Regional Variations Research Articles

International Variation in Health Status Benefits in Patients Undergoing Initial Invasive Versus Conservative Management for Chronic Coronary Disease: Insights From the ISCHEMIA Trial

BACKGROUND: The ISCHEMIA trial (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) demonstrated greater health status benefits with an initial invasive strategy, as compared with a conservative one, for patients with chronic coronary disease and moderate or severe ischemia. Whether these benefits vary globally is important to understand to support global adoption of the results. METHODS: We analyzed participants’ disease-specific health status using the validated 7-item Seattle Angina Questionnaire (SAQ: >5-point differences are clinically important) at baseline and over 1-year follow-up across 37 countries in 6 international regions. The average effect of initial invasive versus conservative strategies on 1-year SAQ scores was estimated using Bayesian proportional odds regression and compared across regions. RESULTS: Considerable regional variation in baseline health status was observed among 4617 participants (mean age=64.4±9.5 years, 24% women), with the mean SAQ summary scores of 67.4±19.5 in Eastern Europe participants (17% of the total), 71.4±15.4 in Asia-Pacific (18%), 74.9±16.7 in Central and South America (10%), 75.5±19.5 in Western Europe (26%), and 78.6±19.2 in North America (28%). One-year improvements in SAQ scores were greater in regions with lower baseline scores with initial invasive management (17.7±20.9 in Eastern Europe and 11.4±19.3 in North America), but similar in the conservative arm. Adjusting for baseline SAQ scores, similar health status benefits of an initial invasive strategy on 1-year SAQ scores were observed (ranging from 2.38 points [95% CI, 0.04–4.50] in North America to 4.66 points [95% CI, 2.46–6.94] in Eastern Europe), with an 88.3% probability that the difference in benefit across regions was <5 points. CONCLUSIONS: In patients with chronic coronary disease and moderate or severe ischemia, initial invasive management was associated with a consistent health status benefit across regions, with modest regional variability, supporting the international generalizability of health status benefits from invasive management of chronic coronary disease. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01471522

Self-censorship in using social media in Bangladesh: Does regime structure matter?

influences social media users' self-censorship by examining how repression, legal frameworks, surveillance, and media control affect online expression and free speech. Method: This study on self-censorship in Bangladesh used interviews, content analysis, focus groups, and surveys to understand users' online behavior under a hybrid regime. The results showed that laws such as the Digital Security Act increased self-regulation. Results: The study revealed that regime structure significantly impacts self-censorship on social media in Bangladesh. Democratic environments reduce self-censorship, whereas restrictive regimes increase it. Higher educational levels are associated with greater self-censorship, likely due to heightened awareness of the consequences. Gender and government actions had a minimal impact. An interaction effect demonstrates that a "climate of fear" combined with critical content intensifies self-censorship, emphasizing the role of regime type and freedom of expression in shaping online behavior. Limitations: The study on self-censorship in Bangladesh has limitations, including sample bias, potential inaccuracies due to self-reporting, overlooking regional variations, and cultural factors, which affect the generalizability of findings across different contexts. Contributions: This study provides valuable insights into how the regime structure influences self-censorship on social media in Bangladesh. By highlighting the correlation between authoritarian tendencies and increased self-censorship, this study elucidates the impact of laws such as the Digital Security Act on online behavior. The findings contribute to understanding the broader effects of political regimes on digital expression, offering a framework for examining self-censorship in varying political contexts, and informing future research on digital rights and freedom of expression.

Patient Safety Culture in Hospital Settings Across Continents: A Systematic Review

Patient Safety Culture (PSC) is the cornerstone of quality healthcare. Prior research has highlighted the critical role of a safety culture in healthcare. The Institute of Medicine (IOM) has emphasized its effectiveness in reducing errors and improving patient care. This systematic review investigated variations in how staff at international hospitals perceive PSC. In addition to assessing the status of patient safety, this investigation offers a comprehensive synthesis of research from multiple countries to inform future research endeavors. It focused on studies published between 2010 and 2024 that used the standardized Hospital Survey on Patient Safety Culture (HSOPSC) tool, versions 1.0 and 2.0. By following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, the review identified vital strengths and weaknesses in PSC globally. Despite these variations, two key strengths emerged consistently across studies, particularly in Asia: teamwork within units and a focus on continuous learning. However, healthcare professionals also raised concerns about a punitive environment that discourages error reporting and inadequate staffing levels. Interestingly, nurses held less positive views on some PSC aspects compared to mixed staff. Several PSC areas of concern raised in previous studies have continued to appear in recent studies. These findings highlight the need for a holistic approach to strengthen PSC globally. This includes fostering a just culture that encourages error reporting, addressing staffing shortages, and promoting open communication among all healthcare professionals. Additionally, tailoring interventions to address regional variations is crucial for creating a safer and more supportive environment for patients worldwide.

