Search Results (1,645)

Achieving environmentally sustainable growth is a core challenge for developing economies, yet the welfare consequences of green development policies for vulnerable populations remain understudied. This article investigates the distributional impacts of one of the world’s largest development interventions: China’s energy transition. By integrating provincial-level energy metrics with a decade-long household panel survey (CFPS), we employ a fixed-effects model to provide a holistic assessment of the policy’s effects on household well-being. The analysis reveals a stark trade-off: a 10% increase in clean energy adoption generates significant non-monetary well-being gains, equivalent to a 190,000 CNY annual income rise, primarily through improved environmental quality and cleaner cooking fuel access. However, these benefits are partially offset by rising energy costs. Our heterogeneity analysis reveals a clear regressive burden: the transition significantly increases energy expenditures for rural and low-income households, while having a negligible or even cost-reducing effect on their urban and high-income counterparts. Our findings demonstrate that while the energy transition promotes aggregate welfare, its benefits are unevenly distributed, potentially exacerbating energy poverty and inequality. This underscores a critical development challenge: green growth is not automatically inclusive. We argue that for the energy transition to be truly pro-poor, it must be accompanied by robust social protection mechanisms, such as targeted subsidies, to shield the most vulnerable from the adverse economic shocks of the policy. Full article

Urban models support sustainable, resilient, and equitable planning, but their validity hinges on underlying spatial data. This study examines the epistemological and technical consequences of relying on two dominant yet divergent platforms—OpenStreetMap (OSM) and Google Maps—for extracting proximity-based amenities within the 15-min city framework. Across four European contexts—Versilia, Gothenburg, Nice, and Vienna—we compare (i) data completeness and spatial coverage; (ii) semantic categories; and (iii) the effects of data heterogeneity on accessibility modelling. Findings show that OSM, while semantically consistent and openly accessible, systematically underrepresents peripheral amenities, introducing bias towards urban cores in accessibility metrics. Conversely, Google Maps provides broader coverage but is constrained by dependencies on extraction methods, opaque data structures, and ambiguous classification schemes, which hinder reproducibility, reduce interpretability, and limit its analytical robustness. These divergences yield distinct accessibility landscapes and competing readings of functionality and spatial equity. We argue that data source choice and protocol design are epistemological decisions and advocate transparent, hybrid strategies with cross-platform semantic harmonisation to strengthen robustness, equity, and policy relevance. Full article

Areas characterised by high ecological and cultural value are increasingly exposed to overtourism and intensifying land-use pressures, often exacerbated by mobility policies aimed at enhancing regional accessibility and promoting tourism. These dynamics create spatial tensions, particularly in environmentally sensitive areas such as those within the Natura 2000 network and Sites of Community Importance (SCIs), where intensified visitor flows, and infrastructure expansion can disrupt the balance between conservation and development. This study offers a geospatial analysis of the current state (2024) of such dynamics in the Lazio Region (Italy), evaluating the effects of mobility strategies on ecological vulnerability and tourism pressure. By applying isochrone-based accessibility modelling, GIS buffer analysis, and spatial overlays, the research maps the intersection of accessibility, heritage value, and environmental sensitivity. The methodology enables the identification of critical zones where accessibility improvements coincide with heightened ecological risk and tourism-related stress. The original contribution of this work lies in its integrated spatial framework, which combines accessibility metrics with indicators of ecological and heritage significance to visualise and assess emerging risk areas. The Lazio Region, distinguished by its heterogeneous landscapes and ambitious mobility planning initiatives, constitutes a significant case study for examining how policy-driven improvements in transport infrastructure may inadvertently exacerbate spatial disparities and intensify ecological vulnerabilities in peripheral and sensitive territorial contexts. The findings support the formulation of adaptive, place-based policy recommendations aimed at mitigating the unintended consequences of accessibility-led tourism strategies. These include prioritising soft mobility, enhancing regulatory protection in high-risk zones, and fostering coordinated governance across sectors. Ultimately, the study advances a replicable methodology to inform sustainable territorial governance and balance tourism development with environmental preservation. Full article

