Green finance, as a major policy innovation under the guidance of high-quality economic development, can optimize the economic development mode and structure through green investment to enhance the rationalization and advanced level of industrial structure, and ultimately enhance the level of high-quality development of China’s economy. Based on the panel data of 30 provinces and cities in China from 2009–2019, this study examines the impact of green finance on economic high-quality development and its transmission path using the intermediary model. Based on this, a model with moderated intermediation effects is constructed to explore the mechanism of green finance on an economic high-quality path based on the intermediation path of industrial structure advancement and industrial structure rationalization and the moderated effect of environmental regulation. Finally, regional heterogeneity analysis is conducted. The study found that, firstly, green finance significantly contributes to high-quality economic development, and there is a positive mediating effect of both advanced and rationalized industrial structure. Secondly, environmental regulation positively regulates the positive impact of green finance development on industrial structure upgrading and strengthens the role of industrial structure upgrading in promoting economic quality development, as well as playing a significant positive regulating role in the direct effect of green finance on economic quality development. Finally, there are regional differences in the impact of green finance on high-quality economic development. With China committing to peak carbon dioxide emissions before 2030 and achieving carbon neutrality before 2060, the Central Economic Work Conference urged quicker steps to present an action plan that enables the peaking of emissions. Green development is the core key element of high-quality economic development, and the development of green finance is urgently needed to practice green development. China is one of the countries that has established a systematic green financial policy framework, and improving the framework of the green financial system has been elevated to the national strategic level. In 2021, the balance of green credit in China has reached 15.9 trillion and the stock of green bonds has reached 1.16 trillion. Green finance is the “lubricant” and “booster” of green development, which can guide the flow of funds and enhance the level of resource allocation to promote the development of green industries [Research in the area of the relationship between finance and economic development started early, with Goldsmith  having sIn the research related to green finance, since the emergence of green finance theory in the 1980s, some scholars have conducted more research on the connotation and development necessity of green finance ,11,12. HIn summary, on the one hand, finance can promote economic development. However, in the field of green finance, although some studies have been conducted to explore the relationship between green finance and economic development, there is still insufficient research on the mechanism of action and transmission mechanism of the relationship between green finance and high-quality economic development. In addition, there is no literature specifically based on the intermediary effect of industrial structure upgrading and the regulatory effect of environmental regulation to study the effect of green finance on economic development. On the other hand, most existing studies focus on the impact of green finance on economic aggregates, with insufficient research on regional heterogeneity. Based on this, the incremental effect of this study is reflected in: first, constructing a comprehensive index system through multiple dimensions, comprehensively examining and evaluating the level of green finance and high-quality economic development in China, and enriching and improving the definition measurement and theoretical research system of both; second, constructing a model with regulated intermediary effects, and exploring the transmission path of green finance to promote high-quality economic development based on the intermediary path of industrial structure upgrading and the regulation effect of environmental regulation; third, the total effect of green finance on high-quality economic development, with the direct effect and the indirect effect through the rationalization and upgrading of industrial structure analyzed under different levels of environmental regulation, and the moderating effect of environmental regulation explored in depth. Finally, we analyze the regional heterogeneity of the promotion effect of green finance to explore the regional development differences in China, with the findings providing a basis for promoting high-quality economic development with green finance.Green finance provides a financing path for green development and is an important tool for achieving high-quality economic development. Cowan points out that green finance can be regarded as a special service industry, which can efficiently promote green economic development through financial support strategies . Green fFirst, the capital formation function. Green finance allocates a variety of innovative financial instruments and their combinations to facilitate the transformation of savings into investment. This will enable the green industry to obtain sufficient funds to expand the scale of production and innovative green technology development, furthering the process of economic sustainability. Second, the resource allocation function. Green finance reduces the amount of credit financing for traditional polluting industries, forcing them to introduce green labor and production technology innovation, promoting green transformation and upgrading of industries, and promoting green development. Third, the information transfer function. The implementation of green financial policies can transmit the implementation of the country’s commitment to sustainable economic development, which in turn can change and optimize corporate behavior, innovative green technology upgrades, and production efficiency, thereby promoting the green development of the economy. Fourth, the factor guidance function. Green finance can guide the flow of funds through the role of market mechanisms, through interest rate policies, subsidy mechanisms, differential loan amounts, and other policies to reduce the risk of environmentally friendly projects, promote the establishment of green projects and the development of green industries, the formation of economies of scale, and ultimately achieve high-quality economic development. Based on this, this study proposes Hypothesis 1.Hypothesis 1.Green finance has a direct role in promoting high-quality economic development.Green finance is a key policy to achieving low-carbon economic development, which is of great significance to improve environmental quality, optimize the economic development model, and adjust the economic structure.First, green finance concentrates capital in green industries. Green finance can pool capital through financial intermediaries and financial markets via various financing mechanisms, and guide the flow of capital to green industries such as energy conservation and emission reduction, ecological maintenance, resource conservation, and recycling through green financial tools and services, as well as differentiated credit policies, to meet the capital needs of enterprises with market competitiveness, and support the creation, production and operation, investment, and technological research and development of enterprises. At the same time, it raises the investment and financing costs of the highly polluting and energy-consuming enterprises or a series of projects, inhibits their development, and overall promotes the development of the industry to environmental protection, both rational and advanced. This is especially so with the efficient allocation of resources and the transition of the industrial structure to technology-intensive, with the highly polluting and energy-consuming enterprises gradually starting to adjust to low energy consumption and low emissions. The ecological model of green finance has been adjusted.Second, green finance has the function of industrial integration. In the implementation of green concepts and financial policies, highly polluting and energy-consuming enterprises conduct research and development of green technologies due to the pressure of survival, reduce enterprise energy consumption and promote product upgrading to green transformation and upgrading, and improve enterprise production efficiency. In addition, Zhou  indicateBased on the above analysis, this study proposes Hypothesis 2.Hypothesis 2.Green finance effectively promotes the upgrading of industrial structure, and then enhances high-quality economic development.In summary, the mechanism of green finance’s effect on high-quality economic development is shown in Combining the “negative externality” of ecological pollution and the theory of market failure in economics, it is impossible to achieve the Pareto optimum by relying only on the market mechanism to allocate resources, but also must rely on government intervention, i.e., corresponding environmental regulation to ensure the reasonable allocation of resources. At the macro level, the current high quality of economic development requires, firstly, that economies increase financial investment in green environmental capital, including renewable energy and the circular economy and, secondly, that environmental policies are disciplined so that highly polluting and energy-intensive industries can green their production. All of these require the financial sector to actively guide and allocate funds between industries in order to facilitate the transformation and upgrading of industries. When green technology innovation achieves breakthroughs and green industries rise, benefiting from the realization of positive externalities of green industries, a positive feedback mechanism will be formed within the economy where economic and environmental benefits co-exist, thus achieving a win–win situation for both high-quality economic development and environmental protection. Based on the existing research, this study innovatively introduces environmental regulation as a moderating variable to analyze the impact of its moderating effect on the three paths, and then optimizes the external path boundary, in order to examine the level of economic quality development in a comprehensive way.Firstly, concerning the regulatory effect of environmental regulation between green finance and quality economic development, green finance can be complemented by market regulation and mandatory government control, optimizing the previous paths of environmental regulation, promoting green transformation, and improving the quality of economic development . SecondlHypothesis 3.Environmental regulation positively regulates the relationship between green finance and quality economic development.Hypothesis 4.The relationship between environmental regulation positively regulates both green finance and industrial structure upgrading.Hypothesis 5.The relationship between environmental regulation positively regulates industrial structure upgrading and high-quality economic development.We summarize the moderating effect of environmental regulation between green finance development, industrial structure upgrading, and high-quality economic development, as shown in Economic quality development level (EQUA): In the 13th Five-Year Plan in China, the concept of “green development” was introduced for the first time, and the social development goal of “Innovation, Coordination, Green, Openness, and Sharing” was established, which indicates that high-quality economic development has become an important feature of socialism in the new era.On the basis of following the above development concept, the research idea of Cheng  is referGreen finance (GF): In 2016, the People’s Bank of China (PBOC) and others released the “Guiding Recommendations on Building a Green Financial System”, which optimized and improved the green financial system, indicating that green finance is a national strategic policy to promote the process of sustainable development through green credit, bonds, stock indexes, insurance, and carbon finance. Therefore, by analyzing the above guiding recommendations and referring to Zhou et al. , this stAs can be seen from The main reason for the gap between China’s high-quality economic development and the growth rate of green finance is that since the reform and the country opening up, China’s economy has continued to grow at a high rate. However, in recent years, China’s society has transitioned from a production-based society to a consumption-based