Correlation Between the Prevalence of Myasthenia Gravis and the Frequency of Class II Human Leucocyte Antigen Alleles in Various Geographical Locations Around the World.

Myasthenia gravis (MG) is an autoimmune condition characterised by muscle weakness due to antibodies produced against post-synaptic receptors. The impact of MG can be significant, especially with an ageing population. Human leukocyte antigens (HLA) are polymorphic genes associated with autoimmune conditions. Establishing the HLA alleles associated with MG may aid in the diagnosis, screening and early management of individuals at risk of MG. This research aims to establish the class II HLA alleles associated with the prevalence of MG in various regions of the world and identify the alleles that could predispose to the condition. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow chart and various databases including, Scopus and PubMed as well as other sources were used to find appropriate papers on HLA class II alleles associated with MG and the prevalence of MG in various countries. The frequency of selected HLA alleles in selected regions were obtained from the website, allelefrequencies.net. From this, a correlation coefficient and p-value were calculated to investigate whether the frequency of MG and the prevalence of HLA alleles had a significant association. The results highlighted two HLA alleles, DRB1*04:04 and DRB1*03, to have a significant positive association with the prevalence of MG. The frequency of the alleles showed regional variation, with European countries, particularly Northern Europe, exhibiting the highest frequencies. A significant positive correlation between HLA-DRB1*04:04 and DRB1*03 showed with the prevalence of MG, highlighting these alleles as a possible cause of the disease. Screening for these alleles, particularly in Northern Europe, may help identify individuals susceptible to MG.

Patients with influenza admitted to a tertiary-care hospital in Riyadh between 2018 and 2022: characteristics, outcomes and factors associated with ICU admission and mortality

BackgroundInfluenza is a common cause of hospital admissions globally with regional variations in epidemiology and clinical profile. We evaluated the characteristics and outcomes of patients with influenza admitted to a tertiary-care center in Riyadh, Saudi Arabia.MethodsThis was a retrospective cohort of adult patients admitted with polymerase chain reaction-confirmed influenza to King Abdulaziz Medical City-Riyadh between January 1, 2018, and May 31, 2022. We compared patients who required intensive care unit (ICU) admission to those who did not and performed multivariable logistic regression to assess the predictors of ICU admission and hospital mortality.ResultsDuring the study period, 675 adult patients were hospitalized with influenza (median age 68.0 years, females 53.8%, hypertension 59.9%, diabetes 55.1%, and chronic respiratory disease 31.1%). Most admissions (83.0%) were in the colder months (October to March) in Riyadh with inter-seasonal cases even in the summertime (June to August). Influenza A was responsible for 79.0% of cases, with H3N2 and H1N1 subtypes commonly circulating in the study period. Respiratory viral coinfection occurred in 12 patients (1.8%) and bacterial coinfection in 42 patients (17.4%). 151 patients (22.4%) required ICU admission, of which 62.3% received vasopressors and 48.0% mechanical ventilation. Risk factors for ICU admission were younger age, hypertension, bilateral lung infiltrates on chest X-ray, and Pneumonia Severity Index. The overall hospital mortality was 7.4% (22.5% for ICU patients, p < 0.0001). Mortality was 45.0% in patients with bacterial coinfection, 30.9% in those requiring vasopressors, and 29.2% in those who received mechanical ventilation. Female sex (odds ratio [OR], 2.096; 95% confidence interval [CI] 1.070, 4.104), ischemic heart disease (OR, 3.053; 95% CI 1.457, 6.394), immunosuppressed state (OR, 7.102; 95% CI 1.803, 27.975), Pneumonia Severity Index (OR, 1.029; 95% CI, 1.017, 1.041), leukocyte count and serum lactate level (OR, 1.394; 95% CI, 1.163, 1.671) were independently associated with hospital mortality.ConclusionsInfluenza followed a seasonal pattern in Saudi Arabia, with H3N2 and H1N1 being the predominant circulating strains during the study period. ICU admission was required for > 20%. Female sex, high Pneumonia Severity Index, ischemic heart disease, and immunosuppressed state were associated with increased mortality.

