Due to the changes in the domestic and international economic situation in the post-pandemic era, the economic development of the Guangdong-Hong Kong-Macao Greater Bay Area has become unstable in many aspects. The paper adopted the Pressure-State-Response (PSR) model to build a regional economic resilience evaluation system from the perspective of public health emergencies. Then, the spatial and temporal evolution of the economic resilience of the Guangdong-Hong Kong-Macao Greater Bay Area and the influencing factors were explored by using entropy weight method, GIS and gray correlation method. The conclusions show that: (1) Temporally, the economic resilience of the Guangdong-Hong Kong-Macao Greater Bay Area has generally increased from 2010 to 2021, and is divided into three main stages: rapid development, adjustment to fluctuations and stable development. (2) Spatially, the overall pattern of economic resilience in the Guangdong-Hong Kong-Macao Greater Bay Area is high in the middle and south and low in the northwest, and shows a “stochastic—equalized—polarized” pattern of transformation. (3) In terms of influencing factors, economic status and economic response are the main dimensions affecting the resilience level of the economic system in the Guangdong-Hong Kong-Macao region. The level of scientific research and innovation, medical governance, government regulation and the rationalization of the industrial system are the key factors. The COVID-19 epidemic swept the world in 2020, which caused a number of problems including disruption of international trade, price fluctuations, increased unemployment, and increased pressure on government spending on health care, thereby impacting the economic stability of countries. The intensification of globalization has made the world economy a mutually integrated organic whole, but at the same time, the economic development of cities and regions is inevitably influenced by the external environment. With the increasingly frequent flow of products, resources, and human resources between countries, the threat of global epidemics will be a problem that cities and regions must deal with in their economic development, and economic resilience has also become a strategic issue that countries must pay attention to in their economic development  model to build a regional economic resilience evaluation system. Moreover, the entropy power method, GIS and gray correlation method are combined to explore the spatial and temporal evolution and influencing factors of the economic resilience of Guangdong-Hong Kong-Macao Greater Bay Area, so as to provide suggestions for the economic transformation and upgrading of the Guangdong-Hong Kong-Macao Greater Bay Area under the post-pandemic era.The PSR model was originally proposed by Canadian statisticians David and Tony to address ecological and environmental issues . It reveAt present, most of the processes of economic resilience evaluation still decompose the regional system into parallel vertical subsystems such as industrial structure, technology level and economic scale, but the positive and negative feedback processes between the front-end and the regional subject are still less emphasized. If the PSR model is used, it is possible to describe more accurately the process properties of the economic resilience of the system by using the logical thinking of mutual regulation of the region from the subject system and the stress risk input to the system and the three-way feedback of the system's own state changes.Therefore, based on the above understanding, the economic system process can be divided into three stages: riskiness before the shock, stability and resistance during the shock, and resilience and evolutionary power after the shock, which correspond to the three process elements of “pressure-state-response” in the PSR model, respectively. In this study, three dimensions of the resilience process are proposed for the regional economic system to cope with the disturbance, namely, economic pressure, economic status, and economic response as shown in Economic pressure refers to the pressure on the system during the outbreak of public health emergencies and its aftermath, and is characterized by its own potential riskiness. It can be interpreted as the low exposure of the system to the risk of public health emergencies and its negative effects, reflecting the external disturbances and endogenous perturbation dynamics of the regional economic system. Economic vulnerability can be used as a measure of the relative loss value of the regional economy, usually manifested as employment decline, trade pressure, and financial risk, that is, risk vulnerability .Economic status refers to the stability of the system's own structure and its resistance to disturbances, while it is constantly changing in the process of negative effect of “pressure” and positive feedback of “response.” Economic status consists of economic stability and economic resistance. Economic stability can spontaneously maintain the ability of its own structural system to function as an internal stabilizer; economic resistance refers to the ability of the regional economic system to withstand shocks. It usually operates in the form of consumption level, economic base, industrial structure and capital input.Economic response refers to the ability of the subjects of the urban economic system to respond and take actions in response to disturbances, reflecting the ability of the subjects of the regional economic system to deal with risks, learn from shocks and disturbances and optimize their own organizational structure. Economic recovery capacity means that the speed and extent of recovery from shocks can be achieved through rapid and diversified response measures. Economic evolutionary power is the ability to renew and reorganize internal structures and functions, generating new development models and paths for the purpose of strengthening the development of economic agents.For the connotation of economic resilience, Martin proposed four dimensions of regional economic vulnerability, resistance, stability, and resilience to break down the operation process of economic resilience. Zeng  also conIn order to eliminate the influence caused by data units and subjective determination of index weights, this paper adopts the extreme value entropy method to dimensionlessly process and assign weights to the selected indexes. The greater the index dispersion, the greater the entropy value, and the greater the effective information reflected. It means that the greater the influence on the evaluation, the more significant the weight is. On the contrary, the smaller the index dispersion, the smaller the influence and the smaller the weight , 33. The(1) Building the original matrixn (year/city) * m (index). Let the value of the jth index for the ith year (city) be Xij.Build the matrix of (2) Standardizing the dataXj is a positive index or negative index, the following can be derived:Assuming that the evaluation index Xj is a suitability index, the following can be derived:If the evaluation index Pij of the ith city/year to the jth index(3) Calculate the ratio ej of the jth index(4) Calculate the entropy value dj of the jth index(5) Calculate the co-efficient of variation wj of the jth index(6) Calculate the weight Based on the data samples, the gray correlation analysis uses the geometric similarity between the parent sequence and the signature sequence to identify the closeness of the association, and obtains the gray correlation between the parent sequence and each signature sequence. The greater the correlation, the closer the relationship between the signature sequence and the parent sequence, and vice versa. The formula is as follows:i(j) denotes the gray correlation co-efficient, Qi denotes the parent sequence, where, ζn denotes the number, Wj denotes the weight. The greater the value of the correlation co-efficient rj, the higher the impact of the index on the comprehensive resilience level.where, Located in the south of China, the Guangdong-Hong Kong-Macao Greater Bay Area now covers Guangzhou, Shenzhen, Foshan, Dongguan, Zhuhai, Huizhou, Zhongshan, Jiangmen, Zhaoqing, as well as Hong Kong and Macau as shown in The time span of this study is 2010–2019, and the data sources include the fourth national economic census, statistical yearbooks of each region, statistical yearbooks of the Pearl River Delta city cluster, statistical yearbooks of cities in China and national economic statistical bulletins. Since the statistical standards vary from city to city, the number of registered unemployed in Hong Kong and Macau in this study is the unemployed population, the total retail sales of social consumer goods in Hong Kong is the total value of retail sales, and the total retail sales of social consumer goods in Macau is the total sales of retail trade. The total volume of imports and exports in Hong Kong and Macao is the total volume of trade; at the same time, all of them are converted into RMB at the current exchange rate of the year.* index, and the results are shown in The economic data of the Greater Bay Area from 2010 to 2021 are used to construct a matrix of yearFirst, the period from 2010 to 2013 represents the period of rapid development of the Greater Bay Area. During this period, the Greater Bay Area advocated a model of rapid economic construction, thus maintaining a high rate of economic resilience development, with economic pressure, economic status and economic response all making improvements to varying degrees. After the 2009 H1N1 and 2008 financial crisis, economic pressure, economic status and economic response maintained a dynamic equilibrium relationship that promotes each other. At this time, the economic pressure risk is high, the economic status foundation is weak, and the economic response capability is insufficient. If one of them fails, the whole system will be affected. Therefore, they are developing more in a relatively “conservative” way. In terms of a single index, fixed asset investment and the deposit-to-loan ratio have a short-lived mini-peak, which caters to the massive tides of economic development in the early stages and a huge amount of capital is needed to promote the economic vitality of the Greater Bay Area.Second, the period from 2013 to 2017 represents the period of fluctuations and adjustment of economic resilience. It is the transition period of industrialization in the Greater Bay Area, where economic pressure and economic status underwent rapid changes and adjustments, and then the three converged in 2014, and then became differentiated. Economic pressure, economic status, and economic response became distant from each other, and the economic system of the Greater Bay Area regulated itself mainly in the form of status-response. From a single index, the value added of tertiary industry witnessed explosive growth, the economic structure of the Greater Bay Area was upgraded, entrepreneurship and scientific research vitality emerged in the budding stage of development, and the industrial structure tended to be diversified and intelligent.Third, the period from 2017 to 2021 represents the period of stable development of economic resilience. At this point, the industrial transformation of the Greater Bay Area matured, from the original high-speed development mode to high-quality development mode, and the industrial structure was gradually adjusted from labor-intensive to knowledge-intensive industries. Economic pressure gradually decreased, while economic status and economic response slowly increased, and the distance between the three gradually expanded, with the economic system in a high-exposure development model. The fall in economic pressure means that the economic system is more likely to face high-risk shocks. However, the economic system is less likely to collapse even after a public health emergency by continuously strengthening the substrate of economic status, increasing the threshold of economic resilience against the maximum risk intensity, and establishing an economic response at the same time. Furthermore, the rapid response and regulation allows the economic system to return to its original stage of development, as exemplified by the COVID-19 epidemic in 2020. The economic resilience of the Greater Bay Area declined briefly when the crisis occurred, but soon rebounded and continued to grow. In terms of a single index, the rapid rise in entrepreneurial innovation and R&D vitality signifies the beginning of a massive renewal of the industrial structure based on technological innovation. The spike in the loan-to-deposit ratio could easily cause a payment crisis in banks, which would spread further to lead to a financial crisis.