Izmir University

This study investigates how internal governance design supports credible ESG performance by distinguishing between Incentive and Oversight Architectures. Using 13,993 firm-year observations of US nonfinancial firms from 2018 to 2024, we estimate fixed effects and two-step system GMM models. Results indicate sustainability-linked incentives, CSR committees, committee independence, and board gender diversity are positively associated with ESG performance, whereas CEO duality is negatively related. Pillar-level analyses show governance scores reflect structural compliance, while environmental and social scores depend on combined incentives and resource-rich oversight. Industry analyses validate incentives and independence as consistent drivers. Carbon intensity moderates the relationship between committee independence and ESG performance. Restricted stock units specifically improve ESG outcomes. Overall, stronger sustainability outcomes are more likely when Incentive and Oversight Architectures operate as a bundle. Credible ESG performance requires aligning incentive structures with independent oversight, offering insights for policymakers seeking to foster substantive sustainability.

This paper examines how profit relates to ecological footprint intensity and how the link is shaped by artificial intelligence capability and education quality. We analyze 53,081 firm year observations from 15 innovation-leading economies during 2003-2022 using system GMM. The findings reveal that (i) profitability is associated with lower footprint intensity (ii) artificial intelligence capability is associated with higher footprint intensity and weakens the footprint-reducing effect of profitability, while education quality is associated with lower intensity and strengthens that channel, (iii) the joint effect of profitability, AI capability, and education quality increases footprint intensity. The findings speak to responsible production and climate action agendas. The study findings indicate that the interactions between profitability, artificial intelligence capability, and education quality have a multi-layered structure in terms of environmental sustainability. In line with sustainable development goals, recommendations focus on subjecting artificial intelligence investments to mandatory environmental impact assessments, and aligning education systems with sustainable production and environmental responsibility awareness.

BACKGROUND:Chemotherapy-induced thrombocytopenia (CIT) is a common complication of chemotherapy that is associated with bleeding, reduced relative dose intensity, and potentially worse outcomes. No widely available therapies are approved for CIT. METHODS:We conducted a phase 3, international, double-blind, randomized, placebo-controlled trial involving patients with persistent CIT (platelet count, ≤85×109 per liter on trial day 1) who were receiving oxaliplatin-based multiagent cytotoxic chemotherapy for gastrointestinal cancers. Patients were randomly assigned in a 2:1 ratio to receive romiplostim or placebo for three chemotherapy cycles. The primary end point was the absence of CIT-induced modifications of the chemotherapy dose (reduction, delay, omission, or discontinuation) in both the second and third chemotherapy cycles. RESULTS:Of the 165 patients who underwent randomization (109 in the romiplostim group and 56 in the placebo group), 75% had colorectal cancer, 13% had gastroesophageal cancer, and 12% had pancreatic cancer; 72% of the patients in the romiplostim group and 61% of those in the placebo group had stage 4 disease. The percentage of patients with no CIT-induced modifications of the chemotherapy dose was 84% (92 of 109 patients) with romiplostim and 36% (20 of 56 patients) with placebo, which corresponded to an odds ratio of 10.16 (95% confidence interval [CI], 4.44 to 23.72; P<0.001) and a risk ratio of 2.77 (95% CI, 1.78 to 4.30; P<0.001). Adverse events of grade 3 or higher occurred in 37% of the patients who received romiplostim and in 22% of those who received placebo, which primarily reflected chemotherapy effects. Adverse events that were considered by the investigator to be related to romiplostim or placebo occurred in 12% of patients who received romiplostim and in 7% who received placebo, with the most frequent being nausea (2% in each group) and headache (2% in the romiplostim group); none were serious or led to death or discontinuation of romiplostim, placebo, or chemotherapy. Thromboembolic events occurred in 2% of patients who received romiplostim and in no patients who received placebo. CONCLUSIONS:In this phase 3, placebo-controlled trial, romiplostim was efficacious in treating CIT. (Funded by Amgen and the Biomedical Advanced Research and Development Authority; RECITE ClinicalTrials.gov number, NCT03362177.).

This study examines the relationship between military spending, economic growth, and gender inequality in Middle East and North Africa (MENA) countries. Military spending may stimulate short-term growth through aggregate demand but undermine long-term growth by diverting resources from productive sectors. It may also exacerbate gender inequality by crowding out social expenditures that disproportionately benefit women. As a result, military spending can affect economic growth both directly and indirectly through its impact on gender inequality. Despite the importance of this channel, the trivariate relationship among military spending, gender inequality, and growth remains underexplored. Focusing on 19 MENA countries over 1990-2018 and using the Gender Inequality Index, this study provides new evidence on the direct and indirect effects of military spending on economic growth.JEL Classification: H56, J16, O47

The American Society of Anesthesiologists physical status classification system is widely used to evaluate perioperative risk; however, its subjective nature may lead to variability, particularly in pediatric patients. This study aimed to evaluate the awareness and application of pediatric ASA classification among anesthesiology and reanimation physicians in Türkiye and to investigate the effect of professional experience on risk assessment. This cross-sectional survey study was conducted using an online questionnaire distributed to anesthesiology and reanimation physicians working in different institutions across the country. The survey included demographic characteristics, professional experience, routine use of ASA classification, and fifteen pediatric clinical case scenarios. Participants were asked to assign an ASA physical status classification ranging from I to V for each scenario. For statistical analysis, ASA classifications were grouped as low risk (ASA I–II) and high risk (ASA III–V). Participants were categorized according to professional experience as ≤10 years and >10 years, and associations between experience level and high-risk ASA assignment were analyzed using chi-square tests. A total of 212 physicians participated in the study, with a mean age of 37.75 ± 8.67 years. Most participants reported using the ASA classification routinely (98.6%), applying it in pediatric patients (90.6%), and considering it influential in clinical decision-making (96.7%). In most clinical scenarios, no significant difference was observed between experience groups in high-risk ASA assignment. However, in three scenarios involving a patient with severe autism, a patient with asymptomatic atrial septal defect, and a patient with a history of Wolff–Parkinson–White syndrome treated with ablation, physicians with ≤10 years of experience assigned significantly higher ASA classifications compared with those with more experience. These findings indicate that although pediatric ASA classification is widely used in clinical practice, variability related to professional experience may occur, particularly in borderline cases between ASA II and ASA III.