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12 pages, 535 KiB  
Article
Real-World Effectiveness of Rosuvastatin–Ezetimibe Single Pill (Rovazet®) in Korean Dyslipidemia Patients
by Hack-Lyoung Kim, Hyun Sung Joh, Sang-Hyun Kim and Myung-A Kim
J. Clin. Med. 2025, 14(15), 5480; https://doi.org/10.3390/jcm14155480 - 4 Aug 2025
Abstract
Background: Fixed-dose combinations of rosuvastatin and ezetimibe are increasingly used in clinical practice, but real-world data on their effectiveness and safety in large populations remain limited. Methods: This prospective, single-group, open-label, non-interventional observational study was conducted in the Republic of Korea to evaluate [...] Read more.
Background: Fixed-dose combinations of rosuvastatin and ezetimibe are increasingly used in clinical practice, but real-world data on their effectiveness and safety in large populations remain limited. Methods: This prospective, single-group, open-label, non-interventional observational study was conducted in the Republic of Korea to evaluate the effectiveness and safety of Rovazet® (a fixed-dose combination of rosuvastatin and ezetimibe). Patients were prospectively enrolled from 235 institutions (50 general hospitals and 185 private clinics) as part of routine clinical practice over a five-year period. Lipid profiles and medication compliance questionnaire results were collected at baseline, 12 weeks, and 24 weeks of treatment. Results: A total of 5527 patients with dyslipidemia, the majority were men (53.0%), and the mean age was 60.4 years. Rovazet® significantly reduced low-density lipoprotein cholesterol (LDL-C) by 23.5% at 12 weeks (from 117.47 ± 50.65 mg/dL to 81.14 ± 38.20 mg/dL; p < 0.0001) and by 27.4% at 24 weeks (from 117.47 ± 50.65 mg/dL to 74.52 ± 33.36 mg/dL; p < 0.0001). Total cholesterol was significantly reduced by 17.7% at 12 weeks and by 19.8% at 24 weeks. Rovazet® treatment reduced triglycerides by 4.1% at 12 weeks and by 7.2% at 24 weeks. High-density lipoprotein cholesterol increased by 4.5% at 12 weeks and by 7.9% at 24 weeks following Rovazet® treatment. These changes in lipid profiles were consistent, regardless of cardiovascular risk profiles. By 24 weeks of treatment with Rovazet®, 91.8% of patients had reached their target LDL-C goals. Adverse drug reactions were reported in 2.81% of patients, most of which were minor, indicating that Rovazet® was well tolerated. Conclusions: Rovazet® was effective in improving lipid profiles and well tolerated in Korean adults with dyslipidemia. Full article
(This article belongs to the Section Pharmacology)
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24 pages, 1376 KiB  
Article
Smart Agriculture in Ecuador: Adoption of IoT Technologies by Farmers in Guayas to Improve Agricultural Yields
by Ruth Rubí Peña-Holguín, Carlos Andrés Vaca-Coronel, Ruth María Farías-Lema, Sonnia Valeria Zapatier-Castro and Juan Diego Valenzuela-Cobos
Agriculture 2025, 15(15), 1679; https://doi.org/10.3390/agriculture15151679 - 2 Aug 2025
Viewed by 284
Abstract
The adoption of digital technologies, such as the Internet of Things (IoT), has emerged as a key strategy to improve efficiency, sustainability, and productivity in the agricultural sector, especially in contexts of modernization and digital transformation in developing regions. This study analyzes the [...] Read more.
