Financial Constraints Research Articles

OGC SO07 - A retrospective service evaluation of the impact of a dedicated oesophago-gastric cancer (OGC) dietitian in the OG surgical oncology team

Abstract Background Patients with OGC frequently present with malnutrition. Oncological care pathways advocate for dietitian’s to be essential member’s of the multi-disciplinary team (MDT), as it is well-established that malnutrition significantly increases rates of post-operative complications, length-of-stay (LoS) and mortality. However, due to financial constraints, specialist OGC dietetic support is not always resourced. To reduce the potential for nutrition related incidents, a dedicated OGC dietitian’s post was funded to support the pre-operative nutritional optimisation of OGC patients. The aim of this service evaluation was to evaluate the OGC dietitian’s impact on dietetic and surgical outcomes in a tertiary referral centre. Method The OGC dietitian reviewed all potentially curative patients at or within 48 hours of their first OGC surgical clinic; compared to >8 weeks pre-dietitian, with some patients not even reviewed before surgery. Weekly telephone or face-to-face dietetic-led clinics enabled more functional assessments (hand-grip strength (HGS)). Attendance to MDT was mandatory. Dietetic and surgical outcome data was collected for curative patients between July 2022 and April 2023 (pre-dietitian) (n=25) and July 2023 and April 2024 (OGC dietitian in-post) (n=19). Patient reported experience measures (PREMs) were collected. Data was analysed on excel. Ethical approval was not needed for this retrospective service evaluation. Results Pre-dietitian, 28% (n=7) experienced >5% (clinically significant) pre-operative weight loss compared to 11% (n=2) post-dietitian. 58% (n=12) patient’s post-dietitian gained weight from first dietetic contact up until date of surgery, compared to 44% (n=11) pre-dietitian. Mean HGS increased by 1.3kg (SD 2.77) from pre-operative to post-operative dietetic assessments in patients with OGC dietitian. More patient’s pre-dietitian experienced post-operative complications (42%) compared to post-dietitian at 31%. Average post-operative LoS was 19 days pre-dietitian versus 15 days post. 100% positive feedback was received from completed PREMs regarding OGC dietitian, with themes including consistent and timely communication, in-depth knowledge and empathy and compassion. Conclusion Mandatory inclusion of dietitians within the OGC pathway can support the pre-operative optimisation of patients, and impact positively on patient surgical outcomes. This service evaluation demonstrates that with increased dietetic contact, patients experience less clinically important weight loss, whilst feeling empowered and confident in their nutritional care. More research in a larger cohort of patients is required to provide an adequately powered study.

Who cares about environmental, social and governance performance? Family versus non-family firms

Purpose This paper aims to explore the nexus between family involvement and environmental, social and governance (ESG) performance based on socioemotional wealth theory, and it also analyzes the potential influence mechanism. Design/methodology/approach Based on the categorization of China Stock Market & Accounting Research database, this study divides the Chinese listed firms into family and nonfamily firms and applies multiple regression methods to test the theoretical hypotheses. Findings Family involvement can incentivize corporations to enhance corporate transparency, which can in turn enhance their ESG performance. The role of family involvement in bolstering corporate ESG performance is negatively contingent on external financing constraints. Originality/value There are insufficient studies on the nexus between family ownership and ESG performance. The findings provide insights into helping policymakers formulate targeted measures to encourage corporations to be more active in promoting ESG initiatives.

Implementing traceability technologies to promote ethical sourcing in Ghana’s fashion and apparel industry

ABSTRACT The demand for traceability has emerged as a significant imperative within the framework of an ethical supply chain that includes multiple stages. This study focusses on the implementation and impact of traceability technology in the Ghanaian fashion industry. The study employed descriptive and explanatory research, using a 700-stakeholder sample, a standardised questionnaire, and descriptive and inferential statistical methods. The findings of the study indicate that QR codes, GPS tracking, sustainable material tracing, and consumer interaction apps demonstrate a high level of effectiveness within the Ghanaian fashion business. The implementation of traceability technology faces challenges like limited knowledge, research insufficient, lack of coordination, policy absence, financial constraints, technological infrastructure limitations, data privacy concerns, opposition, and training gaps. Stakeholders generally support the implementation of coordination policies and regulatory compliance strategies, suggesting that factors like awareness, research, cost, infrastructure, data protection, opposition, and training should be prioritised.

