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Four System Enablers Of Large-System Transformation In Health Care: A Mixed Methods Realist Evaluation, Emilie Francis-Auton, Janet C. Long, Mitchell Sarkies, Natalie Roberts, Johanna Westbrook, Jean Frederic Levesque, Diane E. Watson, Rebecca Hardwick, Peter Hibbert, Chiara Pomare, Jeffrey Braithwaite

Peninsula Medical School

Policy Points The implementation of large-scale health care interventions relies on a shared vision, commitment to change, coordination across sites, and a spanning of siloed knowledge. Enablers of the system should include building an authorizing environment; providing relevant, meaningful, transparent, and timely data; designating and distributing leadership and decision making; and fostering the emergence of a learning culture. Attention to these four enablers can set up a positive feedback loop to foster positive change that can protect against the loss of key staff, the presence of lone disruptors, and the enervating effects of uncertainty. Context: Large-scale transformative initiatives have the …

Enhanced Bmp Signaling In Cathepsin K-Positive Tendon Progenitors Induces Heterotopic Ossification, Hiroyuki Yamaguchi, Margaret Li, Megumi Kitami, Sowmya Swaminathan, Yuji Mishina, Yoshihiro Komatsu

Faculty, Staff and Student Publications

Heterotopic ossification (HO) is abnormal bone growth in soft tissues that results from injury, trauma, and rare genetic disorders. Bone morphogenetic proteins (BMPs) are critical osteogenic regulators which are involved in HO. However, it remains unclear how BMP signaling interacts with other extracellular stimuli to form HO. To address this question, using the Cre-loxP recombination system in mice, we conditionally expressed the constitutively activated BMP type I receptor ALK2 with a Q207D mutation (Ca-ALK2) in Cathepsin K-Cre labeled tendon progenitors (hereafter “Ca-Alk2:Ctsk-Cre”). Ca-Alk2:Ctsk-Cre mice were viable but they formed spontaneous HO in the Achilles tendon. Histological and molecular …

Comparison Of Edta And Boric Acid Irrigation In Terms Of Root Canal Dentin Microhardness And Sealer Penetration Depth, Selen İnce Yusufoğlu, Esma Saricam, Neslihan Bulak, Mustafa Güngörmüs, Fatih Tulumbacı, Suat Özcan

Journal of Dentistry Indonesia

Chemo mechanical preparation is one of the important stages for successful endodontic treatment, and Boric acid has been proposed as an alternative irrigation solution for root canal treatment. Objective: The purpose of this study was to evaluate the effect of irrigation with boric acid (BA) and EDTA on the mineral content and microhardness of dentin and penetration of the AH Plus root canal sealer. Methods: 63 single-rooted teeth were instrumented. Microhardness analysis, 45 teeth were cut longitudinally and then transversely to obtain dentin. Pre- and post-treatment microhardness values were measured. The samples were randomly assigned into 3 groups …

Effect Of Triple Antibiotic Paste, Double Antibiotic Paste, And Calcium Hydroxide On Antibiotic Resistance Of Tet Repressor Proteins, Tetracycline Resistance Gene W, And Tetracycline Resistance Gene Q: A Randomized Controlled Clinical Trial, Ertuğrul Karataş, Özgen Kırmızıbekmez, Mustafa Özkan Baltacı, Ahmet Adıgüzel

Journal of Dentistry Indonesia

Objective: To investigate the effect of the use of Calcium Hydroxide (Ca(OH)2), Triple Antibiotic Paste (TAP), and Double Antibiotic Paste (DAP) as intra-canal medicaments on the development of antibiotic resistance by evaluating tetracycline genes. Methods: Forty five patients were randomly assigned into 3 groups according to the intracanal medication using a web program (www.randomizer.org), (Ca(OH)2, TAP and DAP). Root canal bacteriological samples were collected before root canal treatment (S1) and after chemo-mechanical procedures (S2). Following root canal shaping procedures, intra-canal medication of the root canals was performed with selected intra-canal medicament. A second appointment was planned for the …

Evaluation Of Trabecular Bone Around The Impacted Maxillary Canine On Cbct Images By Fractal Analysis, Zeynep Betül Arslan, Berrin Çelik

