Financial Constraints Research Articles

Opportunities and challenges in utilizing community assets to extend chronic care management in podoconiosis endemic areas: Evidence from Northwestern Ethiopia.

Community-based chronic care intervention is important in the control and prevention of lifelong conditions such as podoconiosis and similar 'intensive disease management' neglected tropical diseases (NTDs). Despite a call for such interventions, few efforts have been made to identify opportunities and challenges related to their implementation. Employing a qualitative approach, this study explored the possibility of engaging community actors, physical places and networks to promote chronic care management in rural Ethiopia. We gathered data from affected individuals, community members, local leaders, health professionals and community health workers between April and May 2022. The study revealed that affected individuals, family members, religious leaders, traditional leaders, and health professionals have the potential to extend chronic care management in rural areas. Houses, churches, schools, and healthcare facilities are suitable venues at which to perform interventions. Strong community solidarity and political will are vital to chronic care interventions, while lack of understanding about chronic conditions, financial constraints, and limited resources at healthcare facilities could pose challenges. Using community assets has great promise for expanding chronic care management with minimal costs and efforts in under resourced areas. Achieving this will require a successful plan to coordinate the collaboration among the agents and settings.

Treatment-seeking behaviours of patients with tungiasis in endemic areas of Homa Bay County, Kenya: a mixed-methods study

BackgroundTungiasis, an ectoparasitic disease caused by sand fleas, causes suffering to millions of people in the tropics. Although the Kenyan National Policy Guidelines list tungiasis treatments as including disinfectants, flea repellents, and botanical oil, the insufficient knowledge and financial constraints of affected communities have led to neglect and inappropriate self-treatment. Current reports show insignificant progress on educational activities at the community level. Therefore, we investigated community residents’ treatment-seeking behaviour concerning tungiasis, using an endemic area of Kenya as the research setting.MethodsA cross-sectional mixed-methods design was employed. Quantitative data were collected from the participants—410 adults who had experienced tungiasis—using a questionnaire, while qualitative data were collected from 20 older adults to 10 medical staffs using semi-structured individual interviews. The study was conducted in two sub-counties of Homa Bay County, Kenya.ResultsFactors significantly correlated with using non-guideline-listed treatments for tungiasis were ‘not knowing the causse of tungiasis’, ‘not seeking treatment from healthcare facilities and traditional healers’, and ‘wait and see to prevent infection in non-affected members’. The interviews with the older adults revealed 19 self-treatment options for tungiasis, and 40% of the participants opted for self-removal using sharp objects. Only two of these treatments were listed in the guidelines. The most frequently mentioned reason for using a self-treatment option was ‘Someone else’s idea’. The most frequently mentioned reason for choosing the best self-treatment option was ‘Effectiveness’. Interviews with medical staff revealed 11 treatment options; only five of these treatments are listed in the guidelines. The most frequently mentioned reason for selecting/using the treatment was ‘Supply situation’.ConclusionsResidents’ socioeconomic factors, cultural factors, and access to appropriate treatment, as well as knowledge of medical staff were significant factors that influenced the residents’ tungiasis treatment-seeking behaviours. This study provides feasibility and baseline data to establish an effective, safe, and sustainable treatment for tungiasis.

Green Technology Innovations and Corporate Customer Concentration—The Perspectives of Financing Constraints and Social Responsibility

Green technology innovations propel both economic development and environmental sustainability. Exploring the contributing factors to green technology innovations carries important policy implications, but research from the perspective of supply chain relationships has been rare. This paper examines the impact of corporate customer concentration on green technology innovations and explores its influencing mechanisms using the data of Chinese A-share listed companies. The results show that a high customer concentration inhibits the quantity and quality of green technology innovations, a finding that is robust when endogeneity is addressed and when alternative measures and an alternative estimation model are employed. Financing constraints and social responsibility play intermediary roles in the impact of customer concentration on green technology innovations. A high customer concentration tends to increase corporate financing constraints and reduce corporate social responsibility performance, which hinder green technology innovations. The heterogeneity analysis reveals that the inhibitory effect of customer concentration on green technology innovations is less severe in digitally transformed enterprises, mature enterprises, or enterprises with a high level of market power. As this study provides a novel perspective on the contributing factors to corporate green innovations, it offers important policy recommendations.