Unveiling housing preferences amidst flood risks: an empirical study in an emerging market

Purpose This study investigates the interplay between flood risk, financial constraints and buyer behavior in the housing market. It aims to discern how flood experience influences housing choices, particularly among financially constrained buyers. Design/methodology/approach Using hedonic pricing models and probit analysis, this research examines the implicit prices of house characteristics and evaluates the determinants of housing choices, considering factors such as flood risk, financial status and past flood experience. Findings The study underscores that lower house prices incentivize buyers to opt for homes in flood-prone areas, thereby increasing their vulnerability to flood risks. Consequently, financial constraints exacerbate this situation, compelling low-income buyers to accept higher flood risks. However, flood experience fosters risk awareness among buyers, encouraging them to steer clear of flood-prone areas, albeit with lesser efficacy among financially constrained individuals. Originality/value This research contributes to the understanding of how flood risk and financial limitations shape housing decisions. It highlights the role of flood experience in influencing buyer behavior and emphasizes the need for targeted policies to mitigate flood-related risks in the housing market, particularly among economically vulnerable populations.

Exploring the Impact of Trade Credit and Debt on Systemic Risk in the Presence of Financial Distress and Constraints

Based on the extreme value and network contagion theories, this study intends to explore the effects of trade credit, and short/long-term debt on the systemic risk of 205 Pakistani non-financial firms over the period from 2005 to 2021. To evaluate the firms’ systemic contribution and vulnerability, we apply two firm-specific measures, the change in conditional value-at-risk (DCOVAR) and marginal expected shortfall (MES). Our findings reveal a significantly positive impact of trade credit, and short/long-term debt on the systemic contribution and vulnerability of these firms. The findings also indicate that the underlying relationship is significantly moderated by financial distress and financial constraints. Understanding how different forms of debt influence systemic risk can guide policymakers in crafting regulations or interventions to promote a healthier financial environment. Regulators may reevaluate the balance between short/long-term debt usages or develop guidelines for managing trade credit effectively to mitigate systemic risk.

Designing platforms for digital object-based learning

Over the last decade, object-based learning programs have become a staple of museum collections. These programs encourage and allow patrons to engage with a series of curated objects, offering educational experiences through tactile exploration. Naturally, they are focused on having their audience engage with the physical objects themselves (Chatterjee & Hannan 2016). Applying museological practice and object-based learning in the digital context requires not just presenting digital replica of physical objects, but scaffolding their presentation and platform with purpose, intent, and understanding of the strengths and pitfalls of digital delivery (Beetham & Sharpe 2013; De Kluis, Romp, & Land-Zandstra 2024). As such, digital object-based learning platforms and programs purposefully designed for remote learning and online delivery fill a unique niche in the higher education space and are beginning to come into their own. At Macquarie University, objectbasedlearning.com (an initiative of the Faculty of Arts and stewarded by its Learning Design and Production team) was relaunched in late 2023 following an extensive redesign, with learning designers, academics, and students now working together to provide new remote learning opportunities and experiences for the classroom. This presentation introduces the audience to the refurbished website, explains the ethos behind its redesign with an eye to evolving learning spaces and remote learning, and explores the site’s current and future applications and projects as a case study for designing digital object-based learning. The site was designed with future utility and outreach at its core, offering flexibility in how it presents and categorizes digital objects, and a site layout which reflects the needs of its target audience – schoolteachers. The NSW Stages 5 and 6 Curriculum informs the website’s design, determining how objects are grouped, how users navigate the site, and what information and metadata is prioritized, developed, and displayed. Since its relaunch, the website has been utilized in schools and faculties in NSW to deliver object-based learning experiences and classes. While it is too early to publish on outcomes of the project, early feedback has been positive, and new teaching initiatives have developed around the platform. In 2024, student interns at Macquarie were challenged to develop educational materials, lessons, and workshops which took advantage of the potential of technology-enabled object-based learning. These artefacts were designed to give students a unique object-based learning experience, removing the boundaries of physical distance, financial constraints, and fragility of objects. Moreover, student interns involved in the photogrammetric scanning of objects for the website were themselves enjoying an object-based learning experience, engaging with their materiality and learning how best to present the object in a digital environment.