* index is constructed from the economic data of 11 cities in the Greater Bay Area of Guangdong-Hong Kong-Macao, and the results are shown in A matrix of yearFirst, the cities with rapid development include Zhuhai, Foshan, Huizhou, Zhongshan, and Shenzhen. Among them, Zhuhai has the fastest growth in economic resilience in the past 12 years, with an average growth rate of 30.61% as shown in Second, the cities with slow development include Zhaoqing, Jiangmen, Dongguan, Guangzhou, Macau, and Hong Kong. Among them, Hong Kong is the slowest in building economic resilience, with a rate of 10.95% as shown in * index is constructed by counting the panel data of each city in the Guangdong-Hong Kong-Macao Greater Bay Area from 2010 to 2021. Taking the average value of economic resilience of the cities in the Greater Bay Area from 2010 to 2021 as the criterion, four representative nodes were selected in 2010, 2013, 2017 and 2021. With the help of natural breaks classification method in GIS . Once the economic crisis strikes, Macau will be subject to a series of economic chain reactions and the credit crisis will be further aggravated. Although Foshan and Zhongshan do not have as many economic advantages as Guangzhou, Shenzhen, and Zhuhai, they both have their distinctive strengths. Foshan has achieved a good balance in terms of the loan to deposit ratio, and the development model of specialized towns in Foshan has been the unique feature of its economy. Nowadays, Foshan has been trying to diversify the risk by transitioning the original specialization model to a non-related diversification model through banking, scientific and technological innovation and financial means . In receFourth, the space with low resilience is basically in the periphery, such as Jiangmen, Zhaoqing, and Huizhou. Except for 2017, when Huizhou rose to a relatively low resilience, it has been in low resilience for the rest years, with poor performance of various economic indexes. Huizhou suffers from a lack of capital and a large population outflow from Huizhou, resulting in a serious aging population, sluggish economic development, and slow recovery in times of economic crisis. Jiangmen's industrial structure is still being shifted from agriculture to industry, and its economic resilience is low due to its low per capita income, unstable economic base, and delayed industrial restructuring. Zhaoqing suffers from low fiscal revenues and inadequate health personnel, and its industrial base is weak, making it extremely difficult to respond to public health emergencies if they occur.The economic resilience value of the Greater Bay Area calculated is used as the parent sequence of the gray correlation analysis, and the other 18 indexes are used as the signature sequence to analyze the fitting effect of the economic resilience with each index, so as to determine its influencing factors. According to As shown in As shown in As shown in The economic resilience of the Guangdong-Hong Kong-Macao Greater Bay Area continues to grow, with most cities experiencing an increase in their resilience levels. From 2010 to 2021, the economic resilience of the Greater Bay Area has generally improved, mainly divided into three main stages: rapid development, adjustment in fluctuations and stable development. The regional economic structure has been evolving steadily, showing a healthy development of a pressure-state-response pattern, in which the economic resilience indexes regulate, circulate and influence each other. Among them, the pressure resilience increases in the fluctuations, and the external disturbance of the system decreases. The status resilience increases rapidly, and the robustness level of the system continues to grow. The response resilience increases in fluctuations, and the response capacity is constantly enhanced. In the development of resilience of cities within the region, except for Hong Kong and Macau, where the level of resilience is decreasing, there is a steady increase in the resilience of most of the other cities, reflecting the strong resilience of the Greater Bay Area as a whole. However, under the disturbance of changes in the global economic environment and public health emergencies, it is necessary to pay close attention to the dynamics of the Greater Bay Area's economic resilience and its forecast.It develops in an imbalanced way, high in the central and southern parts and low in the northwest. The spatial pattern of the high-resilience areas is stable, mainly concentrated in the first-tier urban areas. Benefiting from the degree of economic development, industrial structure optimization and economic innovation capability, these high-resilience cities play an essential role in enhancing the resilience of the entire Greater Bay Area through economic connectivity. The space with relatively high resilience has shifted, mainly in Jiangmen and Zhongshan in the west wing of the Greater Bay Area, Hong Kong, and Zhuhai in the south of the Greater Bay Area. These cities have a sound industrial base, but have a high economic risk , and are vulnerable to the global economic crisis and their economic resilience fluctuates heavily. The space with relatively low resilience continues to expand, such as Dongguan, Foshan, Zhongshan, and Macau. The industrial structure of these areas is relatively homogeneous, which restricts their economic activities and diversified development, so they need to upgrade and adjust their industries, increase the economic evolutionary power, and improve the level of resilience. The space with low resilience is basically in the periphery. These cities have a poor economic foundation, are lagging behind in industrial restructuring, and are slow to recover from economic crises and public health emergencies once they are hit. Therefore, these cities are the priority target for enhancing the economic resilience of the Greater Bay Area.The economic resilience of the Guangdong-Hong Kong-Macao Greater Bay Area is significantly correlated with the economic status and economic response, while it is less correlated with the economic pressure resilience. Economic evolutionary power is the key, with a correlation co-efficient of 0.7474. Economic stability and economic recovery capacity are the main focus, while the changes in economic resistance and economic risk should be paid attention to. As for the subfactors, local GDP, industrial value added and urban per capita income have contributed significantly to the increased economic resilience of the Greater Bay Area, reflecting the importance of regional social and economic development, industrial construction and market consumption. At the same time, the positive effects of general public budget revenue and the number of patents applied or granted per 10,000 persons also indicate that the government's ability to manage public health emergencies and the technological means in the epidemic also play a crucial role in the socio-economic operation. Therefore, the foundation of economic development, industrial structure, government regulation and control capacity, and technological innovation capacity are of vital importance to the economic resilience of the Greater Bay Area, and are also important elements in the future resilience enhancement path of the Greater Bay Area.The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author/s.YZ and BT contributed to the topic selection, development of the framework and writing of the manuscript, and figures and the literature review. ZC contributed to the data analysis, drawings and the tables. HS contributed to the revision of data analysis and drawings. All authors contributed to the article and approved the submitted version.We are grateful for the financial support from project of the 14th five year plan for the development of Philosophy and Social Sciences in Guangzhou in 2021 (No. 2021GZYB22); College students' innovative entrepreneurial training program: Resilience assessment of urban agglomerations in the Guangdong-Hong Kong-Macao Greater Bay Area based on the PSR model (No. S202013902038); School level scientific research project of Guangzhou Xinhua University (No. 2018KYQN001); Study on the spatial pattern, mechanism and management of innovation in the Guangdong-Hong Kong-Macao Greater Bay Area from the perspective of regional synergy. Project of special innovation classes for regular universities in Guangdong Province  (No. 2020WTSCX136); College students' innovative entrepreneurial training program (No. 201913902171); School level scientific research project of Guangzhou Xinhua University (No. 2018KYZD002); Special research on industry in Longjiang Town, Huilai County (2015HX001).The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Taking advantage of the nature of games to deal with conflicting desires through contextual practices, this study illustrated the formal process of designing a situated serious game to facilitate learning of information ethics, a subject that heavily involves decision making, dilemmas, and conflicts between personal, institutional, and social desires. A simulation game with four mission scenarios covering critical issues of privacy, accuracy, property, and accessibility was developed as a situated, authentic and autonomous learning environment. The player-learners were 40 college students majoring in information science and computer science as pre-service informaticists. In this study, they played the game and their game experiences and decision-making processes were recorded and analyzed. The results suggested that the participants’ knowledge of information ethics was significantly improved after playing the serious game. From the qualitative analysis of their behavioral features, including paths, time spans, and access to different materials, the results supported that the game designed in this study was helpful in improving participants’ understanding, analysis, synthesis, and evaluation of information ethics issues, as well as their judgments. These findings have implications for developing curricula and instructions in information ethics education. The process and scope of information dissemination are expanding along with the rapid development of media and technology. While the access and accessibility to information are improved, in this unique information age, the literacy and ethics of utilizing information have gained importance, especially in the development of information services. Information ethics not only influences people’s behaviors in the production, intermediation, and use of information but also establishes principles for information services governing business and professional practices . Relatedpost hoc survey instruments, as in Ethics is defined as inquiry into the nature and grounds of our moral judgments, standards, and rules of conduct  which foAs information ethics involves field practices and interactions with others for common well-being, practical concerns have placed great emphasis on issues related to information ethics in the contexts of different professions, types