Journal of Dentistry Indonesia

Objective: The aim of this study was to evaluate the position, angulation and surrounding trabecular bone structure of a unilateral impacted maxillary canine (IMC) tooth using fractal analysis. Methods: Cone beam computed tomography images of 50 patients (38 female, 12 male) with unilateral IMC were selected for this retrospective study. A 25x25 pixel region of interest (ROI) was selected in the trabecular bone between the premolars on the impacted and non-impacted side and fractal analysis was conducted. The angulation of unilateral impacted canines was measured and the position was categorized as vestibular, intra-alveolar and palatal. Results: Of …

The Effect Of Several Electric Cigarette Puffs On Nanohybrid Composite Resin Surface Roughness, Alvi Rizqi Amaliyah, Haris Budi Widodo, Irfan Dwiandhono

Journal of Dentistry Indonesia

Nanohybrid composite resin is a dental restorative material comprising micro and nano-sized fillers. When accompanied by smoking habits, it can alter the surface roughness of composite resin. Objective: This study aimed to determine the effect of several electric cigarette (e-cigarette) puffs on the surface roughness of nanohybrid composite resin. Methods: This study was conducted in the experimental laboratory with a pretest-posttest control group design using 48 nanohybrid composite resin specimens divided into six groups. Subsequently, the experimental groups were exposed to 75, 150, 225, 300, and 450 puffs of e-cigarette, and the control group was given artificial saliva …

Management Of Ankyloglossia In A Non-Syndromic Patient Using A Super Pulsed Laser: A Life-Changing Treatment- A Case Report, Urfi Jawed, Afaf Zia, Ramniwas Kumawat, Afshan Bey, Maahin Mahmood

Journal of Dentistry Indonesia

Objective: Ankyloglossia affects a person’s overall well-being and life, from malnutrition due to poor feeding and mechanical problems to psychological stress and low self-esteem, thus affecting social life. This case reports the use of non-scalpel techniques, such as a super pulsed laser, to manage ankyloglossia in a non-syndromic patient suffering from speech incompetence and restricted tongue mobility and highlights its advantages over other conventional techniques. Case Report: A 17-year-old male patient presented with a complaint of restricted tongue mobility, due to which he could not pronounce certain words clearly. As the patient was apprehensive about the use of …

Evaluation Of Morphologic And Morphometric Characteristics Of The Mental Foramen And Anterior Loop In A Turkish Subpopulation Using Cone Beam Computed Tomography, Fatma Büşra Doğan, Faruk Akgünlü

Journal of Dentistry Indonesia

Objective: Before a surgical intervention in the mandibular interforaminal area, it is important to have a full understanding of the anatomy of the mandibular anterior segment. The evaluation of anatomical structures, variations and pathologies is performed with radiological imaging methods. Today, cone beam computed tomography (CBCT) is an imaging method which offers all the features necessary for this. In addition to its importance in surgical applications, it is also valuable in terms of anatomical studies thanks to the reliability of its measurements and the fact that it allows for a three-dimensional evaluation. The mental foramen and anterior loop are …

Prevalence And Clinical Characteristics Of Temporomandibular Disorders In Adults: An Epidemiological Study In The Mediterranean Region Of Türkiye, Esra Yavuz, Selmi Yardimci, Humeyra Tercanli

Journal of Dentistry Indonesia

The prevalence and clinical characteristics of temporomandibular disorders (TMD) in the Mediterranean region of Türkiye have not yet been thoroughly investigated. Objective: This study aimed to determine the prevalence and severity of TMD in a sample of the population in this region and to characterize the clinical findings related to TMD. Methods: Four hundred and one participants were included in this study. “Presence of TMD” in the participants was evaluated using the Fonseca Anamnestic Index. Through clinical examination, the findings in the participants were classified as limited mouth opening, deviation, temporomandibular joint (TMJ) sounds, TMJ pain, and muscle …

Contents Vol 30 No 3 2023, Dr. Yuniardini Septorini Septorini Wimardhani

Journal of Dentistry Indonesia

This is the content of Vol. 30 number 3 2023.