Racing Towards Carbon Neutrality: Synergy Between Environmental Poverty, Environmental Regulations, Financial Constraints and Political Instability

Racing Towards Carbon Neutrality: Synergy Between Environmental Poverty, Environmental Regulations, Financial Constraints and Political Instability

DISP-08. GBM PATIENTS FACE TTF ACCESS AND INFORMATION INEQUITY THAT MAY IMPACT PATIENT OUTCOMES AND QUALITY-OF-LIFE

Abstract We evaluated the quality and accessibility of healthcare for Glioblastoma (GBM) patients across the United States through an online survey distributed to the OurBrainBank community and partners and promoted on social media. A total of 297 patients or caregivers completed the survey (85% caregivers; 15% GBM patients). Median age at diagnosis was 57, lower than the national average. 78% described having some college education, and 69% reported commercial insurance coverage. Our preliminary findings highlight that 82% of respondents reported that their treating doctor recommended the standard-of-care for GBM consisting of tumor resection, 3-6 weeks of chemo/radiation, and 6 months of chemotherapy and sometimes Tumor-Treating-Fields (TTF), per the Comprehensive- Cancer-Network (2021) guidelines. 40% reported no discussion of TTF as an option. Of those offered TTF, nearly half (46%) received it as part of their initial treatment combined with standard chemotherapy and 36% received it as a subsequent option. For those attempting to access TTF, 29% encountered difficulties, often due to financial constraints linked to insurance denials. These findings illuminate significant concerns regarding dissemination of information on treatment options, as well as access to treatments. Access to these treatments can have a significant influence on survival and quality of life of GBM patients. The substantial number of patients not offered TTF, combined with challenges to accessing treatments due to insurance issues, highlight critical obstacles to engaging in informed and shared decision-making. Compared to the general GBM-affected population, our survey respondents tend to be younger and from urban areas, indicating a possible selection bias in survey participation. This skew could lead to an underrepresentation of the challenges encountered by patients facing additional barriers. We are adopting measures to engage a more diverse participant group, especially from rural communities Ongoing targeted recruitment will further elucidate barriers to patient-centered care in GBM, with the potential for significant improvements in survival and QOL.

Utilizing Virtual Reality Tours in Language Learning

Virtual reality (VR) has been recognized as a revolutionary technology in education, providing a multitude of benefits that enhance learning experiences and outcomes. By immersing students in interactive and engaging environments, VR can make abstract concepts tangible, foster deeper understanding, and accommodate diverse learning styles. With VR, students can be fully engaged in dynamic and stimulating environments, which can transform abstract concepts into concrete experiences. This immersive approach can promote a deeper grasp of the subject matter. An example demonstrated how VR may engage students and foster interactive learning by enabling them to investigate intricate systems and surroundings that would be unfeasible or inconvenient (Freina & Ott, 2015). In addition, VR was shown to provide affordances that are believed to enhance learning, such as the first-person experience and the sense of being present in a particular location, also known as presence or spatial presence (Mikropoulos & Natsis, 2011). Although these advantages have been documented, the implementation of this technology has proven challenging or unfeasible for many teachers and learners due to financial constraints. VR photos and videos, which are commonly referred to as 360-degree media, have become readily available resources that can be utilized to create low-cost immersive experiences for people who are learning. Researchers have claimed that previous research has demonstrated the usefulness of these tools in boosting spatial presence and interest among participants in virtual reality tours that were conducted as part of one-off investigations (Petousi et al., 2023). However, these findings need to be supported by research over extended periods of time in a variety of educational settings to gain an understanding of the intricacies and limitations of this technology-based instructional approach. This poster describes two initiatives in which VR tours have been integrated into language learning settings. The first initiative employed a design-based research methodology to assess the efficacy of VR tours among online learners in France and Japan while the second initiative is an ongoing project that focuses on teaching the Filipino Language in a Japanese classroom using blended learning. This poster showcases the results of research conducted as part of the initiatives. The findings demonstrate the positive impact of virtual reality tours on student motivation and highlights the role of various factors, including instructional material, learners' personal traits, and the physical environment in which they engage in online learning, in addition to spatial presence and technological novelty. Moreover, this poster presents information regarding the process of improving the tours and lessons, as well as the platforms and technologies that were utilized to address concerns regarding usability and sustainability.