society, and the goal of economic development has gradually changed from high-speed development to high-quality development, with the slowdown of China’s economic growth rate in line with the basic laws of economic development. The 2007 release of “Opinions on Implementing Environmental Protection Policies and Regulations to Prevent Credit Risks” was the beginning of the development of green finance in China. Based on the continuous development and efficiency improvement of financial institutions and markets, China has a huge potential to develop green finance and has made a series of achievements: in 2021, green credit in China accounted for 10% of the domestic loan balance, the system of green finance is tending to be perfected, the scale of products and instruments is continuing to rise, and the results of international cooperation are becoming more and more abundant. As a result, the level of green finance development has grown significantly in recent years, both nationally and in all regions.Industrial structure upgrading: The difference of industrial structure affects the pattern and process of economic development, and is an important discerning feature of high-quality economic development. Along with the development of green finance, China’s industrial structure has been undergoing transformation. In order to concretely show the current situation of and the level of industrial structure upgrading in China’s economy, this study divides industrial structure upgrading into two levels, industrial structure rationalization (TL) and industrial structure advancement (TS), based on the structuralist viewpoint .The rationalization of industrial structure (TL) reflects the level of coordination among industries, the degree of industrial structure agglomeration, and the rationality and efficiency of production factor allocation. Referring to Gan et al. , the indIn Equation (1), The advanced level of industrial structure (TS): In the process of the economy tending toward service, in the background that the growth rate of the tertiary industry is faster than that of the secondary industry, and the society gradually transitions from production-oriented to capital-intensive and then from capital-intensive to technology-intensive, this study uses the ratio of the output value of tertiary to secondary industry as a measure.Environmental regulation intensity (ER): Environmental regulation intensity can limit the polluting behavior of enterprises and influence economic development through the rational allocation of resources and enhancement of enterprise innovation capacity. In the measurement of environmental regulation indicators, scholars have put forward different views. These include Ren , Shen 3, ShangGuFirstly, the standardized value of j in province i; j in province i for the whole country; i and the whole country, respectively. After obtaining In Equation (2), Finally, based on the standardized values and average weights of each indicator, the environmental regulation intensity of each province is obtained in Equation (3) as:There are many factors that affect the level of high-quality economic development, with the main factors controlled with reference to existing studies. The control variables selected in this study are as follows: (1) Trade dependence (TRA): The ratio of total regional import and export to total regional GDP. (2) Size of foreign investment (FI): The ratio of foreign investment amount to local GDP. (3) Human capital level (HC): The rate of general higher education graduates in this study. (4) Information level (Infor): The ratio of the number of Internet users in this study.The above data were obtained from China Statistical Yearbook, China Science and Technology Statistical Yearbook, WIND database, CSMAR database, and provincial statistical yearbooks from 2009–2019. In the process of data acquisition, the missing data were estimated by the exponential smoothing method. The descriptive statistics of the above variables are shown in This study takes high-quality economic development as the explained variable and green finance as the explanatory variable. To specifically analyze the impact of green finance on the qualitative development of the economy, this study conducts an empirical analysis based on panel data for 30 Chinese provinces from 2009–2019. The panel model is able to overcome the time series analysis being plagued by multiple cointegration and is able to provide more information, more variation, less cointegration, more degrees of freedom, and higher estimation efficiency. The constructed panel model (1) is built as follows:i = 1, 2, 3, …, N represents each province; t = 1, 2, 3, …, N represents each year; In the model, Based on the analysis of the impact of green finance on economic quality development, we then explore whether green finance can have an impact on the level of economic quality development through industrial structure upgrading. Therefore, referring to Wen , we estai and t denote provinces and years, respectively, with the above analysis dividing industrial structure upgrading into industrial structure rationalization (i.e., In the model, To further test the moderating effect of environmental regulation on the mediating effect, referring to Wen , based oThe regression results of green finance on high-quality economic development are shown in The reason: green finance helps to share information among enterprises, government and financial institutions, which enables them to enhance the efficiency of capital factors’ utilization and rationalization of resource allocation. In addition, with the effective regulation of the market mechanism, green enterprises have multiple paths to obtain credit funds, achieve efficient allocation of production factors, and gradually realize economies of scale, which will strongly improve the development of green finance and realize its effective integration with economic development to improve the quality of economic growth. Therefore, the development of green finance has a positive effect on the improvement of economic growth rate, which is consistent with H1.In the basic regression analysis, the coefficients of green finance are significantly positive, so the intermediation effect test can be conducted. The regression results of the mediating effects of industrial structure upgrading are shown in The reasons: First, for industrial structure upgrading, green finance can inhibit the capital inflow of polluting industries; promote the factor gathering of green industries; promote the gradual transformation of industrial structure from labor-intensive to capital-intensive, and then from capital-intensive to technology-intensive; enhance the degree of coordination among industries; and improve the industrial production through the functions of capital orientation, resource allocation, information transfer, and factor integration. It enhances the coordination between industries, improves the allocation efficiency of industrial production elements and resources, and raises the level of industrial rationalization and industrial advancement. On this basis, green finance has an impact on economic growth in terms of both structure and efficiency: in terms of industrial structure, due to the continuous growth of green finance and the gradual expansion of the share of green industries in China, the highly polluting and energy-consuming enterprises are shrinking, and the industrial structure shows the development trend of ecological greening, thus driving the high-quality growth of China’s economy; in the area of comprehensive efficiency, under the comprehensive influence of the risk mechanism, all types of enterprises have been able to improve their competitiveness. In the area of comprehensive efficiency, under the comprehensive influence of risk mechanism, all types of enterprises take the initiative to implement green technology innovation, thus further optimizing the capital efficiency and improving the quality of economic growth.In order to enhance the robustness of the mediation effect test, both Sobel–Goodman and Bootstrap tests are used to validate this study. In the regression results of the mediating effect model with regulation in In this study, we use the Bootstrap method to test the mediating effect model with regulation: the mediating effect of industrial structure upgrading under the moderating effect of different environmental regulation levels, i.e., low environmental regulation level, mean environmental regulation level, and high environmental regulation level, respectively, with the results shown in First, for the conditional direct effect, we can see that with TL as the mediating variable, the conditional direct effects of green finance are 0.2091, 0.3554, and 0.5017 at low-to-high ER levels, respectively; with TS as the mediating variable, the conditional direct effects of green finance are 0.2403, 0.3945, and 0.5487, all gradually increasing, and all with confidence intervals not containing 0. This indicates that the direct effect of green finance on high-quality economic development increases significantly as the ER rises.Second, for the conditional mediating effect, we can see that when TL is the mediating variable, the conditional mediating effects of TL are −0.007, 0.0628, and 0.1764, respectively, and the confidence interval does not contain 0 and the coefficient is significant only when ER is the mean and positive one standard deviation of the mean; with TS as the mediating variable, the conditional mediating effects of TS are −0.0151, 0.0208, and 0.1461, respectively, and the confidence interval does not contain 0 when ER is positive one standard deviation of the mean. The confidence interval does not contain 0 until the ER is one standard deviation, which shows that the mediation effect of TS is only highlighted when the ER is large.Third, for the conditional total effect, we can see that the total effect of green finance on economic quality development is 0.183, 0.4273, and 0.6715 with the confidence interval not containing 0. This indicates that the promotion effect of green finance on economic quality development increases significantly with the increase of ER level.The regression results plot the moderating effect M ± 1SD and J-N, as shown below. From The above analysis shows that an increase in the intensity of environmental regulation is conducive to the further realization of high-quality economic development. At present, the most common environmental policy in China is directive environmental regulation, the main means of which is to force enterprises to meet the emission and technical standards set by the environmental protection authorities through relevant policies. The government should use environmental regulation to force polluting enterprises to take the path of low-carbon and green development. On the other hand, the government should guide green finance to support the research and development and promotion of new technologies and products that are green, energy-saving, and emission-reducing, in order to realize the vision of environmental regulation and green financial innovation. The government should also guide green finance to support the research, development, and promotion of new technologies and energy-saving and emission-reducing products, in order to realize the vision of environmental regulation and green financial innovation to enhance high-quality economic development.In this study, China is divided into East, Central, and West according to the geographical location and economic development for regional heterogeneity analysis, and a regression analysis is conducted to test the regional heterogeneity of the impact of green finance development on economic quality development based on the selection of control variables such as foreign trade dependence, foreign investment scale, and human capital. and the regression results are shown in In order to ensure the robustness of the findings on the impact of green finance on economic quality development, this section conducts robustness tests through the lagged effect of green finance, panel quantile model, and sequential elimination of control variables.High-quality economic development is influenced by both green finance and changes due to the time lag of green finance development. To ensure the robustness of the above findings in this study, green finance with a lag of one period is treated as an explanatory variable and thus subjected to panel regression. As can be seen from the regressions in In the previous paper, the traditional least squares method was used to estimate the mean impact of green finance on economic quality development; quantile regression can reflect the overall distribution level of economic quality development, i.e., the degree of green finance impact under economic quality development in different