of information, and rapidly changing technologies. Since the 1980s, several professional societies of informaticists, such as the Association for Computing Machinery , InstituAlthough the codes of ethics promulgated by the abovementioned professional societies have often been criticized as oversimplifications of information ethics and therefore as being of little help in solving the practical problems or dilemmas in field practices , the devTo address the gap between principle and practice, educational content, resources, and strategies were therefore investigated to supplement learners’ understanding through contextual applications and examples . Albeit According to recent reviews of university information and technology ethics courses , the curGame-based learning meets the learning needs of contextual practices in information ethics education . The higMotivated by the aforementioned issues, this study intended to design a serious game focused on information ethics for pre-service information professionals’ learning of ethical judgments. To transform the acquisition of ethics theories and professional ethics issues into implicit understanding, analysis, and evaluation, a simulation game was developed as a standalone knowledge acquisition mechanism to support the aforementioned situated learning of information ethics. The instructional effectiveness of the game was investigated based on participants’ learning outcomes, i.e., making well-reasoned ethical decisions. A specific theoretical model of ethical decision-making in the domain of informatics  was adopvia changes in quantifiable metrics of their temporal and spatial use logs. The game also recorded participants’ uses and instances of accessing every element as the representations of their decision-making process for further analysis.After the simulation game was developed, an experiment with pre-service information professionals, namely, college students majoring in information and computer science, was conducted. In the designed game, the player-learners assumed the role of an Internet of Things (IoT) company employee in four mission scenarios of information ethical dilemmas and took responsibility for acting out their roles within the narrative through a structured decision-making process. The game was designed with the Unity engine, and players’ ethical decisions were tied directly to the game simulation In the following sections, the detailed design of the simulation game and the setup of the experiment are described.This study designed a story-driven, first-person role-playing game based on the four major issues of privacy, accuracy, property, and accessibility (PAPA) , which aAs shown in Participants experienced the four mission scenarios of privacy, accuracy, property and accessibility in identical sequences see  of encouTaking the mission scenario of privacy issues as an example, This study simulated the ethical decision-making process in game-based ethical analysis training to assist informaticists in coping with new ethical dilemmas presented by information technologies and services. To ensure a comprehensive ethical decision-making process, the theoretical model of the General Theory of Marketing Ethics, or GTME , was adoAs the original model  suggesteMore importantly, GTME  identifiThe subjects for this study were pre-service information professionals, namely, college students majoring in computer science (CS) or library and information science (IS), randomly sampled based on the local statistics of the distribution of majors . The numIn addition to the game metrics see , which rAll 40 participants completed the four mission scenarios of the game designed in this study. Exactly half of them were IS majors from the departments of library and information science and information management science, and the other half were CS majors from the departments of computer science, computer engineering, and electrical engineering. The sample sizes for graduate and undergraduate students were similar, with 22 graduate students and 18 undergraduates participating. The following sections present the analysis of the participants’ behaviors and learning performances from the perspective of the efficiency and effectiveness of their ethical decision-making processes.The total playtime of all participants spent on the designed game was about 50 min . The players spent the most time on the mission scenario of privacy , and the least time on the mission scenario of accessibility issues . Participants’ uses of different elves indicated their references to different evaluation methods, and the players spent more time on teleological evaluation with the Elf of Utility (57.2 s), which provided consequence-based information for assessment. Regarding the quality of the ethical decisions, Interestingly, the game invited every participant to indicate the most decisive theoretical viewpoint in each mission scenario by selecting the most valuable elf, and the results of this subjective selection differed from the above-described behaviors exhibited in the actual decision-making processes captured by the game. t = −4.891, p < 0.01), it was found that IS-majors were more aware of ethical issues and considerations due to the human-centered nature of their discipline and professional conduct , at the end of the game, all participants were asked to respond to four short-answer questions about their understanding of the four theoretical viewpoints. The qualitative analysis of the participants’ answers showed that the majority of the participants established a basic understanding of the four major ethics theories, and they were able to make well-reasoned arguments and see multiple perspectives to approach information ethics issues. Specifically, 97.5% of the participants correctly described consequence-based evaluation based on utilitarianism, and 80.0, 75, and 65% appropriately interpreted rights-based, duty-based, and virtue-based viewpoints, respectively.The player-learner participants gave high appraisals on the simulation game in terms of its interactions and interface. As shown in This study simulated the ethical decision-making process in game-based ethical analysis training to assist informaticists in coping with new ethical dilemmas brought about by information technologies and services. Taking advantage of the nature of the game to deal with conflicting desires, this study designed and developed a simulation game as an authentic and autonomous learning environment for teaching pre-service information professionals about information ethics, a subject that heavily involves decision making, dilemmas, and conflicts between personal and social desires. Using the theoretical framework of GTME  as the sMethodologically, this study contributes to the field studies of decision science by adopting the mechanism of a simulation game to represent the complex situational elements and consequences of the ethical decision-making process, which in the past was a challenge due to the limitations of the survey instruments . The desThe raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.Ethical review and approval was not required for the study on human participants in accordance with the local legislation and institutional requirements. The patients/participants provided their written informed consent to participate in this study.WL: conceptualization, methodology, visualization, investigation, and writing—original draft. J-YW: software and investigation. H-PY: methodology, funding acquisition, and writing—reviewing and editing. All authors contributed to the article and approved the submitted version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Health  is determined by multiple factors: social class, educational background, income, occupation, and race/skin color. Racism can directly impact physical and psychological illnesses, with an effect on social conditions of health. This paper discusses: (1) racism as a root cause of health inequities in Brazil and elsewhere, and (2) how students at the University of Brasilia School of Medicine respond to an anti-racist curriculum. We emphasize that an environment of profound exchanges in the teaching–learning process, adopting anti-racism praxis as a competency in the medical curriculum, is a paradigm shift in medical education and future practice. Health  is determined by multiple factors: social class, educational background, income, occupation, and race/skin color ,2. ConteRacism can directly impact physical and psychological illness ,5, with Even after 134 years of the abolition of slavery in Brazil, slavery had and still has fundamental implications for social inequalities. The black population tends to be born and raised in families with less economic and cultural resources. They face disadvantages that impact school and occupational results, and wage conditions . Black pIn light of those principles and of this reality, this work comments on the incorporation of an anti-racist praxis  in medicThis is a descriptive and qualitative study designed as a narrative report of an undergraduate teaching experience on Black People Health Policies at the Medical School of the Brasilia University. The path taken in one discipline of the reviewed curriculum of the Medical School  is conteThe discipline applies an anti-racist focus to medical teaching, bringing contents such as neglected illnesses  and health of deprived populations . The discipline was created in 2018 and is offered every semester. Each semester, approximately fifty new medical students are enrolled in the discipline, which is mandatory in the medical course. Three professors of Family Medicine are responsible for teaching the health of the black population in this discipline for fifteen weeks, every Wednesday morning for four hours, in the 3rd year of the medical course. When teaching about the health of the black population, professors give lectures and provide content in various formats, such as scientific articles, reference texts on national policies, books, podcasts by jurists and leaders of the black movement, among other audiovisual resources. From the presentation and debate of the content, the students carry out critical reviews in which they evaluate the learning experience, as well as the inclusion of new content in the teaching–learning process.The last course week is used for students and professors to provide and receive feedback interactively. The experience of training participants is captured by interactions during the class and in the final exam. The impressions are contrasted with the challenges of struggling against structural racism in Brazil, especially in Brazilian medical education.In Brazil, the Black and the Health Reform movements fought for universal social rights for the black population and equitable access to health. They achieved the creation of the Unified Health System ,14. HoweIn the case of the black population, special conditions of vulnerability are determined by the environment, such as disqualified and devalued social inclusion , and by the invisibility of their real needs in assistance, health promotion, and disease prevention actions and programs (programmatic vulnerability). This way, black women and men live in a constant defensive state, which collaborates with inappropriate behavior, and psychic, psychosocial, and physical illnesses  .In this country, black skin color is associated with lower levels of education and income, occupational activities with higher risks, and disparity in the access of and difficulties in health care ,5,14. ThDespite institutional pressure for public policies aimed at confronting racism, it took decades for authorities to materialize health and educational initiatives focused on race/color ,14. RaciMedical education centered on the traditional biomedical model removes the psychic and social dimensions of education, limiting the