COMPLIANCE OF EXERCISE IN PATIENTS WITH ANKYLOSING SPONDYLITIS IN LOWER MIDDLE-INCOME COUNTRY

Exercise adherence is crucial for the management of patients with ankylosing spondylitis (AS), particularly in reducing symptoms and improving quality of life. However, barriers to exercise adherence in this patient population remain poorly studied, especially in resource-poor settings. This study focused on assessing exercise adherence among AS patients in Quetta, Pakistan, identifying both challenges and facilitators of adherence. Objective: The objective of this study was to assess exercise adherence among AS patients in Quetta, Pakistan, and explore key factors influencing their adherence to prescribed exercise programs, including barriers such as physical limitations, financial constraints, and social and support systems. Methods: This descriptive cross-sectional study was conducted in several rheumatology outpatient clinics in Quetta from January to July 2024. A purposive sample of 20 AS patients was recruited and a self-administered questionnaire was used to collect clinical and demographic data. Thematic analysis was performed to identify key themes related to exercise adherence, including facilitators and barriers. Results: Of the 20 participants, 60% were male and 40% were female, with a mean age of 45 years. Thematic analysis revealed four key themes: physical barriers (including chronic pain and fatigue), financial challenges (such as not being able to afford a gym membership or transportation), social factors (including stigma and lack of support), and motivational influences. Despite these barriers, social support and personalized exercise prescriptions emerged as key facilitators of adherence. Participants who received personalized exercise programs and education on the benefits of physical activity had higher adherence rates. Conclusion: Exercise adherence among AS patients in Quetta is influenced by a complex interaction of physical, social, and financial factors. Eliminating these barriers through patient-centred strategies, including personalized exercise programs and increased social support, can significantly improve adherence. These findings highlight the need for personalized approaches to promote physical activity among patients with AS, especially in resource-poor settings such as Quetta.

Advances in Global Oyster Reef Restoration: Innovations and Sustainable Ecological Approaches

Oysters have been recognized as ecological engineers for aquatic ecosystems, as oyster reefs provide critical habitats and foraging locations for other marine species. In the past few decades, anthropogenic activities have negatively impacted oyster reef ecosystems across the globe, resulting in a significant decline in their population. This review critically examines the causes and extent of oyster reef degradation, as well as the effectiveness of restoration initiatives employed to reverse this decline. Furthermore, this review evaluates the effectiveness of restoration strategies employed to rehabilitate oyster reefs. Different approaches, such as genetic improvement, suitable site selection, and oyster seeding to enhance oyster reef restorations, are critically reviewed in this paper. Furthermore, some advanced restoration approaches such as 3D printing, shell recycling, and acoustics technologies are also discussed in this paper, which opens the new doors for researchers in the field of restoration ecology. Challenges and barriers hindering successful restoration are also addressed, including financial constraints, regulatory complexities, and public engagement. The findings and insights presented herein contribute to the growing body of knowledge on oyster reef ecology and serve as a valuable resource for policymakers, scientists, and conservation practitioners seeking effective strategies for restoring these vital coastal ecosystems.

A Correlation Relating the Residual Strength Parameters to the Proportions of Clay Fractions and Plasticity Characteristics of Overburden Sediments from the Open-Pit Mine Drmno

One of the prerequisites for the safe exploitation of surface mines is the stability of the working and final slopes of the mine. In order to ensure this, it is necessary to carry out detailed field and laboratory geomechanical tests of the soil and, based on the obtained results, make calculations related to stability analyses. The results obtained in this way are used for dimensioning the slope of exploitation slopes (excavation). Landslides occur when the ultimate shear strength is reached, and therefore, the adequate definition of shear strength parameters is one of the essential prerequisites for successfully solving the stability problem. Unlike earlier tests in Serbia, when the residual shear strength parameters were determined based on the usual conventional methods (direct shear apparatus, triaxial apparatus), this time, in addition to the direct shear apparatus, a ring shear apparatus was also chosen for testing. The paper shows the method of determining the residual shear strength parameters of high plasticity gray clays and siltstones of roof sediments from open pit mine Drmno, using direct and ring shear apparatus. The results show that the residual angle of internal friction for gray clays obtained with the ring shear apparatus is 9.9–10.8°, and for the siltstone, it is 11.8–12.9°, both of which are lower than the values obtained with the direct shear apparatus. In addition, correlations between the residual parameters of soil shear resistance and some physical indicators (plasticity index, clay content) are provided, showing high correlation coefficients. The proposed correlations should be used only when time and financial constraints prevent the execution of actual tests to determine residual shear strength, as concrete experimental procedures provide a much more reliable assessment of the residual strength properties of the soil.