quantiles. The results in Since the regression results and the obtained conclusions may vary depending on the control variables, this study excludes the control variables of foreign capital scale, foreign trade dependence, informationization level, and human capital level in turn and then conducts the robustness test.The regression results are shown in With the transformation of China’s economy from high-speed development to high-quality development, which makes higher requirements for the country’s economic development model and economic structure, China urgently needs to implement green development, and green development requires vigorous development of green finance. Based on economic phenomena and the frontier literature, this study explores the intrinsic mechanism of green finance to promote high-quality economic development based on the mediating effect of industrial structure upgrading and the regulating effect of environmental regulation based on panel data of 30 provinces in China from 2009–2019. The study finds that, firstly, green finance has a significant positive direct contribution to high-quality economic development in China. Secondly, there is a positive partial mediating effect of industrial structure rationalization and industrial structure advancement between green finance and high-quality economic development. Thirdly, for the moderated mediation model, environmental regulation positively moderates the relationship between green finance, industrial structure upgrading, and high-quality economic development, and the positive relationship between the two is enhanced as the intensity of environmental regulation continues to increase. Fourthly, in the heterogeneity analysis of the regional panel regression model, there are regional differences in the impact of green finance on high-quality economic development between the eastern and central and western regions. However, in the above-mentioned process, factors such as the level of green finance development, the rationalization of local industrial structure, and the level of advanced industrial structure, as well as the intensity of environmental regulation, influence and determine the effect of green finance. Therefore, it is necessary for the state, local governments, financial institutions, and enterprises to work together to improve the green financial system in order to promote China’s high-quality economic development. Accordingly, the following policy recommendations are proposed.First, a national coordinated design and improvement of green financial system to promote sustainable development of green finance. In recent years, the National Development and Reform Commission, the Ministry of Finance, and the Ministry of Environmental Protection have launched a series of green financial reform initiatives one after another, and have achieved certain results. However, it is difficult to achieve the goal of high-quality economic development with the existing green financial policies and fragmented measures. Therefore, the first step is to strengthen the top-level design of the green financial system and enhance the intensity of policy implementation. A unified standard system for green finance must be developed and improved in conjunction with market practice, and needs to be gradually refined, clarified, and made operable, in order to gradually expand the scope of standards for the green financial system in building a universal and unified green financial system. Innovation in green financial products and services should be encouraged to provide diversified green financial products, and the enthusiasm of market players to innovate green financial business models needs to be fully mobilized in order to effectively improve the performance of green financial business.Second, accelerate the upgrading of industrial structure and assist high-quality economic development. Research findings show that the upgrading of industrial structure provides a key intermediary path for green finance to drive China’s high-quality economic development. On the one hand, China’s industrial structure should be optimized by vigorously developing emerging enterprises, breaking through the strategic layout of core technologies, and not making massive cuts to highly polluting and energy-consuming enterprises, instead adopting a guiding and incentivized approach to promote them to complete their green transformation. On the other hand, China should enhance the suitability of green financial and fiscal policies, minimize the cyclical fluctuations of policy effects, and ensure the long-term sustainability of policy effects, in order to provide stable financial subsidies and preferential policies for enterprises’ green transformation.Third, optimize the environmental regulation policy channel and enhance the efficiency of environmental policy implementation. China should flexibly exert the influence of environmental regulation on green finance and industrial structure upgrading, and adopt an approach that encourages and regulates both according to the characteristics of different industries. Each region should adopt reasonable environmental regulation measures, according to the characteristics of their respective industrial structures and resource endowment conditions, in order to give full play to the reversing effect of environmental regulation on industrial structure optimization and promote regional industrial transformation and high-quality economic development.Finally, adhere to local conditions and implement differentiated regional policies. China is a vast country, and the level of green finance and high-quality economic development in different regions exhibits regional heterogeneity due to economic, geographical, cultural, and policy conditions. The eastern region should adhere to and improve the existing green financial system, vigorously promote innovation in the green financial system, and continue to maintain the determination for green and high-quality development. For the central and western regions, efforts such as fiscal transfer payments should be increased to find regional advantages, combine regional resource advantages with green finance, achieve differentiation in positioning, and take a leapfrog development path to further narrow the regional gap.


Redes de Atenção à Saúde) in order to meet their health needs-2.Care lines (CL) refer to proposals for articulating resources and health production practices, based on the most relevant epidemiological needs. This allows defining a care flow through which users must travel through Health Care Networks  and Acute Myeloid Leukemia (AML) has increased considerably in most countries and the incidence of HL cases increased by 38.6% between 1990 and 2017.Hodgkin’s Lymphoma (HL), Non-Hodgkin’s Lymphoma (NHL) and Multiple Myeloma (MM) represented, respectively, about 1.4, 7.0 and 2.3 million lives affected by these types of hematological malignancies. In this context, there is a need to systematize the care provided to these patients.Such diseases require specialized attention, rapid diagnosis and effective treatment, given their rapid evolution, such as AML, which, although the prognosis has improved in recent decades, only one in four patients survives five years or moreTherefore, it is essential to sum up the elements for the care provided to patients with hematological malignancies to elaborate and propose a CL for such a specific audience, in order to support a safe, quality and assertive care. Moreover, this compilation of knowledge can support clinical decisions and conduct taken, as well as the performance of professionals and the follow-up of patients between health services, therefore, with triggering and improvement of clinical itinerary, in order to ensure the provision of care based on the best available evidence.Given the above, this study sought to answer the following guiding question: what are the elements for assistance to patients with hematological malignancies that can support the proposition of a CL?To identify the elements for assistance to patients with hematological malignancies to propose a CL.As it was research that used public domain materials and did not involve human beings, it was not necessary to be appreciated by the Research Ethics Committee. However, it is important to highlight that the copyright was respected with correct citation and referencing.-13. The research protocol is registered in the Open Science Framework (https://doi.org/ 10.17605/OSF.IO/VCGPQ).This is a scoping review, based on the method proposed by the JBI Reviewer’s Manual and conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR): Checklist recommendations. It was developed through five stages: I- definition of research question; II- search for relevant studies; III- selection of studies; IV- data extraction and analysis; V- gathering, synthesis and presentation of results.This type of review aims to investigate scientific evidence, identify and map existing gaps in a given area of studyThe first stage included the elaboration of the research question through the PCC strategy .To complete the second stage, the descriptors that encompassed the largest number of studies related to the research topic were identified, through consultation in the Medical Subject Headings (MeSH), for descriptors in English, and in the Health Science Descriptors (DeCS), for descriptors in Portuguese. This process, added to the employment of the Boolean operator AND, culminated in the development of the following search strategy (with its respective descriptors in Portuguese): (Patients AND Patient Care Planning AND Hematologic Neoplasms).Initially, as a way to ensure that there are no studies with the same theme registered in the OSF or published, a broad search was carried out on the platform and in databases to identify protocols or reviews with similar themes. From this diagnosis, it was followed with the steps to consolidate the scoping review.Study selection consisted in identifying texts in the databases and repositories of theses and dissertations by reading title and abstract, for screening the works according to eligibility criteria and reading full text for data extraction. The analyses were performed by peers of reviewers independently and, in case of disagreement, there was discussion for reaching consensus. In cases of doubts and disagreements, the opinion of a third reviewer specialized in the area of the object of study was requested.For the step of separating, summarizing and reporting the essential elements found, a structured instrument specifically designed for this purpose was used. This tool allowed data synthesis, interpretation and basic numerical analysis of the extent, nature and distribution of studies selected to compose the final sample.Repositórios Científicos de Acesso Aberto de Portugal).The searches were carried out in April 2021 in the following databases and repositories of theses and dissertations: U.S. National Library of Medicine (PubMed), Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, Science Direct, PSYCHINFO, EMBASE, Latin American and Caribbean Literature in Health Sciences (LILACS), The National Library of Australia’s Trobe (Trove), Academic Archive Online (DIVA), Electronic Theses Online Service (EThOS), The Education Resources Information Center (ERIC), Theses Canada, DART-Europe E-Theses Portal, National ETD Portal, Theses and Dissertations from Latin America, CAPES Theses and Dissertations Portal and Portuguese Open Access Scientific Repositories  to five (V).From the studies included in the final sample, the following variables were extracted: year of publication, country of study, language, methodological design, level of evidence, level of health care, type of hematological cancer, the area of health professionals and CL used for assistance to patients with hematological malignancies. The studies’ level of evidence was classified according to JBI proposal, which enabled the identification of essential information from the studies, which made it possible to synthesize and interpret data, in addition to generating the basic numerical analysis of the extent, nature and distribution of the studies incorporated in the review.Data mapping occurred through the use of a structured instrument, proposed by JBI ReviewersThe collected data were organized in Microsoft Excel 2016® spreadsheets, analyzed using simple descriptive statistics and presented in graphs, figures, charts and/or tables, as appropriate, to compose the results of this study.Searches in the databases resulted in a final sample consisting of 93 studies, based on the selection process described in Study characterization included in the final sample is described in There are productions from 1978 to the present day, in which an increase in the last decade stands out, with emphasis on the year 2019 . The language of publications was English . Most publications are from the United States of America (USA) .The most developed study design was systematic review  and cohort . Thus, the level of evidence that stood out was II . The assistance provided to people with hematological malignancies stands out due to the levels of health care of high complexity  and medium complexity . The types of hematological malignancies most addressed in the studies were leukemias  and lymphomas . Moreover, the most approached type of care was treatment , followed by diagnosis .It is noteworthy that some studies portrayed more than one type of care, more than one type of hematological malignancy and the care is applied at different levels of health care, as shown in link available in the second paragraph of the method.Article references in the sample of data selected in this research are found in a file attached to the OSF and can be consulted from the access to the platform, through the ,10,17-18.The epidemiological relevance of hematological cancer and the interest in improving care for patients affected by this disease are confirmed by the specific care needs, the quantitative of the final sample of this research, the growing number of scientific productions carried out in the last decade and the increase in rates incidence of this type of cancer-20.The most frequent place of studies was the USA and European countries; on the other hand, it is observed that the African continent had no representation, which is possible to correlate with the investment in the technological apparatus and development of scientific productions in these countries-22 in this group of countries, given that North America has the second highest incidence of NHL cases and Europe ranks third in terms of diagnosis of this disease. Moreover, CLL and AML were more commonly diagnosed in countries located in Europe and North America between 1997 and 2017.Similarly, this relationship may be associated with the magnitude of hematological cancer,24,25,26.Furthermore, the most discussed malignancies in the studies were leukemias and lymphomas, in line with the need to provide care to patients, given that these are the types of hematological cancer most distributed among the population-28.Regarding the level of health care, the findings of this study reveal that onco-hematological care is concentrated at medium and high complexity levels, since cancer is a type of disease that requires adequate equipment and human resources to provide specialized care.However, Primary Health Care (PHC) plays a fundamental role in health promotion, focusing on cancer protection factors, disease screening, early diagnosis, regulation of patients for other levels of care and training of teams, in addition to coordinating and maintaining the care of users with cancer. Thus, it is necessary to improve actions at this level of health care, to minimize the delay in diagnosis, in the provision of care and in the use of resources, in order to guarantee comprehensive care for patients with hematological malignancies.However, it is observed that there are difficulties in providing care to cancer patients in PHC services, due to the need for qualification of professionals involved in the process of identifying signs and symptoms, referral to early diagnosis and treatment, users’ unequal access to available services and delays in carrying out tests and returning for consultations-31, where primary prevention is not possible, related to modifiable factors, often recommended to adults, such as smoking, alcoholism, sedentary lifestyle and other lifestyle habits, the importance of identifying the various technologies developed for the investigation of the disease is emphasized.In this regard, early diagnosis increases success in treatment and chances of cure. Nevertheless, in pediatric leukemia, since it minimizes complications, such as high risk of infections, cachexia, mucositis, depression, loss of social function and other side effects of treatment and impairment caused throughout cancer,37,38,39. In addition, it enables the experience of the cancer coping process with better quality of life and better response to malignancy treatment-41.Another aspect of remarkable relevance is supportive care.From this perspective, it is still necessary to infer a greater focus of the studies in the curative process, to the detriment of the detection and care directed to post-treatment. With this, there is a growing increase in cancer survivors, from the development and success of anticancer therapies,43-44. Thus, palliative care aims to improve care during the final life trajectory and should be integrated in a timely manner in standard oncological care. Nevertheless, the implementation of intensive care until the end of life and frequent hospital deaths,45-46is still observed.However, the mortality rate for hematological malignancies is still high.This is associated with the complex nature of hematological malignancies and their treatment, delays in end-of-life discussions, lack of integration of palliative care services and barriers at home for the patient to experience the end of life at home,47-48.On the other hand, increased survival has implied a new demand for post-treatment care that is not yet met by health services, as studies reveal a high prevalence of unmet needs in this population, such as concerns about changes in concentration and memory, fatigue, change in sexual activity, anxiety, depression, and change in body image.Thus, there is a need for changes in the care of patients with hematological cancer. The determination of a CL that systematizes the therapeutic itinerary of these patients can minimize the existing gaps in the RAS and promote a safe, quality and timely care delivery that can provide a longer survival timeA limitation of this study is the difficulty in accessing articles that are unavailable in full because they do not meet this criterion, a fact that may have led to the loss of publications that could enrich the findings of this study.The present study brings relevant contributions to health, especially in the field of onco-hematology, by highlighting the particularities of the elements that can compose a CL to systematize the services and care provided to patients.It is worth emphasizing the importance of the multidisciplinary team, especially nursing, within this context, as it is the most present professional category throughout the care process. and, thus, with greater opportunities to identify patients’ health-disease needs, outline and make the best decisions and conducts for the implementation of CL, when considering the particularities of each case.In view of the findings, this research achieved the proposed objective and presented the main elements that can support the proposition of a CL for assistance to onco-hematologic patients, when it summarized important aspects about diagnosis, treatment, supportive care, palliative care and post-treatment assistance.Overall, these patients face several obstacles to achieving specialized care, given the complexity surrounding the diagnosis and treatment of hematological malignancies, as well as difficulties that are imposed in relation to access and continuity of care in the network, which often implies an unfavorable outcome and death.To this end, this issue needs to be addressed in new research, seeking to raise evidence to base the practice of health professionals and the dynamics of health services, based on the needs presented, associated with the updating and training of health professionals with new knowledge.


African American communities are frequently depicted as victims of urban conditions. However, a rich culture of grassroots community development and organizing, often led and stewarded by Black women, exists. Many of these efforts involve enhancing economic, political, and educational opportunities and centering ethics of care and caregiving. This is the notion of Black placemaking, which is explicitly community-focused, shaping the social fabric of everyday life and allowing for the development of Black vernacular spaces that became vital to African-American culture. This paper examines how Black older women engage in placemaking by presenting three select case studies. Using a narrative inquiry approach, we conducted secondary data analysis of interviews drawn from larger qualitative studies about aging in communities that took place in San Francisco and New York City. Black feminist spatial imagination, embodiment, and intersectionality theory were our guiding frameworks. Our analysis revealed how the aging Black body is a site that is subjected to socio-political regulation and violence and illuminates how Black women are agents of community resilience, creativity, and transformation. Creating and holding space  with bodies and physical structures that center the Black community is an act of care, self-determination, and resistance to white supremacy. These embodied processes of placemaking have wide-ranging implications for the ways Black neighborhoods are framed and discussed in popular media, empirical research, and policy. Furthermore, they invite a shift in our current approach to placemaking in later life, one that centers the strengths, history, and traditions of the Black community.


Dr. C. Richard Conti, a legendary cardiovascular educator, researcher, and mentor, died suddenly on February 21, 2022, in Gainesville, FL.Dr. Conti was born in 1934 in Bethlehem, PA, graduated from Lehigh University Phi Beta Kappa in 1956 and from the Johns Hopkins University Medical School in 1960. After service in the US Army Medical Corps, Dr. Conti returned to Johns Hopkins for residency in Internal Medicine and Fellowship in Cardiology. His interest was in ischemic heart disease, and he was among the pioneers in interventional cardiology. He chaired the National Heart Lung and Blood Institute (NHLBI) first national randomized trial of medical versus surgical intervention in patients with unstable angina and chaired the Asymptomatic Ischemia Pilot Trial comparing medical therapy with revascularization in patients with stable angina. In 1974, Dr. Conti was recruited to become Chief of Cardiology at the University of Florida in Gainesville. There, as Professor of Medicine, he guided the university, to become nationally and internationally recognized as a center of excellence in cardiovascular research and training. Dr. Conti was a lifelong teacher and learner, chairing the American College of Cardiology (ACC) Self‐Study Education Materials Committee, which served to create the ACC Self‐Assessment Program (ACCSAP). As well, he contributed as Editor in Chief of ACCEL, the audio journal of ACC. In 1989−1990, Dr. Conti served as President of the American College of Cardiology.A passionate educator, he was involved in the early efforts of the American College of Cardiology and ESC international programs, guiding the development and growth of the annual Great Wall International Conference in Cardiology in Beijing. After serving as Chief of Cardiology for 24 years, Dr. Conti relinquished this role in 1998 but remained active directing the Ambulatory Cardiology section at the University of Florida.As well, Dr. Conti served on the subspecialty board of Cardiovascular Disease of the American Board of Internal Medicine and the Cardiology Advisory Committee of the NHLBI. He was recognized for his skill as a teacher and scholar by the British Cardiac Society, the French Cardiac Society, the European Society of Cardiology, the College of Medicine South Africa, and the Venezuelan Cardiac Society among others. He took particular pride in his daughter Jamie, a cardiologist and electrophysiologist at the University of Florida as she progressed to lead the Division of Cardiology. He received the Docteur Honoiris Causa from the Universite de Marseilles in 2000. Dick was a devoted husband, father, grandfather, and great‐grandfather. He was a marathoner and loved to golf, to ski, and to travel, taking his family on cruises worldwide. My husband Julius and I were privileged to join Dick and his lovely wife Ruth on a number of international teaching trips, where he was always the center of vibrant discussions and masterful teaching. Dick mentored many of the current leaders in cardiovascular medicine worldwide and was a personification of the concept of lifelong learning.Dr. Conti authored or coauthored over 600 scientific manuscripts and book chapters and was editor of Clinical Cardiology from 1988 to 2011. He took a strong and enduring interest in the journal, working with Willis Hurst and Bob Schlant and many other giants of cardiology. All of us who joined with him at the editorial board meetings that he hosted every year at the American College of Cardiology will always remember these wonderful occasions.