Green Financial Policy for Fostering Green Technological Innovation: The Role of Financing Constraints, Science Expenditure, and Heightened Industrial Structure

The environment has become an increasing concern due to the accelerated expansion of the world’s economy. Green finance is a crucial strategy for China to address challenges in fostering green innovation and achieving sustainable development. By employing the difference-in-differences (DID) method, this study assessed the influence of green financial policy (GFP) on green technological innovation (GTI) in the Yangtze River Economic Belt (YREB). The results indicate that GFP significantly improves GTI, especially in cities with a lower level of green finance development, cities with a medium level of GTI, and cities upstream of the Yangtze River. A mechanism analysis found that GFP promotes GTI in the YREB by alleviating financing constraints and increasing science expenditures. However, it fails to improve GTI through the heightened industrial structure. The findings provide empirical proof and policy direction for the reformation of green financing and the achievement of ecological transformation in the river basin economy in accordance with the ‘dual-carbon’ goal.

Experience and challenges delivering hepatitis C virus treatment for people who inject drugs in Kenya

Despite having a higher risk of hepatitis C virus (HCV) infections, people who inject drugs (PWID) in sub-Saharan Africa (SSA) have limited access to HCV treatment. There is scarce literature on treatment delivery modalities that overcome logistical and financial barriers. We utilized different service delivery modalities to provide direct-acting antivirals (DAAs) to PWIDs infected with HCV through methadone clinics and needle and syringe program (NSP) sites in Kenya. In collaboration with Kenya’s National AIDS and STI Control Programme (NASCOP), we enrolled individuals with active HCV infection confirmed by HCV RNA detection from methadone and NSP sites in Nairobi, Mombasa, and Kilifi counties. Liver function and hepatitis B virus (HBV) status were assessed at baseline. Those eligible for treatment were offered ledipasvir-sofosbuvir treatment provided by NASCOP through directly observed therapy (DOT). Participants completed a follow-up visit 12 weeks after completing treatment to measure sustained viral response (SVR-12). Challenges faced while delivering HCV treatment at participating sites included the limited availability and reliability of laboratory assays, and financial constraints faced by PWIDs to attend daily DOT. Based on our experience, strategies to deliver HCV treatment for PWID in Kenya should consider improving the availability of laboratory tests and prioritizing treatment through methadone centers to achieve good outcomes.

How does green manufacturing enhance corporate ESG performance? — Empirical evidence from machine learning and text analysis

Green manufacturing, widely recognized as a crucial avenue for companies to achieve sustainable competitive advantages, exerts significant spillover effects on both environmental protection and social responsibility. Accordingly, this can significantly enhance corporate Environmental, Social, and Governance (ESG) practices and enhance overall ESG performance. This study focuses on Chinese A-share listed firms between 2009 and 2022, characterizing their ESG performance. Employing quasi-natural experimental methods, this research evaluates the causal relationships and specific channels through which green manufacturing enhances corporate ESG performance. The findings demonstrate that green manufacturing significantly empowers companies to strengthen their ESG performance. Channel analysis indicates that enhanced green innovation capabilities and the reduction of financing constraints constitute two critical channels through which green manufacturing facilitates ESG performance improvement. Further analysis indicates that all three subsystems in the green manufacturing system significantly empower companies to enhance ESG performance to varying degrees, with the most significant empowerment effect observed in the environmental dimension of ESG performance. The analysis below indicates that the enhancement of corporate ESG performance yields dual benefits, reflected in both economic gains and reputational enhancements.

Does money buy innovation? The effect of the “Innovative City” pilot on firm innovation in China

This study investigates the “Innovative City” pilot in China and its impact on fostering firm innovation by alleviating financial constraints. Employing difference-in-differences-in-differences approach, we provide strong evidence that the policy significantly boosted firm innovation capabilities, measured by increased patenting. A key mechanism is the program's expansion of bank credit access for firms, particularly benefiting financially constrained firms. Furthermore, the positive impact is amplified in regions with more developed banking sectors and for firms with pre-existing bank relationships, highlighting the role of market frictions. These findings highlight the pivotal role of a competitive and transparent credit market.