The Moderating Role of Digital Transformation on the Relationship between CEOs’ Foreign Experience and Financing Constraints of Firms in China

The Moderating Role of Digital Transformation on the Relationship between CEOs’ Foreign Experience and Financing Constraints of Firms in China

Corporate ESG Performance, Green Innovation, and Green New Quality Productivity: Evidence from China

In recent years, China has placed significant emphasis on sustainable economic and social development, actively implementing the concept of green development. In 2023, General Secretary Xi Jinping proposed that all regions should actively develop new-quality productivity, signifying a deepening of green and sustainable development principles. As an internationally recognized indicator for measuring corporate sustainability, Environmental, Social, and Governance (ESG) criteria may influence the enhancement of new-quality productivity across regions, particularly in relation to green new quality productivity. This paper investigates the effects of corporate ESG performance on the levels of green and new-quality productivity using data from China’s A-share listed companies from 2013 to 2022. The findings reveal the following: (1) corporate ESG performance significantly enhances the level of green new quality productivity; (2) mechanism tests indicate that corporate ESG performance enhances green new quality productivity by promoting firms’ green innovation; and (3) further analysis shows that the effect of ESG performance on green new quality productivity is more pronounced in firms with low levels of financing constraints, high media attention, and elevated green awareness among executives. These findings provide empirical evidence for strengthening corporate ESG performance, promoting green innovation, elevating regional levels of green and new-quality productivity, and advancing sustainable development, thereby offering valuable insights for developing countries.

Digital transformation and supply chain concentration: evidence from China

ABSTRACT Excessive supply chain concentration (SCC) introduces various risks, and the factors contributing to SCC are complex and have been rarely explored. This study examines the economic impact of digital transformation on supply chains by analysing data from China’s A-share listed companies (2010–2021) using regression models. The findings demonstrate that digital transformation significantly reduces supply chain concentration and increases the firms’ influence within the supply chain. The mechanism analysis shows that digital transformation makes firms more attractive to suppliers and customers, eases financing constraints, boosts firm reputation, and reduces SCC. The impact is more pronounced in firms facing higher environmental uncertainty or those positioned upstream in the supply chain. Except for blockchain, all five dimensions of digital transformation help to reduce SCC, thereby improving total factor productivity and economic growth. Digital transformation also creates a spillover effect, raising expectations for digital transformation and productivity among suppliers and customers. These findings have significant implications for understanding digital transformation practices and advancing supply chain management. The conclusions remain robust after various tests, including changes to the measures of variables and controls for reverse causality using lagged treatment and instrumental variables.

Empowering university students’ learning in Taiwan’s higher education: Pathways to overcome challenges

Taiwan’s higher education is characterized by tradition, innovation, and persistent pursuit of academic excellence. However, similar to its global counterparts, many challenges are prevalent in Taiwan’s educational sector that impede its progress and effectiveness. These challenges encompass demographic shifts, financial constraints, quality assurance, internationalization efforts, and technology integration. This study analyzes the challenges in higher education in Taiwan, and offers strategies to address them and improve university students’ learning experiences. The researchers used literature analysis methods to analyze the challenges in higher education in Taiwan, and analyze the pathways to overcome challenges. These pathways can address current challenges and help empower students to thrive in Taiwanese higher education, fostering an adaptable, skilled, and socially conscious generation of learners. These pathways are as follows: (1) In response to the declining birthrate, develop university curricula and courses incorporating diverse perspectives, improve university enrollment, and increase investment in higher education; (2) Improve teaching and learning quality assurance; (3) The internationalization of higher education promotes foreign internationalization and local internationalization; (4) Integrating technology into higher education teaching and providing more diverse online teaching and abundant learning experiences for students.