Pesticides are chemical substances used to control, prevent, or destroy agricultural, domestic, and livestock pests. These compounds produce adverse changes in health, and they have been associated with the development of multiple chronic diseases. This study aimed to present a detailed review of the effect of pesticides on the oral cavity and the oral microbiome. In the oral cavity, pesticides alter and/or modify tissues and the microbiome, thereby triggering imbalance in the ecosystem, generating an inflammatory response, and activating hydrolytic enzymes. In particular, the imbalance in the oral microbiome creates a dysbiosis that modifies the number, composition, and/or functions of the constituent microorganisms and the local response of the host. Pesticide exposure alters epithelial cells, and oral microbiota, and disrupts the homeostasis of the oral environment. The presence of pesticides in the oral cavity predisposes the appearance of pathologies such as caries, periodontal diseases, oral cancer, and odontogenic infections. In this study, we analyzed the effect of organochlorines, organophosphates, pyrethroids, carbamates, bipyridyls, and triazineson oral cavity health and ecosystems. Oral diseases are considered early indicators of the general health of a population, and their prevalence is higher in developing than in developed countries . GloballIn the agricultural environment, it has been projected that by 2050, there will be a need for an 80% increase in food production, leading to a predicted increase in the use of these anti-pest chemicals ,5. InforTo assess the risk to oral health from exposure to pesticides, it is necessary to take into account several key factors such as chemical characteristics of the pesticide, characteristics of the oral cavity, and oral microbiota . HoweverPesticide contamination has been linked to many diseases in humans . ContactTo know the degree of risk of an individual due to exposure to pesticides, there is a need for classification of these pesticides based on chemical structure .OC are chlorinated hydrocarbons, classified as aromatic, alicyclic, cyclodienic, and terpenes, with oxygen or sulfur molecules A. They aOther key characteristics are described in A study has revealed that the most widely used pesticides worldwide are OC, OP, P, C, and triazines . Most ofThe main routes of disposal of pesticide presidencies depend on their release by feces or urine. To a lesser extent, it can be removed by sweat, maternal milk, tears, and hair ,25.In oral and inhalation exposure, the oral cavity is the first line of contact with agrochemicals . Therefo2. Homeostasis in the oral cavity depends on factors such as mucosal integrity, saliva, microbial balance, and its response to chemical exposure . Th. Th60]. No reports of damage to the oral cavity were found as a result of triazine exposure. However, other studies on the gastrointestinal (GI) tract epithelium demonstrated that triazine exposure increased oxidative stress levels, decreased antioxidant responses, and altered the structures and metabolism of nucleic acids . SimilarFrom another perspective, the effects of pesticides with mutagenic potential on the oral cavity were analyzed. A study on 29 workers exposed to pesticides showed a high population of micro-nucleated cells in the oral epithelium . In anotStudies have shown that pesticides inhibited muscarinic and nicotinic receptors, resulting in xerostomia, a risk factor for the development of dental caries, oral infections, and mucosal inflammation ,32,34,53The effects of pesticides on the oral cavity were described mainly for OP and B. The most relevant results for these pesticides are described below.Lactobacillus [Exposure to chlorpyrifos (OP) is related to changes in the host microbiome . Oral exbacillus . In contbacillus . Increasbacillus ,55,56,75Glyphosate (OP) has a chelating property. Thus, it was bound to the allosteric site of the microbiota enzyme UDP-N-acetylglucosamine enolpyruvyl transferase (MurA), resulting in changes in its functionality and interference with the synthesis of peptidoglycan which is vital in bacterial growth ,66. ExpoLactobacillus and Granulicatella and their gene expressions [Streptococcus and Halomonas [A study on the effect of azinphos methyl (OP) on the oral microbiota of exposed farmers showed that the pesticide altered membrane permeability and decreased some bacterial communities such as ressions . Moreovealomonas .Exposure to paraquat (B) enhanced the development of periodontal disease by limiting the proliferation of the epithelium of the oral cavity, thereby enhancing its thinning . It shouThere are no extant studies on the effects of OC, P, C, or N, especially on the oral cavity microbiome. Therefore, the results of the evaluation the effects of pesticides on the microbiota of different tissues and organisms are described below, with respect to their impacts on bacterial colonies of the oral cavity, and on biofilm.Streptococcus spp., Lactobacillus spp., Granulicatella, Corynebacterium, and Bifidobacterium  modifies the pH of the oral cavity, thereby altering the homeostasis of the microbiota and favoring the bioaccumulation of the pesticide in the lipophilic zone below the lamina propria.Lactobacillus and increased the count of LPS-carrying bacteria, which disrupt TJ junctions. Analysis of various studies on exposure to pesticides in the microbiota of various tissues and organisms revealed a decrease in Firmicutes and an increase in Bacteroidetes, a finding which, if extrapolated to the oral cavity, would have repercussions on its microbial balance. Furthermore, it was observed that exposure to diazinon and IM increased colonization by Fusobacterium spp., which favors the expression of mesenchymal markers and therefore may account for the development of metastasis. Overall, exposure to pesticides is related to the development of pathologies such as caries, periodontitis, and oral cancer.It is important to note that pesticides impact balance in the oral microbiome, and they influence proinflammatory activities that lead to the weakening of TJ junctions, and also increase the vulnerability of adherens junctions in the wall of the gingival sulcus and the gums. Exposure to OP and B decreased the count of


The dual problems of the public crisis from the global epidemic and the deterioration of the ecological environment constrain the economic development in the Yellow River Basin. To promote the sustainable and balanced development in the Yellow River Basin, this paper takes public health, ecological environment, and economic development, as a whole, to study the coordinated development of the Yellow River Basin. Based on coupling coordinated theory, we use the SMI-P method to evaluate the coordinated development index of public health, the ecological environment, and economic development in the Yellow River Basin. Moreover, we use the coordinated regulation and obstacle factor diagnosis to identify the main influencing factors and design regulation methods to optimize the coordinated development index. The results found that (1), during the research period, there is spatiotemporal heterogeneity in the coordinated development level in the Yellow River Basin. From 2009 to 2019, the overall development index increased steadily, while the regional disparity in the coordinated development level was obvious. (2) The ecological environment indicators contribute more to the relevance and obstacle factors, such as the average concentration of fine particulate matter, per capita arable land area, afforestation area, etc. (3) After regulating the overall development level of the Yellow River Basin, we prove that Path 4, which comprehensively considers the relevance and obstacle factors, performs better. Since the outbreak of the global epidemic, COVID-19, there has been an increasing concern about public health issues ,3. MeanwUnder the background of ecological protection and high-quality development of the Yellow River in China, we explore the synergistic relationship among public health, the ecological environment, and economic development, which aims to provide effective suggestions for the high-quality development of the Yellow River Basin. Existing studies have shown that there is a close and complex causal relationship among the economic development system, public health system, and the ecological environment system . RelativFor the relationship between public health and economic development, the US Special Administrative Committee on Occupational and Environmental Medicine Health emphasized the impact of health on the economy from the perspective of health productivity and health care crisis . Nichol In terms of the relationship between public health and the ecological environment, about 1.6 million deaths each year can be attributed to the unhealthy air, which accounts for about 17% of all deaths in China . GrossmaFor the relationship between the ecological environment and economic development, existing studies verified that the inverted U-shaped relationship between economic growth and environmental degradation is based on the empirical framework of the Environmental Kuznets Curve (EKC) ,29. In r“Coupling coordination” originates from the field of physics and refers to the close connection between each internal and external element of two or more systems. It is mainly used in the field of climate change. As the research moves along, coupling coordination has been introduced to measure the nonlinear interactions between the ecological environment and economic development, as well as public health and economic development. Liao et al. measured the degree of coupling and coordination between economic development and the ecological environment in the Beijing-Tianjin-Hebei region of China, and they made policy recommendations for local coordinated development . Wu et ac); the optimal value (e) represents the maximum value of the indicator increased by 10%; the worst value (a) is the minimum value of the indicator reduced by 10%; the worse value (b) represents the interpolation of a and c; the better value (d) represents the interpolation of c and e.The evaluation method of “single index quantification-multi-index synthesis-multi-criteria integration” , as shown in According to the established evaluation index system for the coordinated development of the public health, ecological environment, and economic development in the Yellow River Basin, we use the Compared to Using the coordinated development index of the upstream, midstream, and downstream, from 2009 to 2019 in From the perspective of each province, the development index of public health, the ecological environment, and economic development in nine provinces is mainly concentrated as 0.1~0.7, involving four levels of basically uncoordinated, less uncoordinated, close to coordination, and more coordinated. Specially, the coordinated