future professional’s tools for care . TeachinThe National Curriculum Guidelines for the Medical Course (2014) incorporate the humanistic view of the patient into the technical–scientific aspects, contributing to the transition from an anatomo-clinical and hospital-centered model to the paradigm of continuous and comprehensive care for the individual . They esThe changes in the National Curriculum emphasize that general practitioners training in primary care and urgency/emergency settings should meet the health needs of the population. For this purpose, the Guidelines are centered on three major areas: Integral Health Care, Health Education and Health Management. These areas are intended to contribute to the development of skills that allow for greater aptitude in dealing with the problems of Brazilian society and public health, with an emphasis on adapting to the demands of the Unified Health System .In this context, it is essential that teaching methodologies promote criticality, reflection, and humanistic skills and attitudes in students . TeachinRacism is widely spread in society, and that is not different in education. From basic to higher education, in public or private sectors, it pervades students and teachers’ relations, curricula, and institutional infra- and superstructure. It, thus, contributes to maintaining an elite-dominated and prejudicial social status quo .The ethnic–racial issue must be widely debated, beyond curriculum components that discuss deprivation, as in the case presented in this paper. The academic universe is poor of popular universities that promote views of liberty and anti-racism as well as an ethnic/racial responsibility. It is urgent that knowledge production stop reproducing the coloniality of knowledge and start promoting the cultural and academic respect to and valuation of indigenous and black ancestry .In health, students and professionals, with an antiracist education and attitude, contribute to break through access barriers, reduce maternal and neonatal mortality, reduce violence, and mitigate other conditions that lead to illness in that population. When well-trained physicians understand the needs and priorities of the black population, they act for the sake of attention, care and health rights .The University of Brasilia School of Medicine reformulated the medical curriculum guided by competency domains: Knowledge, Skills, and Attitudes. Those domains cover themes of black population health, with the objective of discussing racism as a health condition; epidemiology of health problems in the black population; role of the family and community doctor in confronting inequities; and anti-racist practices in health .The experience of the University of Brasilia School of Medicine has shown that students, when provoked to reflect on structural racism, manage to produce critical reviews of excellent quality, in which they articulate the content of classes with health system policies, ethical and existential issues of the doctor–patient relationship, plus aspects of clinical communication and subjective experiences.From the professors’ point of view, the main focus in the training of health professionals is to deal with the racial issue in health. Since 2018, professors have observed that during the classes and in the final exam, the students show that they understand the influence of black race issues in the environmental, organic, and genetic domains. In addition, they incorporated the race–color category in clinical reasoning during the clinical interview. All professors participated in deeper discussions about what the curriculum entails, and they suggested that pedagogical investments should focus on the dialogue between medicine and social sciences. This can expand the students’ theoretical framework, generating new questions and exchanges among professors from medicine and social sciences, as well as expanding critical perspectives in medical training and in life in society.The experience of training participants and the students’ feedback on teaching can be summarized in two points: (1) training was important to understand how to incorporate racial issues in health and (2) the pedagogical investment in different types of teaching materials  was an important stimulus for the study of content.The incorporation of the anti-racist lens in clinical reasoning represents the integral care of the patient and the confrontation of inequities, valuing their epidemiological context and their life narrative . The cliChanging the curriculum, infrastructure, and institutional superstructures for the incorporation of anti-racist practices in health education is a challenge. At the University of Brasilia, we want the ethnic–racial issue to permeate all curricular components of medical education.Finally, pedagogical investments aimed at the dialogue between medicine and social sciences can broaden the theoretical framework of students, as well as critical perspectives in medical education and in life in society. An environment of profound exchanges in the teaching–learning process by adopting anti-racism praxis as a competency in the medical curriculum is a paradigm shift in favor of reducing and combating racial inequities.


Microfluidics is a powerful tool to precisely control fluids as well as to manipulate suspended small particles in a micrometer-sized space. Numerous efforts have been made to develop this technology in interdisciplinary fields including physics, engineering, medicine, biology and chemistry. The efforts in these fields have enabled us to perform automated, high-throughput, and precisely controlled assays to treat micro-objects such as microdroplets, microparticles, and single cells, even with extremely small amounts of samples. Owing to the advantages of microfluidics, clarifying the mechanisms of the microscopic biological phenomena has been one of the central topics in these fields. In this Special Issue, we focused on recent microfluidic approaches that shed light on the biological mechanics and transport phenomena, especially on the deformation and transportation of passive micro-objects exposed to shear stress and behavioral dynamics of bacteria as active microswimmers. This Special Issue contains seven research papers covering different subjects related to cell mechanics and biotransport. Three of the research papers report the experimental approaches, and four of the papers focus on numerical investigations.Lee et al.  reportedOkuyama et al.  experimeSugihara-Seki and Takinouchi  conducteTakeishi et al.  numericaA = b: long side width; h: short side width), and elucidated the variation of the inertial focusing depending on the Reynolds number of 50 to 400. Simulations covered blockage ratios d: a particle diameter). The authors accurately estimated the particle trajectories based on the lift map and Stokes drag, and identified the particle-focusing positions that appeared in the cross-section.Yamashita et al.  numericaOtomo and Kira  theoretiMoreau and Ishimoto  theoretiIn summary, the seven original papers in this Special Issue highlight the recent advances on the deformation, transportation, and behavioral dynamics of passive and active micro-objects, towards the clarification of biological mechanics and transport. We, the Guest Editors, believe that further understanding and the clarification of mechanisms of the microscopic biological phenomena will be provided through the cooperation of experimental, theoretical, and numerical efforts such as those included in this Special Issue. We hope that the Special Issue will be a good starting point for future studies in this field. Finally, the Guest Editors would like to acknowledge all the researchers who contributed their original papers, reviewers who provided fruitful comments, and the members of the editorial office for their valuable time and efforts.


Esophagogastroduodenoscopies and colonoscopies are the main diagnosticexaminations for esophageal, stomach, and colorectal tumors. This study aimed to evaluate the estimates of the incidence of esophageal,stomach, and colorectal cancer; population growth; andesophagogastroduodenoscopies and colonoscopies performed by the UnifiedHealth System (SUS), from 2010 to 2018, in the five regions of the country,and to analyze the relationship between these values. The colorectal tumor had a significant elevation, while the esophageal andgastric maintained the incidences. In the five regions, there was asignificant increase in the number of colonoscopies; however, this increasedid not follow the increase in the population in the North and Northeastregions. There was no significant increase in the number ofesophagogastroduodenoscopies in the North, Northeast, Midwest, and Southregions, and in the North region there was a decrease. In the Northeastregion, there was a decreasing number, and in the South and Midwest regions,the number of examinations remained stable in the period. The Southeastregion recorded an increase in the number of examinations following thepopulation growth. The current number of esophagogastroduodenoscopies and colonoscopiesperformed by the SUS did not follow the population growth, in order toattend the population and diagnose esophageal, stomach, and colorectaltumors. Therefore, the country needs to have adequate and strategic planningon how it will meet the demand for these tests and serve the populationwell, incorporating new technologies. They are also the first option for the diagnosis of gastrointestinaldiseases ,,,,,Both EGD and CLN examinations are performed widely by the Unified Health System(SUS), both in an outpatient clinic and in public and university hospitals. EGDoffers an excellent view of the mucous surfaces of the esophagus, stomach, andproximal duodenum, and CLN allows the examination of the entire colon and rectum andoften the terminal ileum. Both examinations allow diagnostic and therapeuticprocedures, including polypectomy, mucous and submucosal resections, dilation ofstenosis, placement of stents, removal of foreign bodies, gastrostomy,gastrointestinal bleeding treatments with injection of hemostatic solutions,placement of metal clips, electrocoagulation, laser, sclerotherapy, and elasticbandages of esophageal-gastric varices, in addition to other endoscopic therapies.They are mainly performed on an outpatient clinic, since they are safe procedures,with low morbidity and less complication The Brazilian Institute of Geography and Statistics (IBGE) is a government agencyresponsible for the population control and statistical data. It is also responsiblefor the organization and execution of the demographic census, which consists of asurvey of the national population, by states, and by regions, accumulating data onthe number of inhabitants; people’s lives condition; numbers of men, women, adults,and children; and others social and economic information of the country. The lastBrazilian census divulged was in 2018 The National Cancer Institute (INCA) is the Ministry of Health’s organ responsiblefor the development and coordination of integrated actions for the prevention andcontrol of cancer in Brazil. Not only it provides medical and hospital assistanceactivities to cancer patients, as part of the services offered by SUS, but it alsooperates in strategic areas, such as prevention and early detection, specializedprofessionals training, and development of research and epidemiological information.Therefore, it is the main responsibility for cancer statistics in the country toprovide detailed information on incidence, occurrence, and mortality of differenttumors The objective of this study was to conduct a survey on the websites of the INCA,IBGE, and Government Health Department, to obtain, respectively, the estimates ofthe incidence of esophageal, stomach, and colorectal cancer; the population growth;and the number of EGDs and CLNs performed by the SUS, from 2010 to 