Search Results (459)

Background: The Middle East and North Africa (MENA) region faces a high cardiovascular disease (CVD) burden alongside endemic serum 25(OH)D (vitamin D) deficiency. This systematic review examines the relationship between vitamin D deficiency and CVD risk factors in MENA populations. Methods: PubMed, Cochrane Library, and Scopus were searched from inception to 18 October 2024, for observational studies in the MENA region examining vitamin D deficiency and cardiovascular risk factors in adults. Independent data extraction was conducted. Study quality was appraised using the Joanna Briggs Institute tool and the Newcastle–Ottawa Scale, with risk of bias visualized using Robvis. Weighted mean differences in cholesterol, body mass index (BMI), and HbA1c between those with and without vitamin D deficiency were computed with random-effects meta-analysis. The protocol was registered in PROSPERO (ID: CRD42025615188) and funded by the Royal College of Surgeons in Ireland—Medical University of Bahrain. Results: Seventeen studies from nine MENA countries were included, predominantly cross-sectional, involving community-based and disease-specific cohorts. Vitamin D deficiency was highly prevalent and consistently associated with higher adiposity and central obesity. Several studies reported significant links between deficiency and poor glycemic control, particularly in obese and prediabetic groups. Meta-analysis demonstrated significantly higher total cholesterol (MD = 0.32; 95% CI = 0.11 to 0.52, p < 0.001), BMI (MD = 1.81; 95% CI = 0.68 to 2.94, p < 0.001), and HbA1c levels (MD = 0.31; 95% CI = 0.06 to 0.57, p = 0.02) in vitamin D deficient individuals, with notable heterogeneity. Conclusions: Vitamin D deficiency is highly prevalent in the MENA region and consistently associated with adiposity-related risk factors. Despite heterogeneity, findings underscore the need for public health strategies and further research to clarify causal pathways and population-specific interventions. Full article

Background: Total hip arthroplasty (THA) for the late sequelae of childhood septic hip arthritis is technically demanding, and infection-related risk remains incompletely defined. This systematic review and meta-analysis address the research question: “In adults undergoing THA after childhood septic arthritis of the hip, what is the incidence of post-THA infection, revision, and mechanical/neurologic complications?” We systematically reviewed and meta-analyzed outcomes after THA in patients with septic hip arthritis diagnosed at ≤18 years. Methods: PubMed, Web of Science, Scopus, and the Cochrane Library were searched from inception to 31 December 2025 (PRISMA). Eligible studies reported THA outcomes after childhood septic arthritis and met a Methodological Index for Non-Randomized Studies (MINORS) threshold (≥9). A random-effects meta-analysis of events per hip was performed. Results: Nine studies were included; eight contributed to the quantitative synthesis (343 hips). The pooled incidence of any post-THA infection was 1.55% (95% CI 0.38–3.48; I² = 23.8%; 5/343); when microbiology was available, no relapse due to the index organism was reported and events were classified as new infections. The pooled incidence of revision for any cause was 4.99% (95% CI 2.27–8.70; I² = 43.4%; 15/334). Non-infectious complications were clinically relevant, including intraoperative fracture (6.95%) and nerve palsy (4.84%). Evidence was limited by retrospective designs and heterogeneous reporting. Conclusions: THA after childhood septic hip arthritis demonstrates a low risk of postoperative infection, with relapse of the original pathogen appearing rare in carefully selected quiescent cases, but a clinically meaningful burden of mechanical and neurologic complications. These findings underscore the importance of careful preoperative assessment, meticulous surgical technique, and highlight the limitations of the current evidence. The protocol was registered in PROSPERO (ID: CRD420261298181). No external funding was received. Full article