The esterification of glycerol with acetic acid to produce acetylglycerols was investigated both in the absence of a catalyst and using several commercial FAU zeolites with varied acid site concentrations and pore structures. Specifically, ultra-stable Y zeolite (H-USY, CBV720; Si/Al: 15), ammonium Y zeolite (NH₄-Y, CBV300, Si/Al: 2.6), and Na-Y zeolite (CBV100, Si/Al: 2.6) were tested to evaluate their catalytic performance in this reaction. In addition, two control catalysts were assessed under identical conditions: a commercial acidic ion-exchange resin (Amberlyst 15, A15) and a homogeneous acid catalyst (p-toluenesulfonic acid, PTSA). The catalytic performance of both the ultra-stable Y zeolite (CBV720) and Amberlyst 15 resin was comparable to the best results previously reported for solid catalysts. Furthermore, a comprehensive examination of acidity and accessibility was conducted to better understand their behavior. As expected, PTSA exhibited higher yields but also showed common drawbacks associated with homogeneous catalysts, such as corrosion and difficulties in separation. From an environmental perspective, and considering potential reuse cycles, the CBV720 zeolite delivered promising results during five consecutive tests. Its levels of conversion and selectivity were comparable to those obtained with Amberlyst 15, making it a viable alternative for future studies. Full article

Digital inclusive finance (DIF) serves as a critical mechanism for sustainable economic development among marginalized populations. However, DIF’s impact on China’s 376 million migrants remains understudied, despite their significance for inclusive growth. This study provides the first comprehensive empirical analysis of DIF–migrant entrepreneurship relationships using nationally representative data and multiple analytical approaches. Three key findings emerge: First, DIF significantly reduces entrepreneurship likelihood among migrant populations (marginal effect: −0.449, p < 0.01). Second, heterogeneity analysis reveals differential impacts across entrepreneurial motivations—specifically, inhibiting necessity-driven entrepreneurship (marginal effect: −0.426) while showing no significant impact on opportunity-driven entrepreneurship. Third, while DIF reduces overall entrepreneurial participation, it substantially enhances income levels and the employment scale of existing migrant entrepreneurs. Mechanism analysis reveals that DIF operates through expanding urban employment demand and raising wage levels, thereby increasing entrepreneurship’s opportunity cost for migrants. These findings provide evidence for leveraging digital finance to achieve SDG 8 (Decent Work) and SDG 10 (Reduced Inequalities) while ensuring equitable access to digital dividends for vulnerable populations. Full article

Background: Deep infiltrating endometriosis (DIE) frequently affects the posterior pelvic compartment, where accurate non-invasive imaging is essential for diagnosis and surgical planning. Aim: This systematic review evaluates the diagnostic performance of transvaginal ultrasound (TVUS) in detecting posterior compartment DIE, specifically rectosigmoid lesions, uterosacral ligament involvement, and pouch of Douglas obliteration. Material and Methods: A comprehensive literature search of PubMed, Scopus, and Web of Science was performed for studies published between 2015 and 2025. Eligible studies assessed the accuracy of TVUS for posterior compartment DIE using laparoscopy and histology as reference standards. Data on sensitivity, specificity, and overall diagnostic accuracy were extracted or derived. The study’s quality was evaluated using the QUADAS-2 tool. Results: Thirty eligible studies were included. The mean sensitivities and specificities reported in the included studies reached 83.05% and 90.53% for rectosigmoid disease, 78.07% and 90.49% for uterosacral ligament involvement, and 79.58% and 89.75% for pouch of Douglas obliteration, respectively. Adjunctive techniques such as gel sonovaginography, rectal water contrast, or saline instillation into the pouch of Douglas were described, but their use was inconsistent. Marked heterogeneity in patient preparation, scanning protocols, and reporting limited comparability across studies. Despite this, TVUS demonstrated diagnostic performance within a similar range to that reported for MRI in prior systematic reviews, with the advantages of lower cost, accessibility, and integration into routine gynecological practice. Conclusions: TVUS is consistently reported as a reliable and cost-effective imaging modality and, in line with international guidelines, should be considered the first-line option for posterior compartment DIE, though further standardization of scanning and reporting protocols is needed to optimize reproducibility and clinical utility. Full article