The adoption of digital technologies, such as the Internet of Things (IoT), has emerged as a key strategy to improve efficiency, sustainability, and productivity in the agricultural sector, especially in contexts of modernization and digital transformation in developing regions. This study analyzes the key factors influencing the adoption of IoT technologies by farmers in the province of Guayas, Ecuador, and their impact on agricultural yields. The research is grounded in innovation diffusion theory and technology acceptance models, which emphasize the role of perception, usability, training, and economic viability in digital adoption. A total of 250 surveys were administered, with 232 valid responses (92.8% response rate), reflecting strong interest from the agricultural sector in digital transformation and precision agriculture. Using structural equation modeling (SEM), the results confirm that general perception of IoT (β = 0.514), practical functionality (β = 0.488), and technical training (β = 0.523) positively influence adoption, while high implementation costs negatively affect it (β = −0.651), all of which are statistically significant (p < 0.001). Furthermore, adoption has a strong positive effect on agricultural yield (β = 0.795). The model explained a high percentage of variance in both adoption (R2 = 0.771) and performance (R2 = 0.706), supporting its predictive capacity. These findings underscore the need for public and private institutions to implement targeted training and financing strategies to overcome economic barriers and foster the sustainable integration of IoT technologies in Ecuadorian agriculture. Full article
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29 pages, 1125 KiB  
Article
Orchestrating Power: The Cultural–Institutional Nexus and the Rise of Digital Innovation Ecosystems in Great Power Rivalry
by Deganit Paikowsky, Dmitry Payson and Yaacov Falkov
Systems 2025, 13(8), 643; https://doi.org/10.3390/systems13080643 - 1 Aug 2025
Viewed by 326
Abstract
This article examines how digital innovation ecosystems have emerged as strategic institutions of power in contemporary world politics. It argues that, unlike Cold War technological rivalries driven by centralized, state-led control, today’s digital competition depends on states’ capacity to orchestrate scalable, multistakeholder ecosystems. [...] Read more.
This article examines how digital innovation ecosystems have emerged as strategic institutions of power in contemporary world politics. It argues that, unlike Cold War technological rivalries driven by centralized, state-led control, today’s digital competition depends on states’ capacity to orchestrate scalable, multistakeholder ecosystems. Using a cultural–institutional framework, we explain how differences in strategic culture and institutional governance impact the ecosystem’s vitality and performance. A qualitative comparative analysis of the United States, China, and Russia reveals that constructive orchestration, aligning state institutions with generative, commercial-to-national innovation flows, enhances digital leadership, whereas rigid, obstructive governance limits it. This highlights ecosystem governance as a critical dimension of statecraft in the digital age. The findings underscore that the positions of great powers in the global technological hierarchy depend not only on resources or capabilities but also on the effectiveness of ecosystem governance as an evolving instrument of geopolitical power. Full article
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11 pages, 209 KiB  
Article
Knowledge and Awareness of Dental Students and Practitioners About the Utilization of Endocrown
by Raneem Alfahad, Maryam Quritum, Lamia Hakami, Maha Aldandan, Osama Alharbi, Omar Almasoud, Abdullah Alasafirah and Passent Ellakany
Dent. J. 2025, 13(8), 348; https://doi.org/10.3390/dj13080348 - 29 Jul 2025
Viewed by 229
Abstract
Background/Objectives: The aim of this study was to evaluate the level of awareness among dental students and practitioners regarding the utilization of endocrowns in clinical settings, along with any differences in knowledge based on gender, educational level, and workplace. Methods: A [...] Read more.
Background/Objectives: The aim of this study was to evaluate the level of awareness among dental students and practitioners regarding the utilization of endocrowns in clinical settings, along with any differences in knowledge based on gender, educational level, and workplace. Methods: A cross-sectional online survey-based study was conducted, including 1154 participants from various dental institutions across Saudi Arabia. The questionnaire included demographic data and closed-ended questions focused on knowledge and awareness of endocrowns. Data was analyzed using statistical tests, including chi-square, to see any significant differences. Results: Most participants (81%) had knowledge about endocrowns, mainly from their colleagues. Knowledge levels and preferences (like the use of lithium disilicate and adhesive resin cement) differed based on gender, educational level, and workplace. Male participants and undergraduates showed better awareness in some areas. Faculty members mostly depend on college training, while private practitioners obtain most of their information from workshops. Conclusions: Males showed significant superiority in knowledge about endocrown usage. Colleges were the most prevalent source of information regarding endocrown restorations. Significant molar tooth loss and restricted inter-arch space were the most common reasons for utilizing endocrowns. Moreover, endocrowns were considered a viable alternative to traditional post and core. Full article
(This article belongs to the Special Issue Dental Education: Innovation and Challenge)
18 pages, 417 KiB  
Article
The Role of Service Quality in Enhancing Technological Innovation, Satisfaction, and Loyalty Among University Students in Northern Cyprus
by Birgül Gürbüzer and Ahmet Münir Acuner
Sustainability 2025, 17(15), 6832; https://doi.org/10.3390/su17156832 - 28 Jul 2025
Viewed by 331
Abstract
In the increasingly competitive landscape of higher education, student satisfaction and loyalty are recognized as essential components for institutional sustainability and long-term success. This study aims to examine the interrelationships between service quality, technological innovation, student satisfaction, and student loyalty within higher education [...] Read more.