The date palm (Phoenix dactylifera L.) is a significant perennial crop in arid and semi-arid regions. Understanding the evolution of research on this crop is vital for identifying major research trends, current challenges, and emerging areas for future agricultural innovation and sustainable crop management strategies. This study conducts a comprehensive scientometric analysis of 9062 scientific publications indexed in the Scopus database between 1837 and 2025, spanning nearly two centuries of research on date palm. Using bibliometric tools such as Bibliometrix and ScientoPy, the study examines patterns of scientific production, collaboration networks, institutional participation, thematic evolution, and emerging research trends. The results indicate a marked increase in scientific publications, especially after 2007, with Saudi Arabia, Egypt, and Iran among the most productive countries. The thematic structure of the literature shows a shift from early studies on diseases and oasis cultivation to recent research focusing on biomass valorization, activated carbon production, antioxidant properties, pest management with special emphasis on the red palm weevil (Rhynchophorus ferrugineus), mechanical properties of date palm fibers, and plant biotechnology on methods like micropropagation and somatic embryogenesis. Geographically, research activity is concentrated in the Middle East and North Africa, the primary palm-producing region, with Saudi Arabia leading in institutions, researchers, funding, and international collaborations in date palm research. Emerging trends indicate a rising interest in digital tools, particularly artificial intelligence and advanced analytical tools, which are increasingly being explored to improve crop management. Overall, these findings provide a structured overview of the historical development of date palm research and contribute to a deeper understanding of the evolution and organization of scientific knowledge in this field. Additionally, the identification of key research pathways and emerging trends offers valuable insights for guiding future agronomic innovation, supporting evidence-based crop management strategies, and promoting the sustainable development of date palm production systems. Full article

This research enhances the literature on bank capital structure by combining financial intermediation theory with technological innovation to analyse the impact of FinTech adoption and liquidity management on leverage choices in South African banks. Utilising panel data spanning 2015 to 2024 and applying the Generalised Method of Moments (GMM) to tackle endogeneity and dynamic persistence, the research presents new findings from an overlooked emerging market setting. The results show a diverse effect of technology on leverage. Conventional banking systems, represented by automated teller machines (ATMs), show a positive relationship with the total debt ratio (TDR), suggesting a capital-intensive nature of tangible assets. Conversely, digital technologies such as mobile banking and a composite FinTech Index display a notable negative correlation with leverage, indicating that digital transformation improves efficiency, strengthens internal funding capacity, and reduces dependence on external debt. Moreover, increased liquidity levels are negatively correlated with leverage, suggesting that well-capitalised banks with robust liquidity rely less on debt funding. By examining FinTech and liquidity dynamics, the research contributes to both theory and practice, emphasising digital innovation as an alternative to external funding and stressing the importance of sound liquidity management amid evolving regulatory environments such as Basel III. Full article

Large language model (LLM) chatbots, as a widely used form of generative artificial intelligence, have reduced the marginal cost of producing publication-style manuscripts and have expanded feasible routes for manipulating citation metrics within the publishing ecosystem. Citation-based indicators (e.g., the h-index, the i10-index, and total citation counts) remain embedded in research evaluation and are sensitive to indexing practices of bibliographic databases, with Google Scholar providing broad coverage combined with comparatively limited curation. In this study, a systematic literature review is conducted to synthesize reported mechanisms of citation-metric manipulation and to examine limitations of citation-metric use, including evidence reported in civil engineering. A Google Scholar proof-of-concept case study examines whether the indexing of LLM-assisted, non-peer-reviewed documents with concentrated references to a target author is associated with changes in author-level citation metrics under platform-specific conditions. After indexing, a stepwise increase in author-level metrics is observed, demonstrating the feasibility of citation-metric manipulation under the platform-specific conditions. Finally, this paper discusses the implications for research integrity and citation manipulation in the era of generative artificial intelligence. It also presents recommendations for researchers, academic institutions and evaluation committees, publishers and editors, bibliographic database providers, and funding institutions and policymakers. Full article

Population ageing, declining fertility, and falling real interest rates have widened the global pension gap and increased fiscal pressure on pay-as-you-go systems worldwide. These structural challenges are compounded in Ukraine by an extreme demographic shock caused by war, large-scale migration, excess mortality, and a sharp contraction in GDP. This study evaluates the financial resilience and long-term sustainability of the Ukrainian pension system over 2015–2023 and assesses alternative development trajectories under heightened uncertainty. The methodology integrates demographic analysis with financial sustainability assessment and risk management approaches. A composite Sustainability Index is constructed from nine sub-indices that capture the structural, demographic, and economic dimensions of pension system performance. Scenario modelling is applied to simulate three reform pathways: structural transformation through expansion of the funded pillar, demographic adjustments, and accelerated economic recovery. The findings suggest that structural diversification of the pension system, combined with labour market formalisation and macroeconomic stabilisation, represents the most effective strategy for strengthening resilience. The study contributes to the literature on pension sustainability by conceptualising demographic shock as a systemic risk factor and by positioning pension reform within a broader financial risk management framework. Policy implications extend beyond Ukraine to other ageing economies exposed to turbulence. Full article