Telerehabilitation is an effective, accessible addition or alternative to conventional rehabilitation for fracture management, especially in older adults after hip fractures, leveraging video visits, mHealth apps, virtual reality (VR), and wearable sensors to deliver exercise, education, and monitoring at home with high satisfaction and adherence. Across non-surgical and surgical contexts, telemedicine shows feasibility and cost benefits, with mixed superiority but consistent non-inferiority for functional outcomes versus in-person care. In hip fracture populations, randomized and non-randomized studies indicate improvements in functional independence measure (FIM), Timed Up and Go test (TUG), Activities of Daily Living/Instrumental Activities of Daily Living (ADLs/IADLs), and quality of life, with some evidence for reduced anxiety and depression, while effects on mobility, pain, and adverse events remain uncertain overall. In patients with upper-limb fractures, telerehabilitation appears to improve function and pain, though strength gains may lag compared with in-person therapy in some trials; adjuncts like motor imagery and virtual reality may enhance outcomes and motivation. Application is facilitated by user-friendly platforms, caregiver involvement, and simple modalities such as structured phone follow-up. Limitations include small samples, heterogeneous protocols, scarce long-term data, and a predominance of non-inferiority or complementary designs, warranting larger, definitive trials. This technology can lead to improved patient management at home, effortlessly verifying treatment compliance, efficacy, and safety, while simultaneously reducing the need for hospitalization, promoting a more peaceful recovery. Here, we have undertaken a narrative review of the medical–scientific literature in this field. Full article

Background: The digitalization of medical services is promoted as a solution for improving access, quality, and efficiency within healthcare systems. In this context, the study investigates the extent to which digitalization in Romania meets the current needs of patients through a convergent analysis of user perceptions and managerial perspectives. Based on the specialized literature, the research tests two hypotheses: (H1) the implementation of digital technologies significantly contributes to improving the quality of medical services and operational efficiency; (H2) digitalization has a positive impact on patient satisfaction by facilitating access to care and improving communication with medical personnel. Methods: The study adopted methodology is cross-sectional and mixed, including an online mixed-methods questionnaire for patients, distributed between 6 and 14 May 2025, and a qualitative questionnaire with open-ended questions distributed via e-mail to managers from public hospitals through The Administration of Hospitals and Medical Services of Bucharest, between 3 and 24 March 2025. Results: In total, 125 patients and 15 hospital managers participated in the study. Statistical analysis (χ², ordinal regression) and data triangulation highlight a predominantly positive, yet heterogeneous, patient perception of digitalization, with Hypothesis H1 only partially supported (weak, inconsistent, and in some cases negative associations between technology use and perceived service quality). By contrast, H2 was robustly validated, with patient satisfaction strongly linked to tangible benefits, particularly easier access and online appointment scheduling. However, use remains limited to administrative functions, while advanced technologies such as telemedicine or electronic health records are poorly adopted. From an institutional perspective, hospitals predominantly use IT systems for internal purposes, without real patient access to their own data, no interoperability between medical units, and marginal implementation of telemedicine. This reveals a significant gap between user perception and organizational realities, emphasizing the lack of a patient-oriented digital infrastructure. Conclusions: The results highlight the potential of digitalization to enhance patient experience and service efficiency, while also pointing out structural limitations that hinder the full realization of this potential. Patient satisfaction is strongly associated with tangible benefits, particularly easier access and online scheduling, whereas the effect on perceived quality is weaker and sometimes inconsistent. There are significant disparities in digitalization levels between healthcare providers, perceived by patients as public–private differences, and gaps among public hospitals are also confirmed by managerial data. These findings suggest that a successful digital transformation of the medical system in Romania must address both technological infrastructure gaps and organizational barriers, within a coordinated national strategy that ensures interoperability, patient-centered design, and sustainable implementation. Full article