In the increasingly competitive landscape of higher education, student satisfaction and loyalty are recognized as essential components for institutional sustainability and long-term success. This study aims to examine the interrelationships between service quality, technological innovation, student satisfaction, and student loyalty within higher education institutions in the Turkish Republic of Northern Cyprus (TRNC). Grounded in relationship marketing theory and the expectancy–disconfirmation paradigm, the research develops and tests a structural model that investigates the impact of perceived service quality on technological innovation, student satisfaction, and loyalty. The data were collected from 448 undergraduate students studying in the faculties of education at five leading private universities in TRNC, selected based on their international academic rankings. The analysis, conducted using structural equation modelling (SEM), reveals that service quality significantly and directly influences technological innovation, student satisfaction, and student loyalty. Additionally, technological innovation has a positive but comparatively weaker effect on student loyalty. Among the variables, student satisfaction emerges as the strongest determinant of loyalty, serving as a key mediator in the relationship between service quality and loyalty. This research contributes to the higher education literature by extending the traditional service quality–loyalty framework with the inclusion of technological innovation. The findings offer practical insights for university administrators, emphasizing the importance of delivering high-quality educational services combined with continuous digital innovation to enhance the student experience and foster long-term student commitment. Full article
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12 pages, 262 KiB  
Editorial
Procedural Physician-Scientists as Catalysts for Innovation in Team Science and Clinical Care
by Sajid A. Khan, Kurt S. Schultz and Nita Ahuja
Cancers 2025, 17(15), 2468; https://doi.org/10.3390/cancers17152468 - 25 Jul 2025
Viewed by 201
Abstract
Procedural physician-scientists have made significant contributions to medicine and science, with twelve proceduralists receiving a Nobel Prize. Unfortunately, several systemic challenges have jeopardized the existence, let alone the flourishing, of procedural physician-scientists: the widening gap in the National Institutes of Health salary cap, [...] Read more.
Procedural physician-scientists have made significant contributions to medicine and science, with twelve proceduralists receiving a Nobel Prize. Unfortunately, several systemic challenges have jeopardized the existence, let alone the flourishing, of procedural physician-scientists: the widening gap in the National Institutes of Health salary cap, decreasing funding from nonfederal public and private agencies, and shifting priorities among U.S. hospitals, payers, and policymakers toward relative value unit productivity-based compensation and fee-for-service models. Additional pressures include prolonged training pathways and the need to maintain clinical continuity. Adopting a team science approach may offer a powerful strategy to mitigate these competing demands, support rigorous scientific inquiry, and address the growing complexity of biomedical research. Concerted efforts by the federal government, policymakers, corporations, institutions, and procedural departments will also be crucial to restoring the vitality of this diminishing workforce. Full article
(This article belongs to the Special Issue Insights from the Editorial Board Member)
16 pages, 722 KiB  
Article
From Desalination to Governance: A Comparative Study of Water Reuse Strategies in Southern European Hospitality
by Eleonora Santos
Sustainability 2025, 17(15), 6725; https://doi.org/10.3390/su17156725 - 24 Jul 2025
Viewed by 311
Abstract
As climate change intensified water scarcity in Southern Europe, tourism-dependent regions such as Portugal’s Algarve faced growing pressure to adapt their water management systems. This study investigated how hotel groups in the Algarve have adopted and communicated water reuse technologies—specifically desalination and greywater [...] Read more.