This paper examines several portfolio rules for comparing performance against the Shanghai Composite Index. The investor can use mutual funds or sector-based Exchange-Traded funds (ETFs). Five different approaches are applied for analysis. Two core approaches are discussed in detail and compared to passive investing: The top-N strategy and the sector rotation strategy. The Top-N strategy shifts capital each period into the last period rank-N fund, and the sector rotation strategy ranks funds based on their performance in the preceding investment period, forming three baskets: “Winners”, “Median”, and “Losers”. Extensive statistical tests on more than 300 equity mutual funds are performed for the top-N strategy to evaluate performance persistence using quintile sorts, winner–loser spreads, and transition tests. In contrast, the sector-rotation strategy and a holdings-based replication strategy (constructed from annual reports and sector funds) are implemented as case studies using the ten largest funds. Their performance is evaluated using multiple return and risk metrics. Full article

Due to the rapid process of urbanization and the threat of environmental hazards, the need to enhance the intelligence and resilience of urban infrastructure has emerged as a pre-eminent demand of sustainable urban development. This paper evaluates the smart-resilience of urban infrastructure in Kunming by creating a well-developed evaluation framework with reference to the DPSIR (Driving Force–Pressure–State–Impact–Response) model and using the Entropy Weight TOPSIS technique to measure infrastructure performance during the years 2020–2024. The study fills an existing gap in the literature regarding the integration of intelligence and resilience evaluation, as well as the dynamic obstacle diagnosis based on causal logic. It provides a transferable analytical framework and empirical evidence for the “smart-resilience” development of similar cities. The findings suggest that there is steady progress in infrastructure smart-resilience in Kunming, whereby the composite index grew from 0.330 to 0.597, which is equivalent to an average growth rate of about 16.0 per annum. In spite of this favorable tendency, there are a number of structural issues that remain unsolved. The driving force dimension is unstable with regard to long-term mechanisms of investment, and the responding dimension is lagging behind, indicating weaknesses in the governance capacity and inter-departmental coordination. Moreover, extreme weather events have become the major threat to infrastructure systems in the city, superseding traditional social and operational risks; consequently, the city has changed its risk profile. Obstacle factor analysis shows that state and response dimensions make up almost 60% of the total constraint level, which shows the significance of enhancing the effectiveness of management. The research findings are based on the proposal of specific policy actions, such as the creation of special infrastructure resilience funds, the enhancement of mechanisms relating to cross-departmental emergency responses, the implementation of risk-based engineering standards, and the creation of an integrated infrastructure data platform to facilitate efficient, resilient, and sustainable urban governance. Full article

The volatility of oil prices has a considerable impact on the economies of oil-exporting countries, making it critical to understand how price variations affect labour markets and unemployment. This study investigates the distinct role of labour market institutions in moderating the effects of oil price volatility on unemployment. Using the Cross-Sectionally Augmented Autoregressive Distributed Lag Model (CS-ARDL) on a panel dataset of nine African oil-exporting countries from 1994 to 2024, the study establishes a strong negative link between oil price changes and unemployment. Furthermore, the results show that real GDP growth leads to a reduction in unemployment in the long run, while the labour market institutional index has a negative impact on unemployment. Interacting the oil price with the labour market institutional index causes a further reduction in unemployment. These results suggest that good labour market institutions and macroeconomic stability are essential for reducing unemployment. While increases in oil prices directly stimulate a reduction in unemployment in African oil-exporting countries, this impact is reinforced by the presence of good labour market institutions in an economy. Therefore, the results suggest that countries with strong labour market institutions are more resilient in reducing the negative impact of oil price volatility on employment. As such, policymakers must prioritise labour market institutional reforms to enhance countries’ capacity to absorb oil price shocks and reduce unemployment during periods of oil prosperity and shield against employment declines when oil prices drop. Furthermore, the creation of oil stabilisation funds in these countries may serve a similar purpose. Contribution/originality: Against a background of inconclusive empirical evidence in the literature and a dearth of research on African countries, this study investigates the role of labour market institutions (LMIs) in the oil price–unemployment nexus in African oil-exporting countries. While highly dependent on oil revenue, these countries record persistent structural unemployment. Therefore, the study provides critical evidence to guide the formulation of policies necessary to deal with external shocks and facilitate structural shifts required for employment growth. Existing studies consider general institutional variables such as democratic accountability and the rule of law and do not assess the effect of labour market institutions. The current study fills in this gap by assessing the distinct role of labour market institutions that are specifically designed to regulate only work-related activities, such as quality of labour regulations, adequacy of social protection and unemployment benefits. Furthermore, this study employed the cross-sectionally augmented autoregressive distributed lag (CS-ARDL) for econometric estimations. Compared to previous studies, this is a more appropriate method that accounts for unobserved common factors such as oil price shocks affecting all oil-exporting countries simultaneously. Full article