Harnessing the Power of Renewable Energy: A Study of Sustainable Sources and Technologies

This research investigates the capacity of renewable energy technologies to fulfill global energy requirements while mitigating environmental effects, concentrating on primary sources like sun, wind, hydropower, biomass, and geothermal energy. It evaluates the efficacy of various technologies for energy production, efficiency, economic viability, and reduction of carbon emissions. The findings underscore notable progress in solar and wind energy, demonstrating considerable efficiency enhancements (5% for solar PV, 10% for wind turbines) and cost reductions (67% and 64%, respectively) during the last decade. Hydropower is the most efficient energy source, converting 90% of available energy, albeit it is geographically constrained. The research highlights the environmental advantages, noting that renewable technologies substantially decrease CO₂ emissions—hydropower and wind energy prevent 250,000 and 120,000 metric tons of CO₂ annually, respectively. Nonetheless, obstacles such as the variability of solar and wind energy, elevated expenses associated with biomass and geothermal energy, and regional variations in implementation persist as substantial impediments. The research highlights the need for further developments in energy storage, grid modernization, and legislative assistance to expedite the worldwide shift towards renewable energy. This study synthesizes current statistics and trends, emphasizing the vital role of renewable energy in attaining a sustainable, low-carbon future, while also tackling ongoing economic and infrastructural problems.

How does venture capital play a role in corporate green innovation? Evidence from China

This research underscores the critical role of green innovation in advancing corporate sustainability and green transformation. Analyzing 9048 panel data points from China between 2010 and 2021, we applied a series of fixed effect models to assess how venture capital (VC) influences corporate green innovation. The study examined the effect of VC on two key business aspects: the costs of debt financing and the propensity for corporate risk-taking. The findings confirm that venture capital is essential in promoting corporate green innovation by lowering debt-related financial burdens and diminishing firms' inclination to take risks. Additionally, our heterogeneity analysis indicates that venture capital's impact is more pronounced within eastern China and among state-owned enterprises, suggesting regional and ownership-based variations in green innovation dynamics.

Flow-weighted sourcing of freshwater runoff from Pacific-draining continental and coastal basins in south-western Patagonia (41-56° S): characterizing regional inputs to Chilean fjords

Global estimates of the supply of dissolved and suspended materials to the ocean, in order to be relevant at either political or ecological scales, belie a finer-scale analysis necessary for understanding specific terrestrial-marine interactions. This is especially true for continental runoff to the marine critical zone of inland fjords and channels, where mechanisms, drivers, and predictions need to be elaborated in the context of changing land use and shifting climate forcing. In fjords in south-western Patagonia, runoff from small coastal and large continental basins (~310 x103 km2), sourced from a diverse geography and wide climatic gradient (&amp;lt;150 – 6,000+ mm/year), correspond with a very low density of hydrological and water quality observations. Based on the recently developed regional runoff model (FLOW), we estimated the coastal freshwater discharges and characterized flow-weighted sourcing (land use-cover type, climate, glaciers/geology, and soil province) for Pacific drainages from 41° to 56° south latitude. An estimated 692 km3/year (mean across 1979-2018), or 2% of worldwide total, is more than 85% of previous estimates for the much larger Pacific South American input. Based on limited water quality observations and inference from runoff sourcing, we predict general patterns of export for four groups of continental resources important for marine productivity, including: significant regional variation in flow seasonality, a N-S gradient in declining input of silicic acid and increased glacial input of sediment and iron, and potential shift in dissolved organic matter input sources from rainforest (potentially labile) to peatlands (refractory). Finally, we emphasize the temporal and spatial consequences of near-reference condition river runoff for marine ecosystem productivity and function in the Patagonian fjords, with specific recommendations for water quality standards and sustained monitoring for coupled river and marine ecosystems.