levels of Qinghai, Gansu, and Ningxia are less coordinated, and Inner Mongolia, Shaanxi, Shanxi, and Henan are close to coordination. Furthermore, Sichuan has developed from close to coordination to more coordinated, and Shandong is more coordinated, which reaches the highest level of coordination. From the perspective of upstream, midstream, and downstream, the coordinated development level of the downstream is the highest, which is close to coordination, while the level of the midstream has changed from less coordinated to close to coordination. However, the level of the upstream is less uncoordinated, which demonstrates the massive gap among upstream, midstream, and downstream. The coordinated status of each subsection of the basin is consistent with the actual situation. There are, indeed, certain gaps and barriers in the coordinated development index between provinces, as well as the upstream, midstream, and downstream ,52.On the whole, the coordinated development index of each province and upstream, midstream, and downstream have shown an upward trend, which indicates that the coordinated development of the three subsystems of the Yellow River Basin shows a positive rising trend in the future.We used the coordinated development index of each province in k)) and the Based on the calculation of The degree of contribution to the three-subsystem coordinated development, of each indicator in the nine provinces, can be seen in We use Obstacle Factors Diagnosis to calculate the obstacle degree of each index of the nine provinces in the Yellow River Basin, in 2019, and select the eight indicators with higher obstacle degree rankings in each province as the main obstacle factors, which is shown in According to the coordinated development results calculated by the The original data are regulated through the coordinated behavior regulation path, and then, the coordination development index of each path is calculated by the On the whole, the results in In terms of the specific paths, Path 4 has the best coordinated regulation effect from the holistic watershed perspective, which integrally considers the correlation and constraints. The overall coordinated development index increases by 0.42. Moreover, the adjustment effect of other paths, from high to low, is Path 3, Path 1, and Path 2. From the adjustment effect of each province, the Path 4 is still the best one, while Path 1, Path 2, and Path 3 have their own advantages in the adjustment effect when applied to different provinces. In summary, the optimal adjustment method for the optimal set of coordinated regulatory behaviors should be comprehensively considering the correlation and constraints that affect the overall development index. For the indicator’s adjustment, it is necessary to comprehensively consider its own relevance and obstacle factors, and finally, Path 4 is used as the optimal adjustment method in the paper.Existing studies have already developed several methods to quantitatively evaluate the overall coordinated development of the Yellow River Basin. Among them, the coupling coordination method is widely used. The coupling coordination method can measure the close relationship between systems and the influence of one thing on the others . Table 1ogeneity , which iogeneity ,57, but At present, the coupling coordination degree method is mainly used to evaluate the coordination development level . Comparein China . Zuo usein China .In addition, we considered the research scope. We chose the entire province of the watershed as the study area, instead of the prefecture-level cities, because it is difficult to form a relatively complete index system due to the inaccessible data in prefecture-level cities.(1)EEDI) has a higher base value but the slowest growth rate compared with the ecological environment index and economic index [PHDI) and the growth rate are in the middle level. The index of each subsystem in the Yellow River Basin tends to be consistent. However, the overall development index level is not prominent, and each subsystem still has a huge space for ameliorating the development level.The coordinated development index of the public health, ecological environment, and economic development, during the study period, shows an increasing trend ,49. The ic index . The bas(2)During the study period from 2009 to 2019, the overall coordinated development index kept growing steadily from 0.352 to 0.486. The level of coordinated development also has promoted from less coordinated to close to coordination. When discussing the coordinated development level of the upstream, midstream, and downstream, the upstream comes last, followed by the midstream, with the downstream topping the table . As for (3)In terms of correlation, the indicators that have a general impact on the overall coordinated development index of the Yellow River Basin, including the average concentration of fine particulate matter, the per capita arable land, the effective utilization coefficient of farmland irrigation water, the number of people engaged in scientific and technological activities, the number of higher education graduates, the number of beds in health care institutions, the number of travel agencies, and the number of medical institutions . In termBased on the coordinated development of the three subsystems of the ecological environment, economy, and public health, we research the nine provinces in the Yellow River Basin and construct the evaluation system for the public health, ecological environment, and economic development as a whole. In addition, the correlation degree and obstacle degree of the system indicators that affect its coordinated development index are calculated. Furthermore, the coordinated regulation method is adopted to regulate the index system. Based on the above processes, we draw some conclusions:Based on the above research results and conclusions, the following policy recommendations are proposed for the high-quality development in the Yellow River Basin.(1)In terms of the ecological environment, strengthen the intensity of sewage treatment, increase investment in sewage treatment facilities, ameliorate sewage treatment standards to reduce pollution of ecological water, and ensure water safety for residents. In addition, treating agricultural equipment, improving the utilization rate of agricultural irrigation water, and reducing the use of agricultural fertilizers and pesticides can reduce the burden on land and make land sustainable. Moreover, promote the transformation and upgrading of heavily polluted enterprises, use clean energy, develop new technologies, and improve the efficiency of resource utilization and the recycling rate of waste, thereby reducing solid particulate matter and harmful gas emissions and improving air quality. Furthermore, strengthen afforestation, increase the coverage rate of forests and wetlands in the Yellow River Basin, and promote the restoration of the ecological environment on both sides of the Yellow River and the prevention and control of river basin pollution to enhance the environmental carrying capacity and the ability to restore the ecological environment, and the ecological barrier function of the Yellow River Basin can be stably played.(2)In terms of economic development, consider the actual situation of the region, optimize the industrial structure, attach importance to technological innovation, increase investment in research and development, use the actual policy to introduce talents in order to transform the local industry into technology-intensive industries and enhance the local economic creativity. Furthermore, policies guide the increase in the share of the tertiary industry structure, and they increase the disposable income of residents to stimulate economic growth to achieve the purpose of stimulating residents’ consumption and economic growth. Besides, regions should strengthen cooperation with neighbors, so provinces with better economic development can play a leading role in promoting the development of surrounding regions, accelerate economic development in poor regions, and narrow economic regional differences. At the same time of economic development, properly balancing the relationship with other industries enables the formation of a new regional economic pattern with complementary advantages and characteristic development, which realizes the sustainable development of the regional economy.(3)In terms of public health, raise the concept to guide population growth, improve the working welfare of medical personnel, and strengthen policy subsidies for drugs to reduce the degree of aging, improve the motivation of medical staff, and reduce the personal health consumption expenditure of residents. In addition, increase care for the elderly, strictly monitor drinking water resources, improve urban infrastructure and emergency facilities in provinces, and prevent public health crises caused by emergencies, so the lives, health, and safety of residents can be guaranteed, and the happiness and satisfaction of living can be improved. Furthermore, developing fitness and entertainment venues, travel agencies, and other venues for physical exercise and spiritual entertainment can improve the health of residents and achieve the goal of the Healthy China.(4)Promote the comprehensive management of the public health, ecological environment and economy subsystems. The economy can drive the improvement of ecological environment protection and public health, while the high quality of the ecological environment and public health can also promote economic development. Moreover, by breaking administrative barriers, promoting regional open cooperation, market cooperation, brand development, and benefit sharing, establish cooperative and mutual aid relationships and, ultimately, realize the overall high-quality development of the Yellow River BasinFrom an application point of view, the above suggestions may be helpful for policy design. In addition, the scientific and reasonable policies can improve the level of coordinated development of public health, the ecological environment, and economy in the Yellow River Basin, and they promote the high-quality development of public health in the Yellow River Basin, which is in line with our research purposes.Academically, the paper can effectively make up for the relative insufficiency of the current studies on the regulation method of the main factors affecting the overall coordinated development index, and it can also provide auxiliary reference for further research by other scholars. In the future, we will conduct more detailed research on the Yellow River flowing through prefecture-level cities. In addition, this study assigns one-third of the weight to each subsystem of public health, the ecological environment, and economic development, and future research will assign weight to each system in a more rational manner.