Improving the living environment in rural areas is an important task and a key breakthrough point in implementing the rural revitalization strategy. It not only directly affects the vital interests and health protection of farmers, but is also an important measure to promote ecological civilization construction and achieve the development goal of a beautiful China. Taking environmental demonstration villages in Shaanxi Province as the research object, questionnaire data were obtained through field research and face-to-face interviews. This study constructs an evaluation index system covering five dimensions: village appearance, domestic sewage treatment, rural toilet renovation, domestic waste treatment, and construction and management mechanism. The entropy method is used to determine indicator weights, and fuzzy comprehensive evaluation is applied to measure the implementation effect. The research results indicate that the overall effect is between “average” and “good” (score 3.924), with domestic sewage treatment scoring highest and construction and management mechanism lowest. The study identifies key problems such as low farmer participation, insufficient funding sources, inadequate infrastructure maintenance, and weak environmental awareness. Based on these findings, countermeasures are proposed: enhancing farmers’ environmental awareness and participation; diversifying capital investment; improving infrastructure and establishing long-term management mechanisms; cultivating social capital; and strengthening the leading role of the government. This study provides empirical evidence and policy recommendations for improving rural environmental governance. Full article

This study delves into how the literature conceptualizes banking efficiency as a capability shaping sustainability-oriented pathways under conditions of systemic uncertainty, including recurrent economic–financial disruptions and geopolitical shocks. Using records indexed in the Web of Science Core Collection, the study combines bibliometric mapping with conceptual structuring to examine publication dynamics, collaboration networks, and the thematic evolution of research linking bank efficiency, green finance intermediation, sustainable digital innovation, and risk governance. The study reveals a multidimensional knowledge base organized around two converging streams: (i) research on efficiency, stability, and crisis transmission emphasizing intermediation quality, performance under stress, and prudential responses; and (ii) sustainability and innovation scholarship focusing on how financial systems enable eco-innovation diffusion and low-carbon transition through capital allocation, governance mechanisms, and digitally enabled transformation. Across these streams, banking efficiency is increasingly discussed not merely as a performance ratio, but as a strategic capability that becomes particularly salient in crisis environments: it can reduce intermediation frictions when funding conditions tighten, strengthen screening and monitoring of green projects amid elevated uncertainty, and support the continuity and scaling of eco-innovations by improving decision speed and resource allocation through digital tools. Collaboration patterns indicate growing interdisciplinary engagement—especially among European and Asian institutions—where crisis, sustainability, and innovation perspectives are integrated into systems-based approaches to green finance. Building on these insights, the article outlines a research agenda oriented toward innovation outcomes in turbulent contexts, emphasizing (a) measurement strategies that connect efficiency to eco-innovation diffusion and adoption rates during stress periods; (b) comparative analyses of how policy incentives and green market signals interact with bank efficiency across crisis episodes; and (c) hybrid methodological designs combining econometric identification, network analytics, scenario-based stress framing, and AI-enabled analytical tools to capture nonlinear dynamics in efficiency–innovation linkages. Overall, the study clarifies how banking efficiency may condition the capacity of financial institutions to sustain green investment intermediation and advance eco-innovation pathways when uncertainty is systemic rather than episodic. Full article

Cyber aggression and abuse (CAA) has become a major interdisciplinary research area spanning psychology, communication, public health, and computer science. Existing reviews have largely focused on detection methods and model performance, offering limited insight into how CAA research themes have evolved over time at the field level. This study addresses this gap by, to the best of our knowledge, applying Latent Dirichlet Allocation (LDA) to 2309 Web of Science–indexed publications with English-language abstracts published between 2000 and 2024, providing a large-scale, longitudinal, and multi-level analysis of the literature. The model identifies 29 latent topics, which are organized using the User–Activity–Content (UAC) framework to link psychosocial research, platform-mediated behaviors, and computational detection approaches. Temporal analysis reveals a clear methodological transition: early dominance of survey-based and psychosocial themes gradually declines in relative prominence, while computational topics related to machine learning, deep learning, and pre-trained language models exhibit sustained growth, particularly after 2010. A Hot–Cold topic classification further distinguishes emerging, stable, and declining research directions. Journal-level, disciplinary, and geographic analyses reveal systematic differentiation across venues and regions, with complementary emphases on psychosocial and computational approaches. These findings provide a structured, field-level perspective on the evolution of CAA research and offer practical value for researchers, funding agencies, journal editors, and publishers by identifying dominant, emerging, and declining themes that can inform research prioritization, editorial planning, and strategic investment. Full article