Trends in satellite-based ocean parameters through integrated time series decomposition and spectral analysis: 1. chlorophyll, sea surface temperature, and sea level anomaly

Abstract This study investigated trends in satellite-based chlorophyll-a (Chl-a; 1998–2022), sea surface temperature (SST; 1982–2022), and sea level anomaly (SLA; 1993–2021) from the European Space Agency’s Climate Change Initiative records, integrating time series decomposition and spectral analysis. Trends in parameters signify prolonged increases, decreases, or no changes over time. These are time series in the same space as original parameters, excluding seasonalities and noise, and can exhibit nonlinearity. Trend rates approximate the pace of change per time unit. We quantified trends using conventional linear-fit and three incrementally advancing methods for time series decomposition: simple moving average (SMA), seasonal-trend decomposition using locally estimated scatterplot smoothing (STL), and multiple STL (MSTL), across the global ocean, the Bay of Bengal, and the Chesapeake Bay. Challenges in decomposition include specifying accurate seasonal periods that are derived here by combining Fourier and Wavelet Transforms. Globally, SST and SLA trend upwards, and Chl-a has no significant change, yet regional variations are notable. We highlight the advantage of extracting multiple periods with MSTL and, more broadly, decomposition’s role in disentangling time-series components (seasonality, trend, noise) without resorting to monotonic functions, thereby preventing overlooking episodic events. Illustrations include extreme events temporarily counteracting background trends, e.g., the 2010–2011 SLA drop due to La Niña-induced rainfall over land. The continuous analysis clarifies the warming hiatus debate, affirming sustained warming. Decadal trend rates per grid cell are also mapped. These are ubiquitously significant for SST and SLA, whereas Chl-a trend rates are globally low but extreme across coasts and boundary currents.

The evolution of public attention in acute kidney injury and continuous renal replacement therapy: trends analysis from 2004 to 2024.

Acute kidney injury (AKI) and the need for Continuous Renal Replacement Therapy (CRRT) are critically important health concerns. This study analyzes global and regional Internet search queries to understand public attention in AKI and CRRT over time. We used Google Trends™ to analyze search queries for AKI and CRRT from January 2004 to March 2024. The study examined global trends and detailed insights from the United States, including state-by-state breakdowns. We identified patterns, peaks of attention, and temporal trends in public attention, comparing regional variations across the US and top-ranking countries worldwide. Global attention in AKI peaked in October 2022, with Portugal, Zambia, and Spain showing the highest regional attention. Within the United States, peak attention was in February 2008. Tennessee, Pennsylvania, and West Virginia were the top states that paid attention to AKI. Attention in CRRT peaked globally in March 2024. South Korea, Saudi Arabia, and Bahrain have led the global attention to CRRT. In the United States, peak attention was in April 2020. West Virginia, Tennessee, and Kentucky showed the highest state-specific attention in CRRT. This study reveals significant temporal and geographical variations in online search patterns for AKI and CRRT, suggesting evolving public attention to these critical health issues. This knowledge can guide the development of targeted public health initiatives, enhance medical education efforts, and help healthcare systems tailor their approach to improving awareness and outcomes in kidney health across diverse populations.

Increasing engagement with liver disease management across the UK: follow-up cross-sectional survey.

Liver disease is an increasing cause of premature mortality. Early detection of liver disease in primary care gives opportunity to intervene and change outcomes. Engagement in liver disease care by NHS bodies responsible for primary care pathway development could drive improvements. The formation of integrated care systems (ICS) in England provides an opportunity to reassess engagement with liver disease nationally. To update the level of engagement with community chronic liver disease management amongst ICSs and health authorities across the UK. A cross-sectional follow up survey to ICS and UK Health Boards. Questions used for a previous survey in 2020 were adapted and sent electronically to NHS bodies responsible for health care across the UK using a Freedom of Information request. Quantitative analysis used Microsoft Excel. There were 67 responses from 68 possible ICS and Health Board areas representing 99% UK coverage. 27% had a named individual responsible for liver disease. Monitoring of local liver disease health statistics happened in 34% of all UK areas. Comprehensive care pathways were available in 24/67 (36%) of areas, an increase from 26% in the 2020 survey. Areas with no liver pathways in place fell from 58% to 36% between the two surveys. Regional variations persist, with Wales and Scotland moving towards comprehensive coverage. Almost double the number of areas were making use of transient elastography within community pathways of care, up from 25% to 46%. The results of this re-survey highlight improvements, but emphasise the need to build on regional success to further reduce inequality in care commissioning.