Enterprise digital transformation, managerial myopia and cost stickiness

Using Chinese-listed enterprise data from 2010 to 2021, we study the relationships among enterprise digital transformation, managerial myopia and cost stickiness. The results show that enterprise digital transformation inhibits cost stickiness, including operating cost stickiness as well as selling, general and administrative (SG&A) cost stickiness. This result holds after various robustness and endogeneity tests. Additionally, mechanism research indicates that enterprise digital transformation inhibits cost stickiness by reducing adjustment costs (ACs) and alleviating financing constraints (SAs). However, managerial myopia negatively affects the inhibition of enterprise digital transformation on cost stickiness by increasing ACs and aggravating SAs. Furthermore, the relationship between enterprise digital transformation and cost stickiness is stronger for mature, state-owned and high-tech enterprises than for those with better digital economy policy environments.

The efficacy and safety of three different single-use ureteroscopes in retrograde intrarenal surgery: a comparative analysis of a single surgeon's experience in a single center.

To evaluate and compare the clinical results of different single-use flexible ureteroscopes (su-fURS) used in retrograde intrarenal surgery (RIRS). RIRS cases performed identically by an experienced surgeon between 2022 and 2023 in a single center were retrospectively analyzed. These surgeries were performed with three su-fURS (Redpine RP-U-C12, Hugemed HU30, and Pusen Uscope 3022A). In the study, the age, gender, body mass index, and Charlson comorbidity index of the patients were compared, along with their clinical details, such as the stone size, volume, density, location, and history of hydronephrosis or a double J stent or SWL. Operation time, stone-free rates (SFR), perioperative and postoperative complications, and hospitalization times were also compared. The study included 208 patients. Pusen had 63 cases, Hugemed had 62, and Redpine had 83. The comparison of the patient's demographic and clinical properties with stone-related variables was similar between the groups. The SFR was similar between the groups (p = 0.056). Perioperative, postoperative, and total complication rates and the need for a second intervention showed no significant differences among the three groups (p = 0.324, 0.088, 0.061, and 0.052, respectively). In the first study comparing the clinical results of cases in which different su-fURS were used, no difference was observed in surgical outcomes and complications, even though the technical features of these devices were different. Urologists should select su-fURS based on clinical requirements, financial constraints, and personal experiences.

Challenges Facing Students with Special Needs During the Transition from Primary Special Schools to Public Secondary Schools in Morogoro Municipality

The study aimed at investigating the challenges that students with special needs face during the transition from primary special schools to public secondary schools in Morogoro Municipality. The research was conducted in Morogoro Municipality and employed a cross-sectional research design alongside a mixed research approach. The target population included regular teachers and those specializing in special needs education within the municipality. The study sampled 155 respondents, comprising 131 regular teachers and 24 specialized teachers. Data collection was by means of questionnaires and interviews. The data were analyzed using descriptive statistics and thematic analysis. The study reveals major challenges for students with disabilities transitioning to public secondary schools, such as inadequate teacher training, insufficient curriculum adaptation, and limited support systems, compounded by social stigma, financial constraints, and inadequate preparation. To enhance the educational experience for students with disabilities, it is essential to implement comprehensive teacher training on inclusive strategies, adapt curricula to diverse learning needs, and establish robust orientation programs. Increasing funding for assistive technologies, combating social stigma with anti-bullying policies, and improving peer support networks and accessible transportation will further support these students’ integration and development and consequently enhance learning

The cost of going public and financial constraints

AbstractWe provide empirical evidence on the bargaining power model proposed in Hu and Ritter (2007) by examining the financial constraints channel on the direct and indirect cost of going public. We find that financially constrained firms possess lower bargaining power and thereby incur higher direct costs (gross spreads) and higher indirect costs (underpricing) in an IPO. Consistent with the bargaining power model, we find that IPOs of financially constrained firms are usually managed by sole bookrunners and underwritten by smaller syndicates. Finally, we find that these financially constrained IPO firms underperform their non-financially constrained IPO peers in the long term. These results are robust to multiple endogeneity tests.