This study investigates the impact of sustainability-related uncertainty (SRU)—captured via the Sustainability-related Uncertainty Index in equal-weighted (ESGUI_EQ) and GDP-weighted (ESGUI_GDP) forms—on the volatility of green financial assets, focusing on decentralized finance (DeFi) protocols and Environmental, Social, and Governance (ESG)-focused Exchange-Traded Funds (ETFs). Employing a fuzzy logic framework, complemented by 3D surface visualization, Rule Viewer analysis, diagnostic validation, and Granger causality tests, the study uncovers non-linear, asymmetric, and time-varying responses of these assets to sustainability ambiguity. Empirical results reveal a structural divergence: DeFi protocols amplify volatility due to fragmented governance, speculative investor behavior, and sensitivity to policy-driven signals, often exhibiting bidirectional predictive feedback with SRU, whereas ESG ETFs maintain stability through diversification, regulatory oversight, and rigorous ESG screening, primarily absorbing sustainability shocks. These findings extend sustainable finance theory by integrating governance, technology, and policy dimensions, and illustrate the value of fuzzy logic combined with Granger causality in modeling complex, ambiguous markets. From a practical standpoint, the study provides actionable guidance for investors, fund managers, and policymakers, emphasizing the importance of technology-informed governance, standardized ESG disclosures, regulatory sandboxes, and continuous monitoring of SRU. Full article

Under the background of the “dual-carbon” goals and the ecological ecological-civilization-construction strategy, improving the synergistic efficiency of pollution reduction and carbon abatement is a key to promoting green high-quality development. Based on a panel of 30 provincial-level regions in China for 2012–2022, this paper evaluates the impact of digital financial inclusion on the synergistic efficiency of pollution reduction and carbon abatement. First, using a global-frontier directional-distance function (DDF), we characterize the improvement space of “desirable-output expansion—simultaneous contraction of pollution and carbon emissions” under given input constraints, and construct a synergistic efficiency indicator (eff_main). Second, we present a correlation benchmark within a two-way fixed-effects (TWFE) framework and use lead/lag (placebo) tests to probe potential endogeneity; we further construct a Bartik (shift–share) instrumental variable and employ Two-Stage Least Squares (2SLS) to strengthen causal identification. The results show that in TWFE regressions, digital financial inclusion (dif100) is positively and significantly correlated with synergistic efficiency, with a coefficient of 0.113 (i.e., an increase of 100 index points in the digital financial inclusion index is associated with an average increase of 0.113 in eff_main), but a significant lead effect is present, so this result should be interpreted as correlational only; 2SLS estimates indicate a robust positive causal effect of digital financial inclusion on synergistic efficiency, with a baseline coefficient of 0.405, rising to 0.501 under lagged specifications—exhibiting a dynamic feature of “gradual release in subsequent years.” The study suggests that developing digital financial inclusion helps raise regions’ comprehensive green-transition performance and sustainable development capacity; policy implications include accelerating the closing of digital infrastructure gaps, improving green-finance institutions and performance constraints, and guiding funds more effectively toward energy-saving, emission reduction and low-carbon technology areas. Full article

(1) Background: In Saudi Arabia, a high-income country with a publicly funded healthcare system, sickle cell disease (SCD) remains a major pediatric health challenge. This study aimed to identify factors associated with healthcare utilization, specifically inpatient (IP), outpatient (OP), and emergency department (ED) visits, among children with SCD in Saudi Arabia. (2) Methods: A retrospective observational study was conducted using data from the KAIMRC registry (2015-2023), including 450 children under 12 years old diagnosed with SCD. Negative binomial regression models were employed to analyze the annual average visits, accounting for clinical, demographic, and regional healthcare resource variables. (3) Results: Key predictors of IP visits included complication count, crisis episodes, and region (eastern, western, and southern regions had higher utilization than central). ED visits were positively associated with complications, crisis episodes, and hydroxyurea use, but negatively associated with bone marrow transplant receipt. OP visits increased with higher Charlson Comorbidity Index scores, age, and bone marrow transplant, but were lower in the eastern region. (4) Conclusions: These findings highlight the influence of clinical and regional factors even within an equitable, high-resource healthcare system. Full article