Case Report And X-Ray Microtomography And Scanning Electron Microscopy Analysis Of Teeth With Hypocalcified Amelogenesis Imperfecta, Rodrigo W. Marinoni, Thiago G. Silva, Leonardo S. Benato, Anelize M B Rumbelsperger, Antonio Adilson Soares De Lima

Journal of Dentistry Indonesia

Amelogenesis imperfecta (AI) is a genetic disease characterized by producing morphological and structural changes in tooth enamel. Objective: To highlight the morphological changes observed in teeth with hypocalcified AI based on scanning electron microscopy and microtomography analysis. Case report: An adult male had teeth seriously compromised by hypocalcified AI. The treatment plan involved removal of third molars followed by restorative and prosthetic treatment. After extraction, the teeth were analyzed by SEM and X-ray microtomography (microCT). Teeth with AI revealed the presence of microfractures arranged from the outer surface to the center of the enamel. Microfractures had a cracked or “cracked …

Surface Roughness Of Restorative Materials After Simulated Toothbrushing With Toothpastes Containing Theobromine And Arginine: An In Vitro Study, Fikri Öcal, Burak Dayi, Zeynep Küçükakçalı

Journal of Dentistry Indonesia

Objective: This study examined the effect of toothpastes containing theobromine and arginine on the roughness changes of microhybrid composite, nanohybrid composite, and giomer restorative materials. Methods: A total of 90 disc-shaped specimens were prepared using microhybrid composite (Arabesk-Ara), nanohybrid composite (Herculite-Her), and giomer (Beautifil II-Gio). The samples were divided into 3 subgroups (n = 10), and initial surface roughness was evaluated with a mechanical profilometer and scanning electron microscopy (SEM). All samples were then subjected to a 1-year brushing simulation via a toothbrushing simulator using toothpastes containing theobromine (Theodent Classic, Theodent) or arginine (Colgate PRO-Relief, Colgate Palmolive); a …

Comparison And Assessment Of Design, Handling Characteristics, And Efficacy Of Hand Instruments In Calculus Removal, Mohan Kumar Pasupuleti, Krishna Ganesh, Gautami S Penmetsa, Boddeda Anusha, Haripriya Narukurthi, Kommina Mouna Sahith

Journal of Dentistry Indonesia

Objective: primary objective of periodontal therapy is to remove supra and subgingival deposits from the tooth surface to stop disease progression. The purpose of the study is to address the instrument selection and its efficacy in calculus removal. Methods: A total of 50 subjects who fulfilled the criteria were included in the study. Participants were subjected to a complete periodontal examination, and the responses from 50 dental house surgeons were compared based on the instrument design, handling characteristics, and efficacy of calculus removal by using two sets of instruments. Results: The LM instrument was rated as best …

Factors Affecting The Preference Of Orthodontic Appliances Among Undergraduate Students In West Jakarta, Joko Kusnoto, Lia H. Andayani, Budi Kusnoto

Journal of Dentistry Indonesia

Malocclusion’s negative impact is not only limited to dentofacial appearance but also related to quality of life. Nowadays, orthodontic treatment can be done using conventional fixed appliances, or removable appliances called clear aligners. The preference for orthodontic appliances can be affected by several factors, including patient characteristics, self-perception, psychosocial, and oral-disorder factors. Objective: This study aims to evaluate the factors affecting the preference for orthodontic appliances among undergraduate students in West Jakarta. Methods: In this cross-sectional study, 244 undergraduate students were retrieved by purposive sampling from 7 universities located in West Jakarta. A self-administered questionnaire was used to …

Elastic Recovery Properties Of Alginate Impression Materials Based On Red Algae Kappaphycus Alvarezii, Didin Erma Indahyani, Izzata Barid, Nafisah Nafisah, Depi Praharani, Agus Sumono, Niken Probosari, Sulistiyani Sulistiyani

Journal of Dentistry Indonesia

Alginate impression materials in dentistry are used to form details of the oral cavity organs. The alginate content in the impression material functions to form a gel. One source of alginate is algae. Objective: This study aims to determine the recovery elasticity and setting time of alginate impression materials made from red algae K. alvarezii. Methods: The sodium alginate in the composition of this alginate impression material was extracted from red algae K. alvarezii. The alginate impression material was tested for setting time and recovery elasticity and compared with commercial impression material (Hygedent®). Results: The elastic …

Enigmatic Cervicofacial Actinomycosis Post Radiotherapy - A Case Report, Amanda Phoon Nguyen