Health-seeking dynamics and uptake of ethnomedical therapies for chronic pain among people who use drugs in Nigeria

This study explored health-seeking practices and utilization of ethnomedical therapies for chronic pain management among people who use drugs (PWUD) in Nigeria. Data were generated through in-depth interviews with PWUD who lived with chronic pain (n = 26). Participants were recruited through snowball sampling in Uyo, Nigeria. Interviews were recorded, transcribed verbatim, coded and analysed thematically. Participants reported challenges with biomedical pain management, including a lack of cure for pain and low adherence to medications due to financial constraints and restrictions on dispensing of pharmaceutical opioids. These challenges contributed to inadequate biomedical management of chronic pain and encouraged utilization of herbal remedies, including those originating from other ethno-linguistic settings. While some preferred herbal remedies to biomedical care, others used these remedies due to inability to access biomedical pain management. Further, while some found herbal remedies to be helpful in relieving pain, others experienced adverse reactions and sought emergency medical services for this reason. As a result, they disavowed ethnomedical therapies and reaffirmed trust in biomedicine. Participants choose between biomedicine and ethnomedical therapies in managing chronic pain, and these choices were often shaped by structural inequality and the wider context of medical pluralism. Findings indicate a need to promote diversity and choice in healthcare and ensure access to safe, equitable and culturally-appropriate care through health insurance coverage and formal regulation of ethnomedical providers.

Digitalization's influence on corporate sustainability strategies in the context of new environmental law

Following the implementation of the new environmental law, this paper investigates the impact of digitalization on corporate sustainability, grounded in digital economy strategies and sustainable development principles. Utilizing a sample of Chinese A-share listed companies from 2015 to 2021, the study explores how corporate digitalization influences their sustainable development and the underlying mechanisms involved. The findings indicate that corporate digitalization significantly improves sustainable development, with internal control quality and financing constraints acting as partial mediators in this process. Based on these findings, recommendations are provided to help Chinese listed companies implement the sustainable development strategies.

ESG performance and green innovation of Chinese enterprises: Based on the perspective of financing constraints

Sustainable development needs to rely on green innovation. Enterprise ESG performance rating to alleviate the information asymmetry between enterprises and investors, for the green innovation provides development opportunities. However, there is a lack of research on the mechanism of the two based on the perspective of financing constraints. Therefore, considering the theories of sustainable development, green innovation, financing constraints and stakeholders, the basic mechanism and non-linear mechanism of ESG and green innovation are explored, aiming to provide reference for playing the role of ESG performance in promoting green innovation. The results show that better ESG performance can significantly promote the output of green innovation, and this promoting effect exists for both high-end green innovation and low-end green innovation, and its main channel is to alleviate financing constraints. In addition, this incentive exists a double threshold of digital finance and a single threshold of enterprise scale. Perfect digital finance and larger enterprise scale will strengthen the incentive effect of enterprise ESG performance on green innovation output. Considering financing constraints, this study further clarifies the relationship between enterprises ESG performance and green innovation, enriching the theoretical framework of green innovation and offering a new pathway for advancing green innovation among Chinese enterprises.

Exploring innovative approaches to fundraising for palliative care

Palliative care is a holistic approach aimed at improving the quality of life for those facing life-limiting illnesses and their families. Palliative care services often face financial constraints that restrict their ability to reach all those in need. There are difficulties accessing traditional funding mechanisms; therefore, innovative fundraising strategies are required to sustain and expand palliative care initiatives. In this paper, diverse fundraising approaches for palliative care are described, based on group discussions and collective brainstorming sessions by clinicians undergoing a Fellowship in Palliative Care. Fundraising approaches that were deemed innovative, yet feasible to apply in each locality, were shortlisted and described, with their strengths and challenges outlined in detail. These approaches include art and photography exhibitions, “piggy-bank” projects, community-based fundraising, charity shops, lottery and lucky draws, shuttle bus services, grants from international organizations and collaborative networks, the use of tap-on technology, festive events, and restaurant partnerships. It is hoped that through these innovative approaches, collaborative efforts, strategic planning, and resource mobilization, it would be possible to generate funds to develop and provide palliative care services for those in need to fulfill a fundamental human right.

Lymphoma in Sub-Saharan Africa: a scoping review of the epidemiology, treatment challenges, and patient pathways.