As climate change intensified water scarcity in Southern Europe, tourism-dependent regions such as Portugal’s Algarve faced growing pressure to adapt their water management systems. This study investigated how hotel groups in the Algarve have adopted and communicated water reuse technologies—specifically desalination and greywater recycling—under environmental, institutional, and reputational constraints. A comparative qualitative case study was conducted involving three hotel groups—Vila Vita Parc, Pestana Group, and Vila Galé—selected through purposive sampling based on organizational capacity and technology adoption stage. The analysis was supported by a supplementary mini-case from Mallorca, Spain. Publicly accessible documents, including sustainability reports, media coverage, and policy frameworks, were thematically coded using organizational environmental behavior theory and the OECD Principles on Water Governance. The results demonstrated that (1) higher organizational capacity was associated with greater maturity in water reuse implementation; (2) communication transparency increased alongside technological advancement; and (3) early-stage adopters encountered stronger financial, regulatory, and operational barriers. These findings culminated in the development of the Maturity–Communication–Governance (MCG) Framework, which elucidates how internal resources, stakeholder signaling, and institutional alignment influence sustainable infrastructure uptake. This research offered policy recommendations to scale water reuse in tourism through financial incentives, regulatory simplification, and public–private partnerships. The study contributed to the literature on sustainable tourism and decentralized climate adaptation, aligning with UN Sustainable Development Goals 6.4, 12.6, and 13. Full article
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57 pages, 1459 KiB  
Article
Sustainable Digital Banking in Turkey: Analysis of Mobile Banking Applications Using Customer-Generated Content
by Yavuz Selim Balcioglu and Furkan Evranos
Sustainability 2025, 17(15), 6676; https://doi.org/10.3390/su17156676 - 22 Jul 2025
Viewed by 401
Abstract
This study addresses a critical gap in understanding how mobile banking applications contribute to sustainable development by introducing a novel text mining framework to analyze sustainability dimensions through user-generated content. We analyzed 120,000 reviews from six major Turkish mobile banking applications using an [...] Read more.
This study addresses a critical gap in understanding how mobile banking applications contribute to sustainable development by introducing a novel text mining framework to analyze sustainability dimensions through user-generated content. We analyzed 120,000 reviews from six major Turkish mobile banking applications using an ownership-sensitive analytical approach that integrates structural topic modeling with four sustainability dimensions (environmental, social, governance, and economic). Our analysis reveals significant institutional differences in sustainability approaches: government-owned banks demonstrate substantially stronger overall sustainability orientation (23.43% vs. 11.83% coverage) with pronounced emphasis on social sustainability (+181.7% growth) and economic development (+104.2% growth), while private banks prioritize innovation-focused sustainability. The temporal analysis (2022–2025) shows accelerating sustainability emphasis across all institutions, with distinct evolution patterns by ownership type. Institution-specific sustainability profiles emerge clearly, with each government bank demonstrating distinctive focus areas aligned with historical missions: cultural heritage preservation, agricultural sector support, and small business development. Mapping to Sustainable Development Goals reveals that government banks prioritize development-focused goals (SDGs 1, 8, and 10), while private banks emphasize innovation-focused goals (SDGs 9 and 17). This research makes three key contributions: demonstrating user-generated content as an effective lens for authentic sustainability assessment, establishing ownership-sensitive evaluation frameworks for digital banking sustainability, and providing empirical evidence for contextualized rather than universal sustainability strategies. The findings offer strategic implications for financial institutions, policymakers, and app developers seeking to enhance sustainable digital banking transformation. Full article
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25 pages, 4929 KiB  
Article
Public–Private Partnership for the Sustainable Development of Tourism Hospitality: Comparisons Between Italy and Saudi Arabia
by Sara Sampieri and Silvia Mazzetto
Sustainability 2025, 17(15), 6662; https://doi.org/10.3390/su17156662 - 22 Jul 2025
Viewed by 580
Abstract
This study examines the role of public–private partnerships in promoting the sustainable development of travel destinations through a comparative analysis of two emblematic heritage-based hospitality projects: Dar Tantora in Al Ula, Saudi Arabia, and Sextantio Le Grotte della Civita in Matera, Italy. These [...] Read more.
This study examines the role of public–private partnerships in promoting the sustainable development of travel destinations through a comparative analysis of two emblematic heritage-based hospitality projects: Dar Tantora in Al Ula, Saudi Arabia, and Sextantio Le Grotte della Civita in Matera, Italy. These case studies were analysed through both architectural–urban and economic–legal perspectives to highlight how public–private partnership models can support heritage conservation, community engagement, and responsible tourism development. A mixed-methods approach was employed, combining quantitative indicators—such as projected profitability, tourist volume, and employment—with qualitative insights from interviews with key stakeholders. The analysis reveals that while both models prioritise cultural authenticity and adaptive reuse, they differ significantly in funding structures, legal frameworks, and governance dynamics. Dar Tantora exemplifies a top-down, publicly funded model integrated into Saudi Arabia’s Vision 2030 strategy, whereas Sextantio reflects a bottom-up, private initiative rooted in social enterprise. The findings offer insights into how different public–private partnership configurations can foster sustainable tourism development, depending on local context, institutional frameworks, and strategic goals. The study contributes to the broader discourse on regenerative tourism, architectural conservation, and policy-driven heritage reuse. Full article
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29 pages, 2168 KiB  
Article
Credit Sales and Risk Scoring: A FinTech Innovation
by Faten Ben Bouheni, Manish Tewari, Andrew Salamon, Payson Johnston and Kevin Hopkins
FinTech 2025, 4(3), 31; https://doi.org/10.3390/fintech4030031 - 18 Jul 2025
Viewed by 404
Abstract
This paper explores the effectiveness of an innovative FinTech risk-scoring model to predict the risk-appropriate return for short-term credit sales. The risk score serves to mitigate the information asymmetry between the seller of receivables (“Seller”) and the purchaser (“Funder”), at the same time [...] Read more.