2018, in the fiveregions of the country , andto analyze the relationship between these values.,,,,The INCA published every 2 years, respectively, in the years 2010, 2012, 2014, 2016,and 2018, reports of the estimated incidence of cancer in the country, in all organsof the human body, as well as by regions The number of the Brazilian population, by regions, were obtained from the IBGEwebsite The number of EGDs and CLNs performed by the SUS, recorded in the site of theGovernment Health Department, in each of the Federation States, from 2010 and 2017(divulged in 2018), were obtained ,Statistical analysis was performed using the computer program SAS System for Windows, version 9.4 . The Jonckheere-Terpstra (JT) test was used to verify the tendency of anincrease in the resident population and outpatient production over the years. Toanalyze the relationship between population growth and outpatient production in eachregion, the analysis of the cross-correlation function (CCF) was carried out The analysis in The analysis in The analysis in The analysis in The analysis in The analysis in Therefore, these results show that in all regions of the country, there was astatistically significant increase in population, between the years 2010 and 2018.The colorectal tumor had a statistically significant increase in the country;however, in the same period, esophageal and gastric tumors did not increase. In thefive regions of the country, there was a significant increase in the number ofcolonoscopies performed from 2010 to 2017; however, this increase did not follow theincrease in the population in the North and Northeast regions.The statistical analyses performed showed that there was no significant increase inthe number of EGDs in the North, Northeast, Midwest, and South region. In the Northregion, there was a decrease in the number of these examinations in the same period.In the Northeast region, a decreasing number has been recorded since 2010. In theSouth and Midwest regions, the number of examinations remained constant. Therefore,in these regions, the number of examinations performed has not followed the samepopulation growth, which has been increasing year by year. On the contrary, in theSoutheast region, there was an increase in the number of EGDs, followed by thepopulation growth, with a statistically significant relationship.The number of endoscopic examinations per 100,000 habitants, in each region, in 2018,varied in the country, as shown in Therefore, the number of EGDs per 100,000 habitants varied from region to region, indecreasing order, respectively, in the Southeast, Midwest, South, Northeast, andNorth regions. The number of CLNs per 100,000 habitants per year also varied fromregion to region, in decreasing order, respectively, in the Southeast, South,Midwest, Northeast, and North regions.,,The incidence and statistics of malignant tumors of the esophagus, stomach, andcolorectal in the Brazilian population are high and significant The most frequent malignant gastric tumors are adenocarcinomas (95%), and in Brazil,13,360 new cases are awaited in men and 7,870 in women for each year of the2020-2022 triennium, with an estimated risk of 12.81 for every 100,000 men and 7.34for every 100,000 women. Among men, in the North , it isthe second most frequent, followed by the Northeast occupying the third position, while in the South ,Southeast , and Midwest (9.38/100.000 habitants), it is thefourth most frequent among the other tumors. Among women, in the North  and South  regions, it is the fifth mostfrequent; in the Northeast  and Central-West regions, it occupies the sixth position; and in the Southeastregion , it occupies the seventh position. In Brazil, in2017, there were 9,206 deaths from gastric cancer in men and 5,107 deaths in women,corresponding to the risk of 9.12 and 4.93 per 100,000 habitants The most frequent colorectal malignancies (divided into colon and rectum) areadenocarcinomas, and in Brazil, it is estimated that for each year of the 2020-2022triennium, 20,520 cases of colorectal cancer in men and 20,470 in women will bediagnosed, corresponding to an estimated risk of 19.63 new cases per 100,000 men and19.03 for every 100,000 women. Among men, in the North  andNortheast  regions, they occupy the fourth position; in theSouth region , it is the third most frequent tumor; and inthe Southeast  and Midwest regions, it is the second most incident. For women, in the Northeast , North , and Midwest regions, it is the third most incident; and in the Southeast  and South  regions, it is the second mostfrequent. In Brazil, in 2017, there were 9,207 deaths from colon and rectal cancer,respectively, in men and women, to the risk of 9.12 and 9.33 per 100,000 habitants,,,Both EGDs and CLNs have many indications among gastroenterologists, digestivesurgeons, general surgeons, proctologists, and general practitioners. They are safeprocedures with low morbidity and are used for the diagnosis of benign and malignantdiseases and for therapeutics The Unified Health System (SUS) records the number of examinations performed in thecountry, state by state. Consulting the online available records, it was possible toconstruct the figures shown in this study, comparing and statistically analyzing thenumber of endoscopic examinations performed, with the population growth recorded byIBGE in the geographic regions and the regional incidence of these malignant tumors,recorded by INCA, year by year.The Brazilian Constitution considers health as a universal right and a governmentalresponsibility to every citizen, through an SUS, created in 1990, as a healthservice, throughout the country, for everyone. Thus, SUS allows the population toaccess the outpatient and hospital health system, from primary care to highlycomplex treatments The population senses, performed by the IBGE, recorded population growth in the fiveBrazilian regions between 2010 and 2017 -5. In coThe results showed that the number of EGDs performed in the North, Northeast, South,and Midwest regions did not increase significantly during the period of this study.In the Northeast region, the number of examinations decreased year by year.Therefore, the number of examinations did not follow the population growth. Only inthe South region, did the number of examinations increase, following the populationgrowth .The number of CLNs increased year by year in the five regions of the country.However, in the North and Northeast regions, population growth was more significantand the number of CLN examinations performed did not follow the population growth and 2.Although malignant gastric tumors have decreased in some countries, in recent years,such as Japan, Korea, and China, their incidence remains high, requiring healthactions for screening in the population, based on encouraging EGDs. In Japan, therewas an increase in the number of examinations per year, by more than 2 million from1996 to 2014. And from 2016, the government started to encourage the requesting ofan increasing number of EGDs in clinics and hospitals, achieving an increase of 8.6%per year, and that a total of 12 million examinations be performed annually, for anestimated population in 2019, of 126 million habitants In China, with 1.4 billion habitants in 2019, it was estimated that approximately 2million Chinese people had malignant gastric tumors, and of this total, 42.7%(40.3-45.0%) remained without diagnosis, due to patients’ delay in seeking medicalhelp and difficulty in performing EGDs. In addition, without systematic screening,it is projected to occur about 10 million cases and 7 million deaths, due to thistumor, in the next 30 years. The authors concluded that the triennial screening,performing periodic EGDs in the population at risk, would gradually reduce by 38.8%(36.9-40.7%), 25.5% (23.4-27.6%), and 17.8% (16.0-19.6%) by 2049, respectively, theproportion of undiagnosed cases of gastric cancer In Germany, 36.6% of deaths from colorectal cancer are estimated to be attributed tothe failure to perform CLNs, this percentage being compared to what also occurs inthe United States, where it is estimated that 38.2% and 33.6%, respectively, betweenthe years 2008-2009 and 2010-2011. The authors concluded that the proportion ofdeaths theoretically that could be prevented in 10 years would be 30.7% and 29%,respectively, in Germany and the United States, in these cited periods ,The cost-effectiveness for detecting malignant esophagogastric junction and gastrictumors in the United States, in a high-risk population, using EGDs, was consideredadvantageous, in relation to the cost of surgical and oncological treatment of thesetumors when diagnosed in advanced phase Hamashima emphasized that endoscopic examinations are the main methods for diagnosinggastric tumors, and the sensitivity and specificity of endoscopic screeningevaluated in South Korea and Japan. Although the reduction in mortality employingendoscopic screening was recorded in several studies, the results remaininsufficient to confirm its effectiveness, and so new screening methods should beintroduced in future ,,,The literature has recorded high rates of colorectal cancer in several countries,including Brazil, and evidenced colonoscopy is the best and most effective screeningtest. Therefore, maximizing its effectiveness and encouraging its performance inadults over 50 years of age is the best way to detect the tumor early and provide anopportunity for appropriate treatment for the patient Taveira et al. calculated the number of EGDs per 100,000 inhabitants per year, forthe period from January 2008 to December 2009, analyzing the total Brazilianpopulation according to IBGE data and the population, in the respective states andregions. The authors concluded that the regions that performed the most EGDs inabsolute number per year, in decreasing order, were Southeast, Northeast, South,Midwest, and North. On the contrary, in these 2 years of study, calculating thenumber of examinations per 100 thousand inhabitants per year, the regions thatperformed more examinations, in decreasing order, were Northeast (654 examinations),Southeast (590 examinations), Midwest (451 examinations), South (409 examinations),and North (323 examinations), with the median being 550 examinations per 100,000habitants per year. By comparing this national average with countries like Ireland,Holland, and England that have health systems similar to SUS and performed 1,322,1,137, and 950 examinations per 100,000 habitants per year, respectively, they foundthat Brazil performed half of the examinations than these countries. The authorsconcluded that adequate planning is necessary to incorporate new diagnostictechnologies in order to serve the population of all regions of the country wellComparing the results obtained by Taveira et al. ,,Patients looking for medical help present these tumors in an advanced form; so it isimportant to implement specific health actions to provide orientations to thepopulation, encouraging the early search for Medical Services and requesting theseendoscopic examinations, for the diagnosis the tumors in early stages. The diagnosisof these tumors in early and non-advanced stages allows greater chances of surgicaland oncological treatments, making possible better disease control and increasedsurvival and quality of life Therefore, it is of great importance to know quantitative data of these examinations,to plan health actions, mainly in the malignant tumors of the digestive system,because of what they represent in the Brazilian population.The current number of EGDs and CLNs performed by the SUS did not follow thepopulation growth, to attend the population and diagnose esophageal, stomach, andcolorectal tumors. Therefore, an adequate and strategic planning of how to attendthe demand for endoscopic examinations is important, in all regions, incorporatingnew technologies, in the diagnosis of these tumors, in future.


