary lymph node dissection in 60/230 (26.1%). Median overall lymph node yield was 4 (IQR 3–7), but this pooled value reflected heterogeneous axillary procedures and should not be interpreted as sentinel node yield alone. In the clinically node-negative upfront SLNB subgroup, median lymph node yield was 4 (IQR 2.75–5), and nodal metastasis was identified in 22/112 patients (19.6%). Overall, nodal metastasis was identified in 58/230 patients (25.2%), with a median of 2 metastatic nodes (IQR 1–3) among nodal-positive cases. Reoperation for axillary lymph node dissection occurred in 14/230 patients (6.1%). In exploratory multivariable analysis, suspicious biopsied-positive nodes (OR 12.85, 95% CI 3.98–41.52), suspicious non-biopsied nodes (OR 15.58, 95% CI 3.44–70.59), and neoadjuvant therapy (OR 0.31, 95% CI 0.11–0.87) were associated with nodal metastasis; these findings should be interpreted cautiously given the expected clinical relationship between preoperative nodal suspicion and nodal positivity, and the limited number of nodal-positive events. Conclusions: Indocyanine green used as a sole tracer demonstrated high technical feasibility within a heterogeneous real-world axillary staging workflow in this single-centre cohort. These findings should be interpreted as implementation-focused feasibility data rather than formal diagnostic validation, given the retrospective design, heterogeneous case mix, and absence of an internal comparator. Full article