This paper explores the effectiveness of an innovative FinTech risk-scoring model to predict the risk-appropriate return for short-term credit sales. The risk score serves to mitigate the information asymmetry between the seller of receivables (“Seller”) and the purchaser (“Funder”), at the same time providing an opportunity for the Funder to earn returns as well as to diversify its portfolio on a risk-appropriate basis. Selling receivables/credit to potential Funders at a risk-appropriate discount also helps Sellers to maintain their short-term financial liquidity and provide the necessary cash flow for operations and other immediate financial needs. We use 18,304 short-term credit-sale transactions between 23 April 2020 and 30 September 2022 from the private FinTech startup Crowdz and its Sustainability, Underwriting, Risk & Financial (SURF) risk-scoring system to analyze the risk/return relationship. The data includes risk scores for both Sellers of receivables (e.g., invoices) along with the Obligors (firms purchasing goods and services from the Seller) on those receivables and provides, as outputs, the mutual gains by the Sellers and the financial institutions or other investors funding the receivables (i.e., the Funders). Our analysis shows that the SURF Score is instrumental in mitigating the information asymmetry between the Sellers and the Funders and provides risk-appropriate periodic returns to the Funders across industries. A comparative analysis shows that the use of SURF technology generates higher risk-appropriate annualized internal rates of return (IRR) as compared to nonuse of the SURF Score risk-scoring system in these transactions. While Sellers and Funders enter into a win-win relationship (in the absence of a default), Sellers of credit instruments are not often scored based on the potential diversification by industry classification. Crowdz’s SURF technology does so and provides Funders with diversification opportunities through numerous invoices of differing amounts and SURF Scores in a wide range of industries. The analysis also shows that Sellers generally have lower financing stability as compared to the Obligors (payers on receivables), a fact captured in the SURF Scores. Full article
(This article belongs to the Special Issue Trends and New Developments in FinTech)
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17 pages, 708 KiB  
Article
Government Communication in Tourism Governance: Analyzing Ministerial Responses to Parliamentary Inquiries and Voter Petitions
by Dat Hung Ho and Hak-Seon Kim
Tour. Hosp. 2025, 6(3), 143; https://doi.org/10.3390/tourhosp6030143 - 18 Jul 2025
Viewed by 314
Abstract
This study analyzes how Vietnam’s Ministry of Culture, Sports and Tourism (MoCST) communicates policy implementation in tourism governance through 35 official responses to citizen petitions, using Heidbreder’s Multilevel Policy Implementation Strategies Framework (centralization, agencification, convergence, networking). Content coding, frequency analysis, co-occurrence network, and [...] Read more.