Synergistic development is the only way which must be passed and a key point to achieve high-quality economic development. This paper regards regional synergetic development as a composite system, builds up the evaluation indicator system, and calculates the level of economic synergetic development of Guangdong-Hong Kong-Macao Greater Bay Area Urban Agglomeration, by using the collaborative degree model of composite system. The results show that each subsystem of the composite system has a high degree of order from 2007 to 2019, but compared with Beijing-Tianjin-Hebei urban agglomeration and Yangtze River Delta urban agglomeration, the level of economic collaborative development of Guangdong-Hong Kong-Macao Greater Bay Area urban agglomeration in 2008–2019 is relatively low and has large spatial differences. The main reason is that under the background of “one country, two systems” policy, the institutional differences between Guangdong, Hong Kong, and Macao have not been effectively linked up and synergetic, Greater Bay Area urban agglomeration has not yet formed an organic whole, and the synergy effect of mutual support and promotion is relatively weak. Based on this, we should seize the great historical opportunity of the construction of Guangdong-Hong Kong-Macao Greater Bay Area, accelerate the construction of the mechanism for the synergetic economic development of the three areas, accelerate the establishment of an integrated market, build a reasonable division of labor system and collaborative innovation system, and jointly promote the synergetic economic development of Greater Bay Area. Outline Development Plan for the Guangdong-Hong Kong-Macao Greater Bay Area was released, marking that this national strategy, which was personally planned, deployed, and promoted by General Secretary Xi Jinping, has entered the stage of full implementation. In the Outline, “promoting the synergetic development of regional economy” and “exploring a new model of synergetic development” are clearly defined as the guiding ideology and strategic positioning. The synergetic development here is a way to fully explore the potential advantages of various regions through efficient and orderly integration, promote the orderly flow and optimal allocation of factor resources to the greatest extent in space, and promote the formation of more effective and rational division of labor and cooperation, so as to release the development mode of the growth potential of new economy , the greater the value is, the greater the contribution of the subsystem to the composite system is. ∂ij and βij are the critical upper limit value and lower limit value of the order parameter, respectively. In the paper, the minimum and maximum values of the order parameter in the research period are selected as representatives. From the perspective of the whole composite system, the contribution of each order parameter component to the subsystem is closely related to its combination form and weight, namely, it needs to be realized through their own integration of μ(bij). The paper adopts the linear weighting method to calculate the order degree of subsystem.μ(bi) is the order degree of the subsystem, μ(bi) ∈ . The larger μ(bi) is, the higher the order degree of the subsystem is, and vice versa. ωjis the indicator weight which is determined by entropy method. First, assuming that there are m cities and n evaluation indicators, the order degree probability distribution of order parameter component isAmong them, μ(bij) ∈ , the entropy value of the jth indicator of the subsystem Ai isAs mentioned in equation (3), k=1/ln m, then, the entropy weight ωj of the jth indicator can be defined asAmong them, Ai of the composite system of regional economic synergetic development in the period t0 is μ0(bi), and the order degree in the period ti is μ1(bi), then the synergy degree E of the regional economic synergetic development system isAssuming that the order degree of the subsystem At the same time， E is . The higher the value is, the higher the level of regional economic synergetic development is, and vice versa. Parameter u measure the synergy direction of each subsystem. When the value of u is 1, the synergy degree E is positive, which indicates that the order degree of each subsystem is in the rising stage, and the composite system is in the synergy and order stage; When the value of u is -1, E is negative, indicating that the order degree of at least one subsystem declines, and the composite system is in the unstable or unsynergetic stage.The value of Guangdong Statistical Yearbook, China Urban Statistical Yearbook, Hong Kong Statistical Yearbook, and Macao Statistical Yearbook over the years.The paper takes the panel data from 2007 to 2019 of the 11 cities of Guangdong-Hong Kong-Macao Greater Bay Area urban agglomeration, namely Guangzhou, Shenzhen, Zhuhai, Foshan, Zhongshan, Zhaoqing, Dongguan, Huizhou, and Jiangmen, as well as Hong Kong and Macao as the main research samples. The data sources of each indicator include Considering that the currency units used by cities in the Pearl River Delta, Hong Kong, and Macao are not the same, in order to facilitate the unification and calculation of indicators, the exchange rates of each year are converted into RMB for indicator statistics and analysis.For the missing original data, the mean method is adopted for processing. The indicator data that are not directly published in the statistical yearbook or annuals is obtained by calculation.According to the calculations of formulas to 5), t, t5), thBased on Referring to the method of Guo Shipping , the papChina Statistical Yearbook and China Urban Statistical Yearbook over the years, as well as the statistical yearbooks of provinces and cities. As shown in In order to further objectively and accurately grasp the economic synergetic development of Guangdong-Hong Kong-Macao Greater Bay Area urban agglomeration, the paper also measures the economic synergetic development level of Beijing-Tianjin-Hebei urban agglomeration and Yangtze River Delta urban agglomeration, using the same method as before. Beijing-Tianjin -Hebei urban agglomeration and Yangtze River Delta urban agglomeration are two regions except Guangdong Hong Kong Macao Great Bay Area in China that are expected to become world-class urban agglomerations, with relatively large economic development scale, relatively high speed, and relatively high population density. The statistical data of these cities are mainly from the From the perspective of the principle of synergetics, only when there is a close relationship between subsystems that promote and depend on each other can the composite system produce a synergistic effect in which the overall function is greater than the simple summation of local functions. Although the subsystems of the composite system have a relatively high order degree, the overall level of the synergetic economic development of Guangdong-Hong Kong-Macao Greater Bay Area is at a low level, lagging behind the Beijing-Tianjin-Hebei urban agglomeration and the Yangtze River Delta urban agglomeration, and there are large spatial differences. This shows that the degree of synergy between the urban agglomerations in Greater Bay Area is low, and the relationship of “mutually beneficial symbiosis and win-win cooperation” has not yet been formed. The reason for this situation mainly comes from the institutional differences between Guangdong, Hong Kong and Macao under the background of “one country, two systems” policy .Different from other urban agglomerations, Guangdong-Hong Kong-Macao Greater Bay Area is a cross-border cooperation of three independent tariff zones within the same sovereign country under the background of “one country, two systems” policy, and implements different political and social systems. This institutional framework ensures that the Pearl River Delta, Hong Kong, and Macao share the same fundamental and long-term interests, and lays a solid foundation for the synergetic development of the economies of the three places, but many institutional differences have also been produced, bringing many imbalances and asymmetries to the economic cooperation among the three regions. For example, Hong Kong and Macao are free ports with a high degree of internationalization and rule of law, perfect market economy rules, and little government intervention in the economy. However, the Pearl River Delta has not been formally integrated with the world economic system, the level of opening to the outside world and the development of market economy need to be improved, and the government-led characteristics are still obvious. At the same time, Guangdong-Hong Kong-Macao Greater Bay Area belongs to three independent tariff areas, so the circulation of goods in the Greater Bay Area faces different trade policies, tax arrangements, and regulatory systems; people from the three places need to apply for visas, so the number of visits is limited, and there are also restrictions on academic qualifications, quotas, duration of stay, social welfare, professional qualification recognition, and so on; the financial supervision systems of Guangdong, Hong Kong, and Macao are independent, the financial markets are isolated from each other, and the three currencies are not circulating with each other; the mainland has opened up to Hong Kong and Macao in the fields of telecommunications and Internet with conditions. The residents of Hong Kong and Macao need to switch networks and pay roaming charges to and from the Pearl River Delta. In order to adapt to or overcome these institutional differences, the market entities of Guangdong, Hong Kong, and Macao need to pay additional institutional transaction costs, resulting in that business activities cannot be carried out on the principle of profit maximization, which reduces the willingness to cooperate across regions. These institutional transaction costs may also cause market segmentation and monopoly, breed local protectionism and departmentalism, form intra-regional trade barriers, and reduce the efficiency and quality of resource allocation in the entire Great Bay Area, which is not conducive to the formation of an integrated market.Since the return of Hong Kong and Macao to China, in order to solve the problem of inclusiveness under the “one country, two systems” policy, a multi-level institutional arrangement from the central government to local levels has been carried out for many years, which helps to promote the in-depth cooperation among Guangdong, Hong Kong, and Macao, but the connection and synergy of the systems among the three places have never achieved a major breakthrough. Driven by a series of institutional arrangements including CEPA and Guangdong Pilot Free Trade Zone, the division of labor and cooperation in the service industry among Guangdong, Hong Kong, and Macao has achieved certain results. However, as the market opening and access conditions, and business environment of the three places have not been effectively connected, the division of labor and cooperation in the service industry among Hong Kong, Macao, and the Pearl River Delta still remains in the traditional fields