Navigating the Challenges and Seizing Opportunities in Implementing Closed-Loop Supply Chains

Closed-Loop Supply Chains (CLSCs) present a transformative solution for industries seeking sustainability by reintegrating returned products through recycling, refurbishment, and remanufacturing, reducing waste and dependency on added resources. While offering substantial benefits, CLSC adoption faces challenges, including high infrastructure costs, complex reverse coordination, and inconsistent regulatory support, which hinder widespread application. Through a mixed-method approach using surveys and case studies, this study reveals barriers such as financial constraints and operational restructuring needs, while highlighting enablers like digital tools (e.g., blockchain, IoT) that enhance efficiency and transparency. Furthermore, it emphasizes the critical role of regulatory incentives (subsidies, tax breaks, and extended producer responsibility mandates) and strategic partnerships that pool resources and share risks, essential for small and medium-sized enterprises (SMEs) aiming to implement CLSCs effectively. By proposing a practical CLSC framework, informed by empirical data, this research provides actionable insights for businesses to embrace circular economy principles, aligning environmental responsibility with corporate resilience, profitability, and consumer expectations. CLSCs, therefore, are not only an environmental solution but also a strategic opportunity that addresses sustainability imperatives while meeting regulatory requirements and advancing competitive advantage.

Circular agro-economies (CAE): reducing waste and increasing profitability in agriculture

This paper explores the concept of Circular Agro-Economies (CAE), a sustainable agricultural model focused on recycling agricultural by-products to minimize waste and maximize profitability for farmers. In contrast to traditional linear agricultural systems, CAE promotes resource efficiency and the development of new value chains through the reuse of organic materials. The paper examines the environmental, economic, and social benefits of adopting CAE, including waste reduction, cost savings, rural development, and job creation. It also discusses the significant barriers to adoption, such as technological limitations, financial constraints, and policy-related challenges. Finally, practical recommendations for farmers, policymakers, and businesses are provided to support the successful implementation of CAE, highlighting the collaborative efforts needed to overcome existing challenges and realize the full potential of this model. Keywords: Circular Agro-Economies, Agricultural Waste Recycling, Sustainable Agriculture, Resource Efficiency, Rural Development, Profitability in Farming.

Dynamic transnational inter-ecosystem framework for smart and inclusive age-friendly environments: The Transnational Local-Sphere Model

The demographic change calls for the creation of age-friendly environments that result from the collaboration between several fields. Previous initiatives fostering age-friendly environments often had less-than-desired impact or reach due to financial and bureaucratic constraints. Additionally, territory-specific standards and needs hinder the replication of good practices. Based on a mixed-methods approach combining a narrative review of knowledge models followed by expert consultation, we propose a framework to maximise the sustainability of Smart Healthy Age-friendly Environment (SHAFE) initiatives by connecting local ecosystems and stakeholders, including underrepresented entities, and thus promote sustainable business models, to ensure the replicability, scalability, and sustainability – the Transnational Local-sphere Model. This social innovation framework goes beyond previously established helix frameworks, by incorporating fresh ideas on democratic policy making, transnational spanning, and inter-ecosystem collaboration, as well as emphasising the role of institutions, stakeholders, networks, and principles. The collaboration and competition between the different stakeholders ensure a value-driven, cost-effective, and inclusive intervention, maximising impact. The Transnational Local-Sphere Model can also be applied in the development of other social innovation initiatives that benefit a usercentred multi-stakeholder inter-ecosystem approach.

Do dual holders enhance or hinder managerial efficiency?

ABSTRACT This study examines the influence of dual ownership on managerial efficiency using panel data from a dataset of U.S. firms spanning 1996 to 2017. Our findings indicate that dual ownership negatively affects managerial efficiency, demonstrating diminishing productivity in resource utilization when dual ownership is present or increases. Cross-sectional analyses suggest that the adverse effect of dual holders on managerial efficiency is more pronounced in dual-held firms with weaker corporate governance and greater financial constraints. Additional analyses, including propensity score matching, change specifications, Lewbel’s instrumental variable approach, and alternative measures of managerial efficiency, corroborate our findings.