This study analyzes how Vietnam’s Ministry of Culture, Sports and Tourism (MoCST) communicates policy implementation in tourism governance through 35 official responses to citizen petitions, using Heidbreder’s Multilevel Policy Implementation Strategies Framework (centralization, agencification, convergence, networking). Content coding, frequency analysis, co-occurrence network, and sentiment analysis reveal a dominant centralization pattern, with MoCST maintaining strong top-down control in decision-making and resource allocation. Convergence reflects increased inter-ministerial coordination, while agencification is limited, and networking with private or civil sectors remains weak. This weak networking limits participatory decision-making and hinders the development of adaptive, community-based tourism initiatives, which are crucial for sustainable tourism governance. Positive sentiment is more associated with centralized and convergent actions, indicating institutional trust. The study extends Heidbreder’s framework to a non-Western, centralized context and calls for stronger local agency roles and inclusive networks to enhance resilience and community ownership in policy implementation. Full article
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23 pages, 1309 KiB  
Review
Development and Transfer of Microbial Agrobiotechnologies in Contrasting Agrosystems: Experience of Kazakhstan and China
by Aimeken M. Nygymetova, Assemgul K. Sadvakasova, Dilnaz E. Zaletova, Bekzhan D. Kossalbayev, Meruyert O. Bauenova, Jingjing Wang, Zhiyong Huang, Fariza K. Sarsekeyeva, Dariga K. Kirbayeva and Suleyman I. Allakhverdiev
Plants 2025, 14(14), 2208; https://doi.org/10.3390/plants14142208 - 17 Jul 2025
Viewed by 491
Abstract
The development and implementation of microbial consortium-based biofertilizers represent a promising direction in sustainable agriculture, particularly in the context of the ongoing global ecological and agricultural crisis. This article examines the agroecological and economic impacts of applying microbial consortiums and explores the mechanisms [...] Read more.
The development and implementation of microbial consortium-based biofertilizers represent a promising direction in sustainable agriculture, particularly in the context of the ongoing global ecological and agricultural crisis. This article examines the agroecological and economic impacts of applying microbial consortiums and explores the mechanisms of technology transfer using the example of two countries with differing levels of scientific and technological advancement–China and Kazakhstan. The analysis of the Chinese experience reveals that the successful integration of microbial biofertilizers into agricultural practice is made possible by a well-established institutional framework that includes strong governmental support for R&D, a robust scientific infrastructure, and effective coordination with the private sector. In contrast, Kazakhstan, despite its favorable agroecological conditions and growing interest among farmers in environmentally friendly technologies, faces several challenges from limited funding to a fragmented technology transfer system. The comparative study demonstrates that adapting Chinese models requires consideration of local specificities and the strengthening of intergovernmental cooperation. The article concludes by emphasizing the need to establish a multi-level innovation ecosystem encompassing the entire cycle of development and deployment of microbial biofertilizers, as a prerequisite for improving agricultural productivity and ensuring food security in countries at different stages of economic development. Full article
(This article belongs to the Special Issue Emerging Trends in Alternative and Sustainable Crop Production)
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24 pages, 740 KiB  
Article
Optimizing Government Debt Structure and Alleviating Financing Constraints: Access to Private Enterprises’ Sustainable Development
by Wenda Sun, Genhua Hu and Tingting Zhu
Sustainability 2025, 17(14), 6509; https://doi.org/10.3390/su17146509 - 16 Jul 2025
Viewed by 393
Abstract
To promote the deepening of reform and the effective implementation of policies, the State Council launched the special supervision of the liquidation of local governments’ arrears in project funds in 2016, which supports the optimization of the government debt structure. Based on the [...] Read more.
To promote the deepening of reform and the effective implementation of policies, the State Council launched the special supervision of the liquidation of local governments’ arrears in project funds in 2016, which supports the optimization of the government debt structure. Based on the quasi-natural experiment of the special supervision action, in this study, we use the difference-in-difference (DID) method to investigate the effect and mechanism of the optimization of the government debt structure on the financing constraints of private enterprises. This research is particularly relevant for private enterprises, which face acute financing challenges and are critical for promoting inclusive economic growth, employment, and innovation—key pillars of sustainable development. The results are as follows. Firstly, the special supervision significantly reduces the financing constraints of private enterprises. Secondly, it has heterogeneous effects on the financing constraints of different types of enterprises, and the alleviating effect is particularly significant for enterprises that rely on the funding support of local governments. This highlights the importance of institutional reforms in fostering equitable access to financial resources for vulnerable enterprise groups such as private enterprises. Thirdly, the optimization of the government debt structure eases enterprises’ financing constraints by improving their capital turnover and trade credit. By enhancing liquidity and creditworthiness, these changes create a more resilient financial environment for private enterprises, supporting their long-term development and contribution to sustainable economic systems. Full article
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27 pages, 541 KiB  
Article
Institutional Quality, Public Debt, and Sustainable Economic Growth: Evidence from a Global Panel
by Hengyu Shi, Dingwei Song and Muhammad Ramzan
Sustainability 2025, 17(14), 6487; https://doi.org/10.3390/su17146487 - 16 Jul 2025
Viewed by 491
Abstract
Achieving sustainable economic growth requires a careful balance between public debt accumulation and the macroeconomic stability necessary for long-term development. While public debt can support growth through productive public investment, excessive debt may crowd out private investment, raise borrowing costs, and undermine financial [...] Read more.