Journal of Dentistry Indonesia

Although thought to be uncommon, it is believed that cervicofacial actinomycosis is underreported due to frequent misdiagnosis. It has been called the “most misdiagnosed disease by experienced clinicians”. A wide range of dental procedures or trauma, including tooth eruption, may precipitate actinomycosis by enabling microorganisms to penetrate the deeper tissue layers via an entry point. This infective disease is significant due to its potentially aggressive and locally destructive nature. This case describes a patient diagnosed with cervicofacial actinomycosis. Her history prior to this was significant for proliferative verrucous leukoplakia, and T4aN0M0 (AJCC 7th Edition) squamous cell carcinoma of the right …

Integration Of Massive Open Online Course (Mooc) In Conventional Teaching And Learning For Fixed Prosthodontics - A Case Study, Nor Faharina Abdul Hamid, Rohana Ahmad, Tong Wah Lim, Nur Hafizah Kamar Affendi, Tengku Fazrina Tengku Mohd Ariff, Melati Mahmud, Siti Mariam Ab Ghani

Journal of Dentistry Indonesia

The potential for Massive Open Online Courses (MOOCs) in clinical dentistry remains vague and inadequately explored. Objectives: The study aims to obtain insight into the development of MOOCs in Fixed Partial Dental Prostheses (FPDPs) and to assess students’ learning preferences, module quality, and interface usability. Methods: The MOOCs was created by seven academicians with prosthodontic backgrounds. After completing the MOOCs and three complementary online discussion sessions, the students (n = 89) were invited to participate in an online survey. SPSS version 23 was used to calculate the frequency, percentage, mean, and standard deviation of categorical data (SD). Results …

Clinically Effective Regenerative Therapy For Primary Endodontic Lesions With Secondary Periodontal Lesions: A Case Report, Martina Amalia, Budi Budi, Iceu Estu Kurmaena, Nevi Yanti, Hesty Nurcahyanti, Aini Hariyani Nasution

Journal of Dentistry Indonesia

The diagnosis and prognosis of teeth with endo-perio lesions present a major challenge for dentists. Proper diagnosis is critical in determining treatment and the long-term prognosis. However, treating complex endodontic and periodontal lesions is one of the most common challenges in current clinical practice. The coexistence of pulpal and periodontal tissue damage may complicate diagnosis and further influence dental prognosis. This article consists of a case report evaluating the efficacy of xenografts and resorbable membrane pericardium in treating bifurcation lesions associated with periodontal lesions of the left mandibular first molar. A 22-year-old female patient was referred by conservative dentistry with …

Mechanisms Linking Proteins And Structural Brain Integrity To Biological Markers Of Alzheimer’S Disease, Adam Turnbull, Yejin Kim, Kai Zhang, Tianrui Mao, Xiaoqian Jiang, Victor Henderson, Zihuai He, Feng Vankee Vankee Lin

Faculty, Staff and Student Publications

Background

Medial temporal lobe (MTL) networks, including posterior-medial (PM) and anterior-temporal (AT) subnetworks, are early affected by Alzheimer’s disease (AD) pathologies (tau, neurodegeneration) and are critical for memory, which declines in AD. The biological pathways linking AD pathology, changes in MTL-AT-PM structural connectivity (SC), and cognitive decline, are unknown. Plasma protein levels reflect those in the cerebrospinal fluid, providing a low-invasive potential means of understanding molecular brain changes that occur in AD. These measures may help explain how AD pathology, MTL-AT-PM SC, and cognitive decline are linked at the molecular level. We used predefined aging-related plasma proteins from a meta-analysis …

Vascular Injury Risk Stratification For Lateral Lumbar Interbody Fusion (Llif) At L4-L5: A Morphometric Study Using Magnetic Resonance Imaging, Takashi Hirase, Aaron J Greenberg, Catherine G Ambrose, Derek T Bernstein, Jeffrey J Ratusznik, Rex A W Marco

Faculty, Staff and Student Publications

BACKGROUND: Proper vascular injury risk stratification (VIRS) methods for L4-L5 lateral lumbar interbody fusion (LLIF) surgery have not been well-described. The objective of this study was to propose a novel VIRS method for L4-L5 LLIF surgery via the transpsoas approach.

METHODS: Axial magnetic resonance imaging (MRI) of adult patients were obtained and analyzed. The VIRS scores were assessed using anterior disc line to posterior vessel wall distance, the disc vessel angle (DVA), and the disc edge to vessel distance at the level of L4-L5 disc space.

RESULTS: Ninety-one consecutive adult patients were included in the study. The right common iliac …

Preliminary Neurocognitive Finding From A Multi-Site Study Investing Long-Term Neurological Impact Of Covid-19 Using Ultra-High Field 7 Tesla Mri-Based Neuroimaging, Jonika D. Tannous, Farhaan S. Vahidy, Riddhi Patira, Alison M. Luckey, Mitzi M. Gonzales, Akram A. Hosseini, Timothy D. Girard, Tamer Ibrahim, Heidi I.L. Jacobs, Valentina R. Garbarino

School of Medicine Publications

Background: Globally, over six hundred million cases of SARS-CoV-2 have been confirmed. As the number of individuals in recovery rises, examining long-term neurological effects, including cognitive impairment and cerebral microstructural and microvascular changes, has become paramount., We present preliminary cognitive findings from an ongoing multi-site study investigating the long-term neurological impacts of COVID-19 using 7 Tesla MRI-based neuroimaging.

Methods: Across 3 US and 1 UK sites, we identified adult (>=18) COVID-19 survivors (CS) and healthy controls (HC) without significant pre-existing medical, neurological, or psychiatric illness. Using the National Alzheimer’s Coordinating Center (NACC) Uniform Data Set (UDS-3) battery …

Lower Locus Coeruleus Integrity In Older Covid-19 Survivors: Initial Findings From An International 7t Mri Consortium, Heidi I.L. Jacobs, Tamer Ibrahim, Farhaan S. Vahidy, Timothy D. Girard, Akram A. Hosseini, Salem Alkateeb, Richard Bowtell, Gowland Penny, Mohamad Habes, Valentina R. Garbarino

School of Medicine Publications

Background: The SARS-CoV-2 coronavirus has been associated with structural brain changes, consistent with its neurological manifestations. Recent studies showed a specific predilection for brainstem glial activation and hypometabolism, possibly indicating involvement of the locus coeruleus. The locus coeruleus (LC) modulates many cognitive functions and behaviors and its norepinephrine projections regulate both immune responses and vascular reactivity. We aimed to examine differences in LC integrity between COVID-19 survivors and controls.

Method: Participants are enrolled across 3 US and 1 UK sites using harmonized cognitive and 7T MR-imaging protocols. Here, we analyzed data from 18 participants enrolled at Houston Methodist (12 COVID-19 …

Hippocampal Subfield Volumes In Covid-19: A Preliminary Multicenter Study Using 7t Mri, Salem Alkateeb, Jinghang Li, Gabriel A. De Erausquin, Monica Goss, Jayandra J. Himali, Karl Li, Rejani R. Nair, Beth E. Snitz, Gowland Penny, Valentina R. Garbarino

School of Medicine Publications

Background: Hippocampal formation atrophy is a well-established imaging biomarker of several neurological diseases, including Alzheimer's disease, temporal lobe epilepsy, and schizophrenia. The hippocampus is divided into subfields that have different functions and vary in sensitivity to different diseases. This study investigates the potential interaction between COVID-19 and the various hippocampus subfields, which may shed light on the long-term neurological consequences of the virus.

Method: We obtained high-resolution T1-weighted (T1w) and T2-weighted (T2w) MRI images using 7T scanners located at three sites in two countries: Pittsburgh (n=14) and Texas (San Antonio and Houston) (n=40) in the USA, and Nottingham, …

Covid-19 May Have A Detrimental Impact On Sensorimotor Function, Monica Goss, Rebecca Bernal, Vibhuti N. Patel, Karl Li, Valentina R. Garbarino, Rejani R. Nair, Heather Snyder, Gabriel A. De Erausquin, Mary Ganguli, Beth E. Snitz, Timothy D. Girard

School of Medicine Publications

Background: The long-term impact of COVID-19 on global health is still unknown. Sensorimotor biomarkers may be promising indicators of lasting effects of COVID-19. Although normal aging may cause changes in sensorimotor function, more severe changes may indicate the subsequent impacts of COVID-19 on brain health. The objective of this study was to investigate the association between COVID-19 and sensorimotor markers (grip strength, gait, and smell) in the 7T neuroCOVID consortium, which is comprised of 5 sites: The University of Texas Health Science Center at San Antonio, Houston Methodist Research Institute, The University of Pittsburgh, Massachusetts General Hospital, and Nottingham University …

Citizens Apart? Representing Post-Brexit Youth Politics In The Uk Media, M Holton, J Lee, S Beech, S Mcdowell

School of Geography, Earth and Environmental Sciences

In 2016, the UK voted to leave the European Union (EU). This outcome was not only unexpected but also had clear geographical and age-bound divisions. While people over the age of 65 tended to vote to leave, younger voters were more likely to vote to remain a part of the EU. Reflecting on 7 years of journalism, this paper explores the ways in which young people have been represented by the news media with regards to the issue of Brexit. It analyses a database of 700 news media articles published from 2016 to 2022 across the UK, equating to 100 …

Advancing The Care Of Individuals With Cancer Through Innovation & Technology: Proceedings From The Cardiology Oncology Innovation Summit 2020 And 2021, Peter Mcgranaghan

All Publications

As cancer therapies increase in effectiveness and patients' life expectancies improve, balancing oncologic efficacy while reducing acute and long-term cardiovascular toxicities has become of paramount importance. To address this pressing need, the Cardiology Oncology Innovation Network (COIN) was formed to bring together domain experts with the overarching goal of collaboratively investigating, applying, and educating widely on various forms of innovation to improve the quality of life and cardiovascular healthcare of patients undergoing and surviving cancer therapies. The COIN mission pillars of innovation, collaboration, and education have been implemented with cross-collaboration among academic institutions, private and public establishments, and industry and …

An Innovative Model Using Promotores Or Community Health Workers For Home Based Dementia Care, Neela K. Patel, Cynthia De La Garza- Parker, Angelica Davila, Noe Garza, Monica Goss, Claudia L. Satizabal, Gabriel A. De Erausquin, Gladys E. Maestre, Sudha Seshadri

School of Medicine Publications

Background: Health disparities and issues with trust building and relationship building are prominent in Hispanic and underserved populations in south Texas. Community health workers can play a bridging role with underserved communities and may be essential in improving the quality and value of health care. The Texas Health and Human Services Commission certifies the training Community Health Workers under the label of “promotores”.

Method: Community health workers were integrated into the primary health care team to serve as a bridge between patient/caregiver dyads and the health care team.

Result: Community health workers (CHWs) connected patients to social determinants …

Dementia And Stroke Risk Associated With Brain Artery Luminal Diameters, Jesus D. Melgarejo, Kursat Gurel, Minghua Liu, Bonnie Levin, Mitchell S.V. Elkind, M. Kamran Ikram, M. Arfan Ikram, Fabrice Crivello, Christophe Tzourio, Zhen-Yu Zhang

School of Medicine Publications

Background: It is unclear whether brain artery diameters measured on conventional T2-weighted brain MRI images relate to dementia and stroke outcomes across distinct populations. We aimed this study to evaluate the association of T2-weighted brain artery luminal diameters with dementia and stroke in three distinct population‑based studies.

Methods: Three longitudinal population-based studies with 8420 adults >40 years old (Northern Manhattan Study [NOMAS] from the United States, and the Rotterdam Study [RS], from the Netherlands, and Three-City, from France) with brain MRI scans obtained between 1999 and 2015. The median follow-up time for clinical events ranged between 7 and …

Education For Primary Care Providers On Advance Care Planning: A Systematic Literature Review, Lindsey Ward

DNP Qualifying Manuscripts

Background: Healthcare providers in primary care treat patients at various stages of life. As patients age, it becomes necessary for providers to support their older patients throughout the aging process and address patient care even into life’s end stages. Primary care providers (PCPs) are well-positioned to provide this support and can do so through incorporating end-of-life (EOL) conversations in practice. Such discussions are called advance care planning (ACP). Though PCPs can play a crucial role in their patients’ EOL care decisions, providers report their limited knowledge of ACP as a barrier to its application.Consequently, further education for providers on utilizing …

Is Public Debt Environmentally Friendly? The Role Of Eu Fiscal Rules On Environmental Quality: An Empirical Assessment, Giovanni Carnazza, Thomas Renström, Luca Spataro

Fondazione Eni Enrico Mattei Working Papers

The EU has embarked on multiple initiatives reflecting its commitment to environmental enhancement and sustainable transitions. Notable among these are the European Green Deal and the NextGenerationEU recovery plan, both pivotal in fostering eco-friendly policies and sustainable practices within