Raising rural household income is central to narrowing the rural–urban gap and advancing common prosperity. Using data from the China Family Panel Studies (CFPS), this study examines the impact of digital skills, a key for human capital, on rural Chinese households’ income and uses a fixed-effects model and the instrumental variable method to address endogeneity. The study finds that digital skills raise total household income, and each additional skill is associated with an increase of CNY 1678. By skill type, online business skills have the largest effect, followed by work–study skills, while entertainment–social skills are negatively associated with income. Heterogeneity analyses indicate larger gains for households with lower educational attainment and lower income, showing that a stronger regional digital environment amplifies these effects. Mechanism tests point to factor reallocation toward the nonfarm sector, via higher probabilities of off-farm employment and entrepreneurship and improved access to formal credit, as the primary pathway. Consistent with these channels, digital skills increase wages and operating income and reduce inequality in these components, as well as benefitting total income, but they have no detectable effect on property or transfer income or their dispersion. These findings point to key implications for boosting rural income growth and reducing inequality, namely strengthening digital skill development and optimizing the digital environment to enhance rural households’ endogenous income-generating capacity. Full article

With the global deceleration of urbanization, traditional regeneration strategies centered on demolition and reconstruction have revealed substantial limitations. Against this backdrop, land-use transformation has emerged as a more cost-effective and less disruptive alternative. Focusing on Chengdu, China, this study employs a causal machine learning framework to rigorously assess the impacts of residential-to-commercial and industrial-to-commercial conversions on urban vitality. The findings demonstrate that population density consistently constitutes the fundamental driver across both transformation pathways. Residential-to-commercial conversion reflects a regeneration trajectory that integrates residential and commercial functions while prioritizing community livability, whereas industrial-to-commercial conversion entails large-scale spatial restructuring and enhanced accessibility. Overall, the study uncovers the heterogeneous causal effects of land-use transformation on urban vitality, thereby providing a theoretical basis to inform differentiated and sustainable urban regeneration policies. Full article

Urban park green space (UPGS) is a key component of urban green infrastructure, yet it faces multiple contradictions, such as insufficient quantity and uneven distribution. Taking Zhengzhou City as a case study, this research explored the impacts of temporal thresholds and the modifiable areal unit problem (MAUP) on UPGS accessibility and equity. An improved multi-modal Gaussian two-step floating catchment area (G2SFCA) method was employed to measure UPGS accessibility, while the Gini coefficient and Lorenz curve were used to analyze its equity. The results show that (1) UPGS presents a dual-core agglomeration feature, with accessibility blind spots surrounding the edge of the study area and relatively low equity in the western and southern regions; (2) changes in temporal thresholds and spatial scales have a significant impact on UPGS accessibility (p < 0.001), whereas their impact on equity is minor; and (3) UPGS distribution suffers from spatial imbalance, with a huge disparity in resource allocation. This study overcomes the limitations of traditional evaluation methods that rely on a single mode or ignore scale effects and provides a more scientific analytical framework for accurately identifying the spatial heterogeneity of UPGS accessibility and the imbalance between supply and demand. Full article

Street design quality and socio-economic factors jointly influence housing prices, but their intertwined effects and spatial variations remain under-quantified. Housing prices not only reflect residents’ neighborhood experiences but also stem from the spillover value of public streets perceived and used by different users. This study takes Tianjin as a case and views the street environment as an immediate experience proxy for through-travelers, combining street view images and crowdsourced perception data to extract both subjective and objective indicators of the street environment, and integrating neighborhood and location characteristics. We use Geographical-XGBoost to evaluate the relative contributions of multiple factors to housing prices and their spatial variations. The results show that incorporating both subjective and objective street information into the Hedonic Pricing Model (HPM) improves its explanatory power, while local modeling with G-XGBoost further reveals significant heterogeneity in the strength and direction of effects across different locations. The results indicate that incorporating both subjective and objective street information into the HPM enhances explanatory power, while local modeling with G-XGBoost reveals significant heterogeneity in the strength and direction of effects across different locations. Street greening, educational resources, and transportation accessibility are consistently associated with higher housing prices, but their strength varies by location. Core urban areas exhibit a “counterproductive effect” in terms of complexity and recognizability, while peripheral areas show a “barely acceptable effect,” which may increase cognitive load and uncertainty for through-travelers. In summary, street environments and socio-economic conditions jointly influence housing prices via a “corridor-side–community-side” dual-pathway: the former (enclosure, safety, recognizability) corresponds to immediate improvements for through-travelers, while the latter (education and public services) corresponds to long-term improvements for residents. Therefore, core urban areas should control design complexity and optimize human-scale safety cues, while peripheral areas should focus on enhancing public services and transportation, and meeting basic quality thresholds with green spaces and open areas. Urban renewal within a 15 min walking radius of residential areas is expected to collaboratively improve daily travel experiences and neighborhood quality for both residents and through-travelers, supporting differentiated housing policy development and enhancing overall quality of life. Full article