Epidemiology and Regional Variation in Additional Surgical Interventions for Children with Congenital Diaphragmatic Hernia: A Multi-institutional Analysis.

To determine practice variation in surgical management of co-morbidities in pediatric patients with Congenital Diaphragmatic Hernia (CDH). A higher percentage of CDH patients are surviving to discharge, accompanied by an increase in morbidity requiring surgical interventions such as tracheostomy and gastrostomy tube insertion. The frequency, trends, and regional variations in operative management of these co-morbidities in this population are unclear. Neonates who underwent CDH repair between 2012-2022 in the United States Pediatric Health Information System database were identified. Multivariable regression identified predictive factors for additional surgical morbidity after CDH repair, defined by an additional surgical intervention during index hospitalization or within one year after discharge. To narrow the spectrum of severity of disease, only patients with an intensive care unit admission on index hospitalization were included. Secondary analysis compared frequency of operations and hospital resource utilization by region. 4003 patients underwent CDH repair and were discharged from their index hospitalization. 1939 (48%) underwent at least one additional surgical procedure after the index CDH repair. Most performed surgeries were gastrostomy tube (28%), fundoplication (13%), and tracheostomy (5%). Covariates associated with additional surgical morbidity included: prematurity (OR 1.38; 95% CI: 1.20-1.59), cardiac co-morbidity (OR 1.31; 95% CI: 1.14-1.49), and chromosomal anomalies (OR 1.76, 95% CI: 1.30-2.40). Northeast (OR: 2.43; CI 1.42-3.52), Midwest (OR 2.11; 95% CI: 1.45-3.07), and South (OR 1.45, 95% CI 1.02-2.12) regions were associated with additional surgical morbidity. Patients who required additional surgical procedures had longer initial inpatient length of stays (71 versus 31d) and higher associated costs ($357,000 versus $161,000). Surgical morbidity exists in CDH patients after initial CDH repair. Counseling families on these outcomes is important in establishing expectations for management. Establishing guidelines for optimal surgical management will require continued reporting from multi-institutional studies.

Research on the Brand Spillover Effect and Regional Differences of Geographical Indication Agricultural Products in Shanxi, Shaanxi, and Henan Regions of China under the Background of Rural Revitalization

[Purpose]This study aims to evaluate the role of the brand strategy for geographical indication(GI) agricultural products in rural revitalization, particularly through an empirical analysis of the brand spillover effects of GI agricultural products in Shanxi, Shaanxi, and Henan provinces, thereby providing a scientific basis for agricultural high-quality development and rural revitalization strategy formulation. [Methodology]A quantitative analysis approach was employed, involving the collection and analysis of market data on GI agricultural products from the three provinces. This analysis assessed their market performance, brand effects, and their impact on agricultural economics and farmers' incomes. Furthermore, the specific role of regional disparities in shaping the brand spillover effects was explored. [Results]The study found that the overall performance of the GI agricultural product markets in the three provinces was positive, with notable brand spillover effects that significantly contributed to the promotion of agricultural economics. However, regional variations in brand development emerged, with cities like Xi'an, Datong, and Zhengzhou exhibiting particularly prominent brand effects, whereas other cities demonstrated less evident brand impacts, indicating a regionalized trend. [Conclusion] The study concludes that the brand spillover effects of GI agricultural products are positively correlated with rural revitalization development, serving as a crucial factor in enhancing agricultural competitiveness and promoting farmers' income. It is recommended that, in light of regional disparities, differentiated brand development strategies be adopted, accompanied by strengthened regional cooperation, to fully leverage the brand advantages of GI agricultural products and facilitate the in-depth implementation of rural revitalization strategies.