A vivid example of art and science intertwining and reflecting across generations.A clear demonstration of beauty and motion in biological iterations.Angiogenesis and stars, the bringers of light and elegance to a dark sky.Interspersing/intermingling collagen, moving clouds in the wind, not to denySheets of collagen, a stable platform over the City of the Valve providing protection.


The field of sex and gender research in health and medicine is growing, and many early- and mid-career researchers (EMCRs) are developing skills in this area. As EMCRs specialising in sex and gender research, we aim to better understand sex- and gender-based determinants of human health, challenge long-standing and pervasive gender biases, and contribute to improving the evidence base upon which clinical guidelines and policy interventions are developed. To effectively achieve these goals, we believe that EMCRs would benefit from understanding the challenges of working in this space and participate in driving change in three key areas. First, in creating greater links between the goals of sex and gender research and addressing systemic bias against women and gender minorities, to effectively translate knowledge about sex and gender differences into improved health outcomes. Second, in expanding the reach of sex and gender research to address women's health in an intersectional way and ensure that it also benefits the health of men, transgender and gender-diverse people and those who are intersex. Third, in working with others in the scientific community to improve methods for sex and gender research, including updating data collection practises, ensuring appropriate statistical analyses and shifting scientific culture to recognise the importance of null findings. By improving focus on these three areas, we see greater potential to translate this research to improve women's health and reduce health inequities for all. There is a well-acknowledged bias against, and underrepresentation of, women in health and biomedical research , 2. To aIn conducting our own research, encompassing different therapeutic areas and sex and gender policies, we visualise sex and gender research as situated inside a complex system including: (i) wider systemic issues of gender bias and health inequities,  (ii) greSex and gender research generally aims to expose, understand, and address health inequities. In particular, this research area focuses on the underrepresentation of women in research studies and the gaps in our understanding of the impact of sex and gender on health and disease. However, researchers, including ourselves, are investigating sex and gender, and their relationship with disease, in systems that reflect broader society's biases against women and gender minorities. This has consequences for the effective translation of research findings into sex- and gender-sensitive approaches to reduce health disparities, and so it is equally important to consider and address gender bias in other areas.First, we must consider that our research is being disseminated to readers that may hold biassed views on women and gender minorities. As a result, there is the potential for findings from sex and gender research in health to be misinterpreted, by researchers, the public and the media , 16. In st century, with 1 in 6 people expected to be 60 years and older by 2030 . The need for large sample sizes in sex and gender research is why large-scale population databases such as the UK Biobank,  and National Health and Medical Research Council of Australia (NHMRC) investigator grant (APP2009726).The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


In the knowledge economy, the process of knowledge sharing and creation for value co-creation frequently emerge in a multi-agent and multi-level system. It's important to consider the roles, functions, and possible interactive knowledge-based activities of key actors for ecological development. Makerspace as an initial stage of incubated platform plays the central and crucial roles of resource orchestrators and platform supporter. Less literature analyses the knowledge ecosystem embedded by makerspaces and considers the interactive process of civil society and natural environment. This study constructs a multi-agent and multi-level knowledge ecosystem from macro, meso, and micro perspective based on Quintuple Helix theory and designs four evolutionary stages of knowledge orchestrating processes. This study finds that the symbiosis, co-evolution, interaction, and orchestration of multiple agents in the knowledge ecosystem should be merged with each other for value co-creation, which helps to take a systematic approach for policymakers, managers, and researchers. The knowledge ecosystem is a non-linear and complex system that focuses on the knowledge interaction between major systems and subsystems  in the knowledge ecosystem should be analyzed for value co-creation at all levels of the knowledge ecosystem. Therefore, makerspaces require for the continuous attention of governments, scholars, business, citizens to make China's innovation and entrepreneurial strategy into an important engine to promote economic development and technological progress.Our work has some implications for policymakers, managers, researchers. Makerspaces have strong linkages to governments, universities, businesses, citizens, and the natural environment. The activities of knowledge exchange, cooperation, collaboration, and orchestration are reinforced in the knowledge networks embedded by makerspaces. The implications from three aspects are consistent with the three levels of our conceptual framework. At the macro-level, makerspaces are elements of the knowledge ecosystem as a whole. The long-term run of makerspaces could structure the relationship of symbiosis, commensalism, intergrowth, and orchestration. The not-for-profit business model is ubiquitous and communal to the sustainability of the sharing economy. At the meso-level, makerspaces play the role of community, embracing diverse populations of makers, startups, and entrepreneurs. Makerspaces need a systematic approach based on the support by multiple agents to provide disparate services to new projects. At the micro-level, makerspaces provide the economic and social environment suitable for interactive knowledge-based activities. Makerspaces should construct more multiple and mature platforms for knowledge exchange and flow among the maker individuals, incubated startups, and the maker culture.For further research, the case study should be extended to other countries, which may be more representative of all types of nations. Further research could compare our findings and practices with different contexts. Furthermore, some empirical data could be collected to verify our conceptual model.The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.All authors listed have made a substantial, direct, and intellectual contribution to the work and approved it for publication.This work was supported by the National Social Science Foundation of China (19BGL031).The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


This paper analyzes the environmental performance, spatial and temporal characteristics, and optimization paths of key polluting industries, represented here by the power industry, using the super-efficient MinDS model. The study shows that the environmental performance as a whole presents the characteristics of an inverted U-shaped and then a U-shaped trend; each region presents an asymmetric state of convergent development followed by differentiated development, with 2014 as the structural change point; the development trend of environmental performance in each region is divided into three categories  and four types of spatial clustering ; and input–output indicators of environmental performance in China and across regions have varying degrees of redundancy, with labor input redundancy being the greatest, followed by capital input, technology input, and pollution emissions. On this basis, we propose to improve the monitoring and inspection mechanism of the implementation process of pollution control in key polluting industries and to improve the level of environmental performance of key polluting industries by optimizing the combination of labor, capital, and technology input factors in each region according to local conditions and adopting differentiated strategies. The main contributions of this paper are threefold: first, we incorporate technological inputs into the environmental performance evaluation index system of the electric power industry, which can better reflect the real inputs of the electric power industry and measure the results more accurately; second, we adopt the MinDS model for measuring the environmental performance level, which can quantitatively analyze the gap between each indicator and the optimal level; and third, we propose a redundancy index, which can be used to compare the redundancy of each indicator and then judge the main efficiency levels of the different factors. Among them, global CO2 emissions from the power sector reached 13 billion tons, accounting for 38% of total energy-related CO2 emissions. China is the world’s largest producer of electricity and the country with the largest increase, accounting for 26.70% of the world’s total power generation capacity. According to the data provided by the 13th Five-Year Plan for Electricity Development (2016–2020), the carbon emissions of coal-fired units in China are as high as 890 g/kWh, while those of the United States and Japan are 433 g/kWh and 544 g/kWh, respectively. Thus, it can be seen that there is some room for decarbonization in China’s electric power and that it is the “front-runner” in terms of controlling carbon emission reduction [At present, China’s economy is in the transition stage from stable growth to high-quality development, and the coordinated development of the economy and the environment is an inevitable requirement for high-quality development. However, the problem of carbon emissions in China is still serious, and environmental problems have seriously restricted the high-quality development of China’s economy. According to relevant statistics, industries with large energy consumption, such as electricity, transportation, construction, and industry, are the main sources of carbon emissions in China, and the sum of their carbon emissions exceeds 74% of the total national carbon emissions ,2,3,4. I by 2060 ,6,7. In  by 2060 ,9,10. Aceduction ,12,13,14Environmental performance, also known as environmental efficiency or eco-efficiency, was first introduced by Schaltegger and Sturm in 1990 . EnvironIn recent years, with the increase in public concern about the environment and the successive introduction of government policies, people have been paying more and more attention to the environmental effects of enterprise production activities. Many scholars have started to pay attention to the environmental governance of heavily polluting industries ,17,18. TLooking at the previous literature on the selection of environmental performance indicators in the power industry, it is difficult to find studies with identical indicators. Peng selected sulfur dioxide emissions , nitrogeFor the measurement methods of environmental