Achieving sustainable economic growth requires a careful balance between public debt accumulation and the macroeconomic stability necessary for long-term development. While public debt can support growth through productive public investment, excessive debt may crowd out private investment, raise borrowing costs, and undermine financial stability, ultimately threatening economic sustainability. In this context, the quality of institutions plays a pivotal moderating role by fostering responsible debt management and ensuring that debt-financed investments contribute to sustainable development. In this context, this study investigates the relationship between public debt and economic growth, with a focus on the moderating role of institutional quality (IQ). Utilizing an unbalanced panel of 115 countries over the period from 1996 to 2021, this study tests the hypothesis that robust institutional frameworks mitigate the negative impact of public debt on economic growth. To address potential endogeneity, this study employs the dynamic system Generalized Method of Moments (GMM) estimation technique. The results reveal that, although the direct effect of public debt on economic growth is negative, the interaction between public debt and IQ yields a positive influence. Furthermore, the results indicate the presence of a threshold beyond which public debt begins to exert a beneficial effect on economic growth, whereas its impact remains adverse below this threshold. These findings underscore the critical importance of sound debt management strategies and institutional development for policymakers, suggesting that effective government governance is essential to harnessing the potential positive effects of public debt on economic growth. Full article
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40 pages, 3646 KiB  
Article
Novel Deep Learning Model for Glaucoma Detection Using Fusion of Fundus and Optical Coherence Tomography Images
by Saad Islam, Ravinesh C. Deo, Prabal Datta Barua, Jeffrey Soar and U. Rajendra Acharya
Sensors 2025, 25(14), 4337; https://doi.org/10.3390/s25144337 - 11 Jul 2025
Viewed by 623
Abstract
Glaucoma is a leading cause of irreversible blindness worldwide, yet early detection can prevent vision loss. This paper proposes a novel deep learning approach that combines two ophthalmic imaging modalities, fundus photographs and optical coherence tomography scans, as paired images from the same [...] Read more.
Glaucoma is a leading cause of irreversible blindness worldwide, yet early detection can prevent vision loss. This paper proposes a novel deep learning approach that combines two ophthalmic imaging modalities, fundus photographs and optical coherence tomography scans, as paired images from the same eye of each patient for automated glaucoma detection. We develop separate convolutional neural network models for fundus and optical coherence tomography images and a fusion model that integrates features from both modalities for each eye. The models are trained and evaluated on a private clinical dataset (Bangladesh Eye Hospital and Institute Ltd.) consisting of 216 healthy eye images (108 fundus, 108 optical coherence tomography) from 108 patients and 200 glaucomatous eye images (100 fundus, 100 optical coherence tomography) from 100 patients. Our methodology includes image preprocessing pipelines for each modality, custom convolutional neural network/ResNet-based architectures for single-modality analysis, and a two-branch fusion network combining fundus and optical coherence tomography feature representations. We report the performance (accuracy, sensitivity, specificity, and area under curve) of the fundus-only, optical coherence tomography-only, and fusion models. In addition to a fixed test set evaluation, we perform five-fold cross-validation, confirming the robustness and consistency of the fusion model across multiple data partitions. On our fixed test set, the fundus-only model achieves 86% accuracy (AUC 0.89) and the optical coherence tomography-only model, 84% accuracy (AUC 0.87). Our fused model reaches 92% accuracy (AUC 0.95), an absolute improvement of 6 percentage points and 8 percentage points over the fundus and OCT baselines, respectively. McNemar’s test on pooled five-fold validation predictions (b = 3, c = 18) yields χ2=10.7 (p = 0.001), and on optical coherence tomography-only vs. fused (b_o = 5, c_o = 20) χo2=9.0 (p = 0.003), confirming that the fusion gains are significant. Five-fold cross-validation further confirms these improvements (mean AUC 0.952±0.011. We also compare our results with the existing literature and discuss the clinical significance, limitations, and future work. To the best of our knowledge, this is the first time a novel deep learning model has been used on a fusion of paired fundus and optical coherence tomography images of the same patient for the detection of glaucoma. Full article
(This article belongs to the Special Issue AI and Big Data Analytics for Medical E-Diagnosis)
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