Sweetening the deal: an infodemiological study of worldwide interest in semaglutide using Google Trends extended for health application programming interface

BackgroundOff-label use of semaglutide for non-diabetic weight loss (which regulators have linked to social media promotion) created worldwide supply shortages. We evaluated worldwide semaglutide interest measured by online search behavior to gauge social media and conventional print media reporting’s effect on search interest.MethodsUsing Google Trends Extended for Health (GTEH) multiple sampling, we retrieved regional online interest (ROI) for all countries and extracted timelines and top search queries for January 2021–August 2023 for countries with median ROI ≥ 20 using the “semaglutide” topic. We obtained semaglutide media reporting from the ProQuest database. We estimated the effect of media and within-country semaglutide interest on between-country interest with Granger causality analysis. We determined changepoints for trends within each country with joinpoint regression. We determined prominent themes in search queries for each country with natural language processing thematic analysis.ResultsTwenty-seven countries were included. Most countries showed an increase in semaglutide interest over time, with Canada and the USA showing the largest sustained interest. Most of the search interest arose from 2022 onwards. Granger’s analysis showed that media coverage could only partially explain interest, and interest in some countries partially preceded interest in others, with the UK and Germany showing strong relationships between news reports and lagged search interest. Joinpoint analysis identified up to four significant within-country changepoints. Most countries showed significant positive weekly trends in 2021–2022, although uptrends in search interest varied considerably between countries. One episode of the Dr. Oz show (TV media event) coincided with strong peaks in numerous countries. Natural language processing of top search queries showed some agreement between countries and country-specific themes. Weight loss was a major theme in most countries, while a diabetes theme was generally absent or weak. Some countries (Australia, Chile, South Africa, UK) had themes for buying Ozempic from (named) local retailers, and Germany had a theme related to buying Ozempic without a script.ConclusionsGTEH data provided insights into global search interest in semaglutide and regional variation. Studies focusing on specific countries which include social media data can elucidate specific drivers behind the surge in off-label use of semaglutide.

ANÁLISE TEMPORAL DA INCIDÊNCIA DE CASOS NOTIFICADOS DA DOENÇA DE CHAGAS NO BRASIL, NO PERÍODO DE 2010-2019

Chagas disease is caused by Trypanosoma cruzi and remains an important public health concern in Brazil, despite control measures adopted over the last few decades. The objective of this study is to carry out a temporal analysis of the incidence of reported cases of Chagas Disease in Brazil from 2010 to 2019, identifying trends and possible associated factors. Secondary data from the Notifiable Diseases Information System (SINAN) were used to calculate incidence rates by region and year. The statistical analysis included linear regression models to evaluate the temporal variation of notifications. The results indicate an overall reduction in notifications in the country during the period analyzed, with significant regional variations. The North region showed an increase in notifications, suggesting the need for greater surveillance and control strategies. In contrast, the Southeast and South regions maintained a stable downward trend, as a result of continued vector control measures. It is concluded that, although cases of Chagas disease are declining in much of Brazil, the disease still represents a public health challenge in some regions, especially in areas where oral transmission and vector synanthropy are on the rise.

Understanding eco-innovation in the Hungarian wine sector

PurposeA growing body of literature analyzes eco-innovation in the wine industry, specifically focusing on the internal and external factors that contribute to sustainable innovation in wineries. The purpose of this study is to classify wineries according to their eco-innovation strategy and investigate variations in innovation groups concerning networking and socio-demographic characteristics.Design/methodology/approachThe authors use an original firm-level survey conducted between June 2022 and January 2023 to study eco-innovation practices of 234 Hungarian winemakers using four groups of indicators: marketing, organizational, process and product innovations. The authors apply principal component analysis and cluster analysis to identify eco-innovation dimensions and group wineries. The authors also investigate the relationship between eco-innovation strategies, determinants and firm-specific characteristics.FindingsThe estimations identify two innovation modes: with Cluster 1 (characterized by innovative wineries) surpassing Cluster 2 (comprising less innovative wineries) in all aspects. Marketing and process innovations were more widespread than product and organizational innovations. The results confirm the importance of firm and manager characteristics, corporate organization and size, age and education of management influence innovation activity.Research limitations/implicationsThe cross-sectional nature of the survey provides a snapshot of the wine industry. To identify changing trends, it is beneficial to conduct follow-up research and ongoing monitoring for a more comprehensive understanding of the dynamics of eco-innovation over time. The study offers valuable information about the Hungarian wine sector, but generalization of results to other geographic areas or wine-producing regions should be careful. The unique characteristics of particular regions might have a different effect on the dynamics of eco-innovation. Comparative studies across different wine regions or countries may reveal regional variations in eco-innovation strategies and the impact of local contexts.Practical implicationsThe study highlights the priority of human elements, such as the commitment of owners and managers to sustainability in driving force for innovation. The ability of businesses to absorb new knowledge and the exchange of information within organizations is crucial in promoting innovation. Considering the results of the survey, managers should proactively strive to improve knowledge transfer and information sharing within their organizations and establish cooperative alliances with universities, research institutes, suppliers, industry bodies and associations and global consultancy firms. Such knowledge-based cooperation can counterweight the innovative inertia of the micro and small enterprises representing the Hungarian wine sector.Social implicationsTo address the issue of “innovative inertia” faced by micro and small businesses in the wine sector, policymakers may implement focused supports, such as educational initiatives and grants, to augment their understanding and promote sustainable innovation. They should initiate intra- and inter-cluster connections and cooperations. Incentives, such as tax reduction or financial support, may stimulate wineries to introduce eco-innovation practices. Policymakers could also streamline the process of obtaining funding or grants for wineries interested in investing in cutting-edge solutions, such as renewable energy or advanced cultivation technologies to accelerate the adoption of sustainable practices.Originality/valueThis study contributes to the eco-innovation literature by providing insights into the drivers and practices of wineries in Hungary. The results emphasize the significance of networking, sharing of knowledge and firm/manager-specific characteristics in influencing eco-innovation in the wine industry.