Improving cancer outcomes in Sub-Saharan Africa (SSA) requires effective implementation of evidence-based strategies. This scoping review maps the evidence on lymphoma epidemiology, treatment challenges, and patient pathways in SSA from 2011 to 2022. A comprehensive three-step search was conducted without language restrictions. Eighty-four publications were included, 83% published after 2017. Southern and Eastern Africa led in output. Most studies were chart reviews (47.6%) and cohort studies (25%). NHL accounted for over 80% of cases, with an age-standardized rate (ASR) reaching 10.9/100,000, while HL had an ASR of 0.4-2.3/100,000. Compared to studies in Europe and US, SSA studies reported lower incidence rates, higher HIV comorbidity, and younger median ages. Diagnosis is often delayed, incomplete and lacks sub-classification with HIV and tuberculosis further complicating care. One-year survival rates are around 50% for NHL and over 75% for HL. Treatment is well-tolerated with an acceptable treatment-related mortality rate. However, outcomes are affected by diagnostic delays, late presentations, and treatment abandonment. Non-clinical aspects of care such as financial constraints negatively impact patient pathways. Addressing diagnostic delays, misdiagnosis, and treatment abandonment is crucial. Strengthening care access, diagnostics, and integrating innovative strategies including a multidisciplinary approach and re-designing efficient clinical diagnostic pathways are vital.

Digital Infrastructure and Firm Resilience: Evidence from China

ABSTRACT We examine the impact of digital infrastructure on firm resilience. Analyzing panel data from listed companies across 306 Chinese cities from 2017 to 2021, we find that firms located in cities with better digital infrastructure experience less severe declines in employment and profits during the COVID-19 pandemic. Our results further show that digital infrastructure bolsters firm resilience by alleviating financing constraints and fostering business innovation. The digital infrastructure effect is particularly strong in non-state-owned, small-scale, low-cash-reserve, and labor-intensive firms.

The Impact of Supply Chain Network Structure on Green Innovation: The Mediating Role of Knowledge Absorption

ABSTRACT Green innovation is key to sustainable development. While the supply chain network affects corporate green innovation, the impact of the network’s structure remains unclear. On the basis of data concerning 737 Shanghai and Shenzhen A-share listed companies in China from 2007 to 2023, this study empirically investigates the impact of supply chain network structure (centrality, structural holes) on green innovation (exploratory, exploitative). The results reveal that centrality inhibits green innovation, whereas structural holes promote such innovation. These findings continue to be supported after robustness and endogeneity tests are performed. An analysis of the mediating mechanism reveals that centrality hinders green innovation by inhibiting knowledge absorption, whereas structural holes promote such innovation by facilitating knowledge absorption. Heterogeneity analysis reveals that high-profit enterprises, nonheavily polluting enterprises and enterprises that face low levels of financing constraints utilize supply chain networks to promote green innovation more effectively. The findings of this research provide both theoretical and empirical guidance for enterprises regarding the ability of supply chain network structure to promote green innovation.

Practices Pertaining to Sustainable Development Goals in University Libraries of Sri Lanka: An Exploratory Study

Sustainable development, embodied in the Sustainable Development Goals (SDGs), is a global obligation. University libraries are crucial in advancing these goals by disseminating knowledge, fostering sustainability, and promoting inclusive practices. This study uses a survey conducted through interviews to explore the practices, strategies, and challenges faced by university libraries in Sri Lanka in aligning with the SDGs. It surveyed SDG practices under five key themes. Sri Lankan university libraries strongly commit to the SDGs through their initiatives in these areas. However, compared to global practices such as seed libraries, zero-waste initiatives recycling projects, sustainable landscaping, rainwater harvesting and financial literacy programs, the scale of their activities remains more localized. Financial constraints, limited resources, and lack of awareness pose common barriers. The study demonstrates that Sri Lankan libraries are good at translating global SDG goals into actionable local initiatives, emphasizing the importance of the context. These libraries provide invaluable insights for other institutions. Future directions include expanding collaborations, enhancing public engagement, and embracing emerging technologies to further the SDG agenda.

A Systematic Literature Review on Augmented Reality in Game-Based Learning for English as a Second Language

This systematic review explores the integration of Augmented Reality (AR) within game-based learning for English as a Second Language (ESL). Based on empirical studies spanning 2020 to 2024 sourced from Web of Science (WoS), Scopus, ERIC, and Google Scholar. The review assesses AR's impact on ESL education. The findings highlight AR's potential to enhance language attainment through mobile applications, fostering learner satisfaction, engagement, and motivation. Additionally, the fusion of game-based learning and AR diversifies learning experiences across subjects, promoting collaboration and communication skills. However, challenges such as technical hurdles, the learning curve for teachers and students, financial constraints, and potential distractions from learning content persist. Despite these obstacles, AR presents promising opportunities for improving ESL learning outcomes. Moreover, it contributes to understanding AR's role in ESL education and underscores the need for further research to address implementation barriers and maximise its educational potential.