performance, researchers have mainly used life cycle analysis (LCA), stochastic frontier analysis (SFA), and data envelopment analysis (DEA) methods. The LCA method mainly focuses on a specific product and measures the environmental efficiency of the product throughout its life cycle, which makes it difficult to evaluate the environmental efficiency of enterprises or industries. The SFA method is a parametric method that requires the determination of efficiency when setting a specific production function and using statistical methods to estimate the parameters, which may result in large errors. Fare and Lovell  first prPrevious studies on the construction and measurement of environmental performance index systems in the power industry have provided us with many insights, but there are also certain problems. First, there is no uniform standard for the selection of environmental performance indicators. For the input indicators, previous scholars have considered three aspects: asset input, labor input, and fuel consumption input; in addition, there are a large number of technical inputs in the power industry, such as power plant consumption rate, line loss rate, and transmission line length ,50,51,52The super-efficient MinDS model combines the super-efficiency model and the minimum distance to strong efficient frontier (MinDS) model. Andersen and Petersen  first prThe first step is to establish the super efficiency SBM model and determine the effective DMU set, which is composed of a DMU with an efficiency level greater than 1; that is, i-th input indicator of the k-th DMU; r-th output indicator of the k-th DMU; i-th input indicator of the j-th DMU other than r-th output indicator of the j-th DMU other than In the above equation, (1) represents the objective function, and (1a)–(1c) represent constraints. The second step is to establish a mixed integer linear programming model under the constraints of the effective DMU set, calculate the super efficiency minds value, and solve the objective function and constraints of the super efficiency minds value model as follows:It can be seen from Equation (2) that the minds model is composed of three parts: objective function (1), constraint b, constraint c, and constraint d. In the above equation, the meanings of We comprehensively consider the ISO14031 environmental performance evaluation system and WBCSD eco-efficiency index system to select the input–output indicators, and the selection of the index system follows the principles of scientificity, validity, measurability, comparability, and systematization. Since the electric power industry is mainly divided into three sectors—the power generation sector, the transmission sector, and the distribution and sales sector—we should include each of them as much as possible in the selection of indicators in order to reflect the environmental performance of the whole electric power industry comprehensively. The basis for the selection of the input and output indicators of the power industry is shown below, and we summarize all the input and output indicators into a table to constitute the environmental performance indicator system of the power industry, as shown in Capital input: This reflects the resource input of electric power enterprises. Since it is difficult to measure the input capital of the power industry, this paper selects the installed capacity indicator, i.e., the overall power of the enterprise’s generating units, to reflect the scale of production capacity input in each region.Labor input: We usually use three methods to measure labor input in the power generation industry: labor time, labor income, and labor headcount. However, due to the residual administrative monopoly in China’s power generation industry, the labor income of employees in the power industry is not a reflection of the value of labor under market conditions. As we do not count the labor time data, we finally chose the number of laborers to represent the labor input. Since it is difficult to obtain the number of employees in the electric power industry in each province, city, and autonomous region directly, we used the number of employees in the heat and power production and supply industry, which is highly related to the electric power industry, to represent the number of employees.Fuel input: This refers to the fuel consumed by power industry enterprises in the process of power generation, which can reflect the degree of fuel utilization. At present, China mainly focuses on thermal power generation, and the energy input required for thermal power generation is mainly coal and fossil energy such as oil, natural gas, and coke. In order to make these energy inputs comparable with each other, we need to convert these energy sources into standard coal consumption uniformly, and finally we express the energy inputs in terms of standard coal consumption for power generation.Technical input: We measure the technical input of the region through power consumption rate in the power plant, line loss rate, and transmission line length. The power consumption rate in the power plant refers to the percentage of electrical energy consumed by the power plant in producing electrical energy of the total amount of electrical energy generated, which reflects the rate of power consumption in the generation chain. The line loss rate refers to the percentage of electrical energy lost in the transmission and distribution process to the electrical energy supplied by the power network and measures the economy of power system operation. The length of transmission lines is directly proportional to the voltage, so there is also a particular influence on line losses.Electricity generation: This refers to the amount of electrical energy produced by a power plant, which is the value of the main product or service of the power industry.Gross regional product: Electric energy, as an essential secondary energy source, provides power for all fields of social production, and electricity consumption shows a strong positive correlation with economic growth; therefore, it is feasible to measure the economic output of the regional power industry using the regional GDP.2 emissions, SO2 emissions, and nitrogen oxides; so, we chose these three environmental pollution indicators.Environmental pollution: According to the principle of conservation of matter, fuel consumption causes environmental pollution. The pollutants produced by the power industry are mainly COSince data from Tibet, Hong Kong, Macau, and Taiwan are difficult to obtain, this paper analyzes data from the remaining 30 provinces, autonomous regions, and municipalities under the direct control of the central government in China. According to the availability of data, we selected the data of the last ten years, i.e., 2010–2019, for the study. The data on labor force and gross regional product were obtained from the China Statistical Yearbook and all other data were obtained from the China Electricity Yearbook. For the few missing values, interpolation and extrapolation methods were used to obtain them. In order to eliminate the influence of price factors, the data of gross regional product were calculated in constant prices with 2010 as the base period.We obtained data on fuel coal consumption and nitrogen oxide emissions in the thermal power industry from the Annual Report of China Environmental Statistics. Currently, the Chinese Yearbook does not contain data on pollution emissions in the power industry by region for all years. Some literature directly uses industrial emissions instead of power industry emissions, which is likely to affect the accuracy of the results. To make up for this deficiency, we based this analysis on the results of the first national pollution source survey of the State Council in 2008 and the emission coefficient of major pollutants in the thermal power industry calculated by the State Grid Group of China and the State Grid Institute of Environmental Protection of China. The determination methods of pollutant emissions of thermal power plants include the measurement method, material balance algorithm, element balance method, production and emission coefficient method, etc. The production and discharge coefficient method has the advantages of simplicity, clarity, and easy operation. Therefore, this method is the most general and effective technical means of determination at present. We estimated the carbon dioxide emissions based on the changes in three driving factors, namely, power generation, coal consumption for power supply, and carbon emission intensity, as shown in Equation (3). We estimated the sulfur dioxide emissions based on the power generation, the sulfur content of coal combustion, the emission factors of different combustion equipment, and the efficiency of pollutant treatment, as shown in Equation (4).In Equations (3) and (4), Considering that the DEA model should make the input–output indicators as concise as possible when it is applied in practice, we use the entropy value method to downscale the three indicators of technological inputs and the three indicators of environmental pollution emissions and synthesize a total input technology indicator and a total environmental pollution emission indicator, respectively. The descriptive statistical results of the input–output index system of environmental performance of the power industry are shown in The software used in this study was MaxDEA 8 Ultra. The first version of MaxDEA was developed by ChengGang in 2009, and then ChengGang released more versions of MaxDEA one after another, including MaxDEA Basic, MaxDEA Pro, and MaxDEA Ultra. MaxDEA Ultra is an optimization of MaxDEA Basic and MaxDEA Pro. MaxDEA Ultra contains all the functions of MaxDEA Basic and MaxDEA Pro, and the measurable DEA models included in this version are more comprehensive, faster, and support multi-core CPU parallel computing; so, this paper uses MaxDEA 8 Ultra software for measurement . In thisFrom To reflect on the degree of variation in the environmental performance of the power industry in each region, we plotted the standard deviation of the environmental performance of the power industry in each region from 2010 to 2019 in We believe that the possible reason for the above results is that, in 2011, the State Council issued the Opinions of the State Council on Strengthening Environmental Protection Priorities and the Notice of the State Council on the Issuance of the National Environmental Protection 12th Five-Year Plan, which proposed measures to control the total emissions of sulfur dioxide and nitrogen oxides in the power industry. The State Council’s “12th Five-Year Plan” notice proposed to control the total emissions of sulfur dioxide and nitrogen oxide in the power industry. Since 2011, power companies in all regions have raised their awareness of environmental protection and environmental pollution emissions in the power industry have been decreasing year by year; thus, environmental performance has begun to increase. Since in the initial stage, the sensitivity to environmental regulation was higher in regions with small power scales than in regions with large power scales, this led to the gradual reduction of individual differences between regions and the rate of reduction slowed down. Starting from 2014, the State Council issued the “Guidance on Further Promoting the Pilot Program of Paid Use and Trading of Emission Rights”, which proposed the establishment of a paid use system of emission rights. According to Wang and Liu , it is kConsidering the change and ranking of the environmental performance of the electric power industry from 2010 to 2019 in each region, we roughly classify the trend of change in the environmental performance of the electric power industry into three types, including rising, falling, and smoothness. The regions and characteristics included in each type are as follows.