Understanding the hierarchical structure of collagen fibers of the human periodontal ligament: Implications for biomechanical characteristics

The periodontal ligament (PDL) is a unique fibrous connective tissue that regulates periodontal homeostasis mechanisms. Its biomechanical properties primarily reside in the hierarchical and non-uniform collagenous network. This study aimed to investigate the region-specific structure and composition of collagen fibers in the PDL at various scales and to explore their relationship with mechanical properties in a split-mouth design. Fresh human cadaver transverse PDL specimens of maxillary anterior teeth were categorized into cervical, middle, and apical groups. These specimens were analyzed via Masson’s trichrome staining, scanning electron microscopy, picrosirius red (PSR) staining, three-dimensional (3D) reconstruction, Raman spectroscopy, and uniaxial tensile test. Statistical analyses were performed to compare the structural, compositional, and tensile properties among the groups. Notably, the middle PDL samples exhibited superior tensile strength and higher fiber area fraction than the other two transverse sections. Despite a higher mineral-to-matrix ratio and a different collagen secondary structure, the apical PDL demonstrated a relatively weaker tensile strength, possibly associated with its discovered sparser collagen fiber areal fraction. The cervical region, characterized by a mediocre fiber areal fraction, displayed diminished tensile strength. The 3D reconstructed collagenous network model and PSR staining exposed the fiber interaction and the micropores. Microscale porosity and variations in collagen secondary structure, particularly in the apical region, suggest adaptive mechanisms for accommodating compressive forces and maintaining functional integrity. Variance in the tensile properties of samples in different force directions indicated the significant influence of fiber orientation and root level on tissue mechanics. Statement of significanceThis study provides critical insights into the biomechanical and structural properties of the human periodontal ligament (PDL), particularly focusing on the underexplored anterior teeth. Through advanced techniques like SEM, histological staining, 3D reconstruction, Raman spectroscopy, and tensile testing, we reveal significant regional variations in PDL collagen organization, composition, and biomechanical properties. Our findings address a crucial knowledge gap concerning the material mechanics of the PDL, offering a foundational understanding for future periodontal tissue engineering and biomimetic material development. This multi-scale analysis underscores the importance of both mesoscale structural characteristics and nanoscale molecular structures in maintaining PDL mechanical integrity.

People’s awareness and behaviours of circular economy around the world: literature review and research agenda