Chronic rhinosinusitis (CRS) is increasingly recognized as a heterogeneous condition characterized by distinct inflammatory endotypes. In Western populations, CRS is mostly type 2 (T2) eosinophilic. In contrast, Asian cohorts show higher rates of non-T2 endotypes, posing unique challenges and limiting the applicability of Western treatment models. This expert commentary and scoping review explores endotype-driven care in CRS, synthesizes current research on Asian CRS cohorts, and examines existing gaps in our understanding, particularly in non-T2 CRS. Endotype-driven care improves treatment precision and minimizes therapeutic failure. However, most models remain largely Western-centric. Establishing Asia-specific criteria, accessible diagnostics, and therapies for non-T2 disease is essential. Full article

Background: Maturity-onset diabetes of the young (MODY) is a heterogeneous group of monogenic diabetes forms that are frequently misclassified as type 1 or type 2 diabetes due to overlapping phenotypic features. The true prevalence of MODY is likely substantially underestimated. As DNA-based diagnostics become increasingly accessible, an expanding number of novel genetic variants are being identified. Objectives: The aim of this study was to characterize the clinical and genetic features of patients carrying rare variants in the BLK, KLF11, PAX4, PDX1, and CEL genes, with attention to population-specific aspects, family history, and treatment outcomes. Methods: Targeted next-generation sequencing (NGS) using a custom-designed panel covering 27 genes implicated in MODY, neonatal diabetes, and related hereditary syndromes was performed on the Illumina NovaSeq 6000 platform (Illumina). Results: We identified 21 variants in five genes associated with rare MODY subtypes among 24 unrelated patients. MODY9 was diagnosed in two unrelated patients of Russian ethnicity harboring an identical heterozygous missense mutation in exon 5 of the PAX4 gene (HG38, chr7:127615049G>A, c.191C>T, p.Thr64Ile), which has not been previously described in patients with diabetes. MODY11 was diagnosed in a patient carrying the c.773-1G>A variant in the BLK gene. A patient with a de novo c.40_41dupGC (p.Val15Glnfs*41) variant in the KLF11 gene was clinically diagnosed with type 1 diabetes. Conclusion: Our findings expand the current understanding of rare MODY subtypes and contribute to the growing body of evidence on the spectrum and frequency of potentially pathogenic variants in BLK, CEL, KLF11, PDX1, and PAX4 genes across ethnically diverse populations worldwide. Full article

Population aging presents pressing public health challenges, calling for accessible and effective interventions to preserve functional capacity and prevent frailty. Walking football, an adapted sport for older adults, has emerged as a promising approach by combining aerobic activity, neuromuscular stimulation, and social engagement. This scoping review aimed to synthesize experimental evidence on its effect on physical and functional outcomes in older adults. Following PRISMC-ScR and Joanna Briggs Institute guidelines, a systematic search across seven databases identified 10 studies with 332 participants (mean age 68.7 years, 85.2% male). Interventions lasted 6–16 weeks, with two to three weekly sessions. The outcomes assessed included strength, agility, cardiorespiratory fitness, body composition, and clinical parameters. Six studies reported improvements in at least one component of physical fitness, particularly handgrip strength, abdominal fat reduction, and aerobic capacity. Among the included studies, three were randomized controlled trials, four quasi-experimental designs, and three intervention studies without control groups, highlighting the methodological heterogeneity of the field. Some studies also reported benefits in blood pressure, glucose, cholesterol, and quality of life. Despite promising results, the literature lacks large-scale randomized trials, female representation, and long-term assessments. Walking football appears to be a safe, multicomponent, and low-cost strategy to support healthy aging and warrants integrations into public health policies. Full article