(1) Rising type. This includes relatively economically developed areas such as Beijing, Hebei, Shanghai, Jiangsu, Fujian, Shandong, Sichuan, Yunnan, Jiangxi, Liaoning, Xinjiang, and Hainan. This is basically consistent with the conclusion reached by Peng . The bet(2) Declining type. This includes Qinghai, Shanxi, Guizhou, Zhejiang, and Hubei. This is basically the same as the conclusion of the study by Guo et al. . The dec(3) Smooth type. This includes Gansu, Guangxi, Hunan, Jilin, Shaanxi, Henan, Tianjin, Anhui, Heilongjiang, Inner Mongolia, Chongqing, Ningxia, and Guangdong. This is basically the same as the findings of Peng  and Guo The natural interruption point grading method is a map grading algorithm proposed by Chen et al. . This is(1) Ultra-high-level regions. From (2) High-level regions. As we can see from (3) Medium-level regions. From (4) Low-level regions. As shown in In the super-efficient MinDS model, the slack variable represents an optimization quantity, which indicates the “distance” of the DMU from the effective frontier, which reflects the input redundancy and output deficiency of the DMU. In order to measure the relative redundancy level of each input–output indicator, we define the redundancy index. The redundancy degree is expressed as the ratio of the absolute amount of the slack scalar of each indicator to the original value of the input or output indicator. In this study, we first screened out the regions with efficiency values less than 1 from 2010 to 2019; i.e., the inefficient regions that needed improvement. Then, the redundancy of each indicator in these regions was calculated. Using the redundancy degrees of these indicators, it is possible to analyze both the gap between each indicator and the optimal level of environmental performance of the power industry nationwide and in each region, as well as their trends. It provides a clear guiding direction for the enhancement and improvement of the environmental performance of the power industry nationwide and in each region.We used the average of each indicator in the inefficient regions from 2010 to 2019 to represent the redundancy of each input–output indicator of environmental performance of the national power industry from 2010 to 2019. We use histograms to represent the redundancy of each indicator of the environmental performance of the electric power industry in China in 2010 and 2019, as shown in From In order to explore the gap between each indicator and the optimal level of environmental performance in the power industry in each region and the trend of change, we drew bubble diagrams, as shown in Based on previous studies, this paper constructs an environmental performance evaluation index system based on the electric power industry as an example, by which the environmental performance level of key polluting industries in China is evaluated, the spatial and temporal characteristics of the environmental performance level of each region in China are explored, the gap between the current environmental performance level and the optimal level is quantitatively analyzed, and the path to improve the environmental performance level of key polluting industries in China is proposed. The main contributions of this paper are threefold. First, we incorporate technological inputs into the environmental performance evaluation index system of the electric power industry, which can better reflect the real inputs of the electric power industry and measure the results more accurately. Second, we adopt the MinDS model for measuring the environmental performance level, which can quantitatively analyze the gap between each indicator and the optimal level. Third, we propose a redundancy index, which can be used to compare the redundancy of each indicator and then judge the main efficiency levels of different factors. The main conclusions drawn in this paper are as follows.(1) The overall environmental performance of China’s electric power industry shows the characteristics of an inverted U-shaped first and then a U-shaped trend. The environmental performance of the electric power industry in each region presents an asymmetrical state with 2014 as the structural change point, with convergence development coming first followed by differentiation development.(2) The trend of environmental performance changes in the electric power industry in each region can be roughly divided into three categories: rising, falling, and stable. The rising type includes Beijing, Hebei, Shanghai, Jiangsu, Fujian, Shandong, Sichuan, Yunnan, Jiangxi, Liaoning, Xinjiang, and Hainan. The falling type mainly includes Qinghai, Shanxi, Guizhou, Zhejiang, and Hubei. The stable type mainly includes Gansu, Guangxi, Hunan, Jilin, Shaanxi, Henan, Tianjin, Anhui, Heilongjiang, Inner Mongolia, Chongqing, Ningxia, and Guangdong.(3) The spatial clustering effect of the environmental performance of the power industry in each region is divided into four types: ultra-high level, high level, medium level, and low level. The ultra-high-level regions are Beijing, Shanghai, Jiangsu, Hainan, and Qinghai. The high-level regions are Inner Mongolia, Tianjin, Anhui, Fujian, Guangdong, Yunnan, Hubei, Sichuan, and Ningxia The medium-level regions are Shanxi, Shaanxi, Chongqing, Guizhou, Jiangxi, Zhejiang, and Shandong. The low-level regions are Heilongjiang, Jilin, Liaoning, Hebei, Henan, Hunan, Gansu, Xinjiang, and Guangxi.(4) The input–output indicators of environmental performance in China’s power industry have different degrees of redundancy. The redundancy of labor input is the largest, followed by capital input, and finally technology input, power generation, regional GDP, and fuel input. There is redundancy in capital inputs in Gansu, Guizhou, and Henan; redundancy in technology inputs in Hebei, Henan, Heilongjiang, Hunan, Jiangxi, Shanxi, and Shaanxi; and excessive non-desired outputs of environmental pollution emissions in Guangxi, Jiangxi, Liaoning, Shaanxi, Zhejiang, and Chongqing.(5) The inefficient provinces are not invariant across regions. During the analysis period, Guizhou, Shanxi, and Zhejiang moved from efficient provinces to the ranks of inefficient provinces, and Jilin, Shandong, Sichuan, Xinjiang, and Yunnan moved from inefficient provinces to the ranks of efficient provinces; the redundancy degree of most indicators in each inefficient province has improved to different degrees, among which the labor input redundancy has improved the most.This paper argues that efforts should be made in the following aspects to promote the improvement of the environmental performance level of key polluting industries in China.(1) Improve the supervision and inspection mechanism of the implementation process of pollution control in key polluting industries. From the previous analysis, it can be seen that the release of environmental pollution control-related documents can greatly enhance the environmental awareness of environmental pollution subjects, but the results of the implementation process vary greatly from region to region. The implementation process should be concretized and involve the development of emission reduction standards, regular publication of the list of exceedances, proposed corrective measures, and tracking implementation. This is the only way to fundamentally improve the environmental performance of key polluting industries.(2) Each region should adopt differentiated strategies to improve the environmental performance of key polluting industries according to local conditions. Regions with a high level of economic development should make full use of their economic base to develop carbon emission reduction technologies and actively export them to maximize the technology spillover effect. For western regions with inherent advantages, they should make full use of their own advantages to build photovoltaic power parks to serve the national strategy of “west–east power transmission”. For areas with mainly thermal power generation, it is difficult to realize the transformation of the power industry structure in a short period of time; so, the production efficiency of the original power generation method should be improved. In short, the whole country should play to the strengths of each region to complement each other’s weaknesses and optimize the environmental performance of key polluting industries as a whole.(3) Optimize the combination of labor, capital, and technology input factors and improve the efficiency of factor inputs. Labor, capital, and technology inputs are important factors that limit the level of environmental performance of key polluting industries in China and in each region. Today, when the demographic dividend no longer exists, improving labor efficiency is a necessity. The excessive redundancy of labor should be reduced by streamlining personnel, improving the intellectual quality and skill quality of labor, and establishing an effective wage-restraint mechanism. Key polluting industries tend to invest more, and the excessive investment of capital is a serious waste of resources, which should be eliminated by replacing outdated equipment, accurate measurements, and updating as needed. The excessive investment of technology is mainly caused by high plant electricity rates and excessive consumption of line loss rates, which should be vigorously targeted via research on and development of low energy consumption wind and smoke systems, desulfurization systems and powder making systems, power grid transformations, and sound line loss management systems. The inputs of labor, capital, and technology cannot be considered in isolation; only by optimizing the quantity and quality of labor, capital, and technology can we fundamentally improve the environmental performance of key polluting industries in China and its regions.This paper analyzes the environmental performance, spatial and temporal characteristics, and optimization paths of key polluting industries, represented here by the electric power industry, using the super-efficient MinDS model. In the future, we can use the super-efficient MinDS–Malmquist combination model to further analyze the changes in environmental technology in the electric power industry and reveal the sources of environmental performance changes. According to our analysis, the environmental performance of China’s electric power industry shows a rising–declining–rising trend, and the standard deviation shows a declining–rising trend, indicating that the individual differences between different regions first decreased and then expanded, which may be related to the scale of the electric power industry and environmental regulation. There may be a threshold effect, which should further be explored in the future.