PurposeThis paper aims to explore global research on individuals’ awareness and behaviours related to the Circular Economy, aiming to deepen the understanding of how people engage with and contribute to CE practices.Design/methodology/approachUsing a systematic literature review (SLR), this study methodically collects, codifies, analyses, synthesizes and interprets existing literature and research on Circular Economy. This approach aims for a comprehensive understanding of current global perspectives and practices.FindingsThe analysis reveals an increasing trend in empirical research focusing on Circular Economy strategies. This paper has identified 22 key strategies linked to public awareness and behaviours towards Circular Economy, noting that purchasing recycled products is the most commonly observed behaviour. The findings highlight the growing importance and complexity of individual roles in the Circular Economy.Research limitations/implicationsThe study underscores the importance of consumer behaviour in advancing Circular Economy practices. This paper observes that despite the growth in Circular Economy research, there is still a notable gap in awareness and behaviour, even in developed countries. This is attributed to a lack of conceptual understanding, educational disparities, resource limitations, a limited grasp of cost–benefit considerations and inadequate government support. The paper also explores regional and sector-specific variations in Circular Economy adoption, with insights from countries such as the USA, China, the UK, Germany, France and Norway.Practical implicationsThis study underscores the importance of consumer behaviour in advancing Circular Economy practices. Despite the growth in Circular Economy research, there is still a notable gap in awareness and behaviour, even in developed countries. This is attributed to a lack of conceptual understanding, educational disparities, resource limitations, a limited grasp of cost–benefit considerations and inadequate government support. The paper also explores regional and sector-specific variations in Circular Economy adoption, with insights from countries such as the USA, China, the UK, Germany, France and Norway.Social implicationsThis research underscores the impact of demographic and sociocultural factors, including age, education, social norms and attitudes, on Circular Economy engagement. It identifies potential research areas, including examining cultural influences on social and personal norms related to circular behaviours. Ultimately, the study emphasizes the need for a coordinated, cross-sectoral effort to facilitate a sustainable transition to a Circular Economy, addressing barriers and fostering awareness and behaviours conducive to circular practices.Originality/valueThis study acknowledges challenges affecting the maturity of Circular Economy practices, including a lack of comprehension, educational disparities, resource constraints and limited government support. It also underscores the impact of social and cultural factors on Circular Economy engagement. It suggests promising avenues for future research, providing valuable insights into the state of Circular Economy practices and offering a roadmap for advancing global sustainability initiatives.

Surveillance of adverse events following varicella vaccine immunization in Jiangsu province, China from 2017 to 2023

To assess the safety of varicella vaccine (VarV) by conducting post-marketing surveillance on adverse events following immunization (AEFI) in Jiangsu Province, China.MethodsWe utilized the AEFI Information System of mainland China to monitor and categorize adverse reactions associated with VarV.ResultsThe incidence rate of AEFI was significantly higher after the first dose (48.79/100,000 doses) compared to the second dose (45.18/100,000 doses) (χ2 = 4.63, P = 0.031). Regional variations in AEFI incidence were observed within Jiangsu Province. Common reactions comprised 90.96% of AEFIs, while rare reactions and coincidental events accounted for 6.59% and 0.51%, respectively. Notably, there were no adverse events linked to vaccine quality, program errors, psychogenic reactions, or fatalities. Over 96% of AEFIs occurred within three days of VarV administration, with redness at the injection site (2.6 cm to 5 cm in diameter) being the most frequently observed symptom.ConclusionVarV demonstrates a commendable safety profile. Although there was a slight increase in AEFI incidence between 2022 and 2023, common vaccine reactions were predominantly observed, and the rates of rare reactions remained very low.

Multi-Graph Assessment of Temporal and Extratemporal Lobe Epilepsy in Resting-State fMRI

Epilepsy is a common neurological disorder that affects millions of people worldwide, disrupting brain networks and causing recurrent seizures. In this regard, investigating the distinctive characteristics of brain connectivity is crucial to understanding the underlying neural processes of epilepsy. However, the various graph-theory frameworks and different estimation measures may yield significant variability among the results of different studies. On this premise, this study investigates the brain network topological variations between patients with temporal lobe epilepsy (TLE) and extratemporal lobe epilepsy (ETLE) using both directed and undirected network connectivity methods as well as different graph-theory metrics. Our results reveal distinct topological differences in connectivity graphs between the two epilepsy groups, with TLE patients displaying more disassortative graphs at lower density levels compared to ETLE patients. Moreover, we highlight the variations in the hub regions across different network metrics, underscoring the importance of considering various centrality measures for a comprehensive understanding of brain network dynamics in epilepsy. Our findings suggest that the differences in brain network organization between TLE and ETLE patients could be attributed to the unique characteristics of each epilepsy type, offering insights into potential biomarkers for type-specific epilepsy diagnosis and treatment.