such as transportation service, tourism service, and business service. Hong Kong's advantageous fields such as insurance, law, accounting, and construction have not really achieved effective connection and complementary advantages with the manufacturing industry in the Pearl River Delta. In addition, with the convergence of the economic development structure of the Pearl River Delta, Hong Kong, and Macao, as well as the improvement of the mainland's infrastructure, the three places have launched homogeneous competition in the fields of finance, logistics, exhibition, and scientific and technological innovation. Such a division of labor has not only prevented Guangdong, Hong Kong, and Macao from becoming an economic community and interest community with shared risks and interests but also brought too much internal friction to the construction of the Great Bay Area, which reduces the overall effect of economic development.Constructing a mechanism for synergetic economic development and uniting the awareness of common development of all parties: giving full play to the advantages of “one country, two systems” policy, constructing a common framework across the institutional gap, planning and laying out the development of Greater Bay Area as a whole, and promoting the three regions from complementary advantages to integration of advantages are important guarantees and top priority for the synergetic economic development of Greater Bay Area urban agglomeration. It is suggested to establish a “Leading Group for the Synergistic Economic Development of Guangdong-Hong Kong-Macao Greater Bay Area Urban Agglomeration” as the organization for overall planning, decision-making and synergy, which is responsible for promoting the synergy among the cities in the Greater Bay Area at the national level; the “Synergy and Management Organization for the Synergistic Economic Development of Guangdong-Hong Kong-Macao Greater Bay Area Urban Agglomeration” should be established as the daily leadership and executive organization for the synergetic economic development of Greater Bay area to be responsible for the implementation and implementation of various plans and designs, the formulation of supporting supplementary agreements and implementation rules, and the guidance of specific work; the “Supervision and Management Organization for the Synergistic Economic Development of Guangdong-Hong Kong-Macao Greater Bay Area Urban Agglomeration” should be set up to supervise the implementation of synergetic policies and measures, and restrict the behaviors of all partners according to the agreement. In addition, we should also construct a multi-level interest compensation mechanism in Greater Bay Area, coordinate the overall interests and local interests of the urban agglomeration in Greater Bay Area, and improve the motivation and willingness of the synergetic development of the three places.Constructing an integrated market in Greater Bay Area and accelerating the connection of business environment and rules: it is suggested that the duty-free policy for products originating in Hong Kong and Macao under the CEPA agreement should be extended to all products from Hong Kong and Macao, including imports from Hong Kong and Macao. We should continue to deepen the implementation of the measures for the opening of service trade under the CEPA agreement, try to cancel the restrictions on the share ratio and access conditions for the investors of Hong Kong and Macao to enter the finance, telecommunications, culture, and other fields of the Guangdong Pilot Free Trade Zone, relax the approval of investment fields and qualifications, cancel the foreign exchange management system, and construct an integrated financial market among the three regions. We should also encourage the telecommunication companies in the three places to cooperate in a win-win way and construct an interconnected, convenient and smooth Internet and communication network in Greater Bay Area, promote the electronization and automation of endorsement and customs clearance in the three places, speed up the construction of self-service customs clearance and inspection channels, and realize “one endorsement, multiple trips.” In addition, it is necessary to accelerate the formulation of unified industry service standards, professional qualifications and professional titles in Greater Bay Area, carry out pilot work of mutual recognition of professional qualifications in Greater Bay Area, explore the establishment of a list of professional qualifications of Guangdong, Hong Kong and Macao talents, and study and carry out mutual recognition of academic qualifications in the three places. We need to increase efforts to replicate and promote the successful experience of the reform in the areas of commercial registration, in-process and after event supervision in the free trade zone to other cities in the Greater Bay Area, and gradually improve the legal, international, and convenient business environment. Finally, we should reform the customs management system and the setting of layout, speed up the realization of the goal of “Liberalizing the First Line and Managing the Second Line” in Greater Bay Area, and promote the innovative models such as “one place, two inspections” and “cooperative inspection” .Constructing a reasonable division of labor system and form a regional community of interests: based on the existing two-wheel drive model of the advanced manufacturing and the modern service industry, a division of labor system of Greater Bay Area urban agglomeration with complementary advantages and misplaced competition will be formed to comprehensively improve the overall competitiveness. Guangzhou should play the central role as the “headquarters,” maintain its radiation and diffusion capacity to the Pearl River Delta, and promote the upgrading of industrial structure by cultivating strategic emerging industries such as biomedicine, new materials, new energy, and marine biology. Shenzhen can make use of its high-tech industrial characteristics to improve the scientific and technological content and innovation level of manufacturing industry, realize the strong combination of technological innovation and financial industry, and form complementary advantages with Hong Kong. Foshan, Dongguan, and Zhongshan can accelerate the landing and transformation of high-tech achievements from Guangzhou and Shenzhen, and accelerate the transformation and upgrading of traditional manufacturing industries. Huizhou, Jiangmen, and Zhaoqing should actively undertake the transfer of relevant industries to achieve dislocation development. Hong Kong and Macao should actively integrate into the overall development situation of the Greater Bay Area, and take advantage of their service industry advantages to drive the transformation and upgrading of the manufacturing industry and the development of modern service industry in the Pearl River Delta. At the same time, we should consolidate and enhance the status and functions of Hong Kong as an international financial center, shipping center, and trade center, continue to give full play to the unique advantages of Hong Kong and Macao as “super contacts,” and build the Great Bay Area into a high-level opening-up platform.Constructing a synergetic innovation system and creating a first-class science and technology bay area: innovation is the driving force for the synergetic development of the regional economy. We should strengthen the integration of innovation resources in the three regions, optimize the innovation environment, and construct a synergetic innovation system for Greater Bay Area. The major universities and scientific research institutes in Guangzhou can strengthen the research and exploration of basic frontier fields and the education and training of innovative talents. Tianhe High Tech Development Zone, science city, and other advantageous strategic platforms should strengthen the joint innovation with advanced manufacturing industries in Foshan, Dongguan, and Zhongshan. Shenzhen should focus on the development of high-tech industries and strive to achieve breakthroughs of the core technologies in the fields of new energy, new technology, biomedicine, energy conservation, and environmental protection. Many well-known universities and scientific research institutions in Hong Kong should strengthen their cooperation with universities and enterprises in the Pearl River Delta to accelerate the implementation and transformation of scientific research achievements while improving research and development capabilities. The three places should jointly construct a technological innovation service platform for Greater Bay Area, especially for small and medium-sized enterprises, to promote the smooth implementation of enterprise innovation activities and technological upgrading. The financial institutions should be encouraged to introduce capital into the process of industrial incubation and transformation of innovative technologies, and provide targeted financial products and services. The connection of intellectual property protection mechanisms among the Pearl River Delta, Hong Kong, and Macao should be accelerated to optimize the external environment for scientific and technological innovation. Finally, we should take advantage of preferential policies in registered residence, taxation, customs clearance, and other aspects to attract innovative talents and innovative enterprises to gather and flow freely in Greater Bay Area.The paper constructs an evaluation indicator system of regional economic synergetic development, applies the synergy degree model of the composite system to calculate the economic synergy level of Guangdong-Hong Kong Macao Greater Bay Area urban agglomeration from 2008 to 2019, and compares it with Beijing-Tianjin-Hebei urban agglomeration and Yangtze River Delta urban agglomeration. The following conclusions are drawn: (1) The economic synergy development level of Guangdong-Hong Kong-Macao Greater Bay Area has changed significantly in different periods, showing a gradual upward trend on the whole from non-synergy stage to primary synergy stage; (2) There are large spatial differences in the level of synergetic economic development of Guangdong-Hong Kong-Macao Greater Bay Area urban agglomeration. The level of synergetic economic development of sub-core cities is the highest, followed by core cities and non-core cities; (3) Through the comparison, the synergetic economic development of Guangdong-Hong Kong-Macao Greater Bay Area urban agglomeration has the roughly same trend as the Yangtze River Delta urban agglomeration and Beijing Tianjin Hebei urban agglomeration, but it is still at a low level. The main reason for these current situations is that the institutional differences under the background of “one country, two systems” policy in the urban agglomeration of Guangdong-Hong Kong-Macao Greater Bay Area have not been effectively connected and synergetic, resulting in loose cooperation among the three places, and the synergistic effect of mutual and joint cooperation is still relatively weak. Based on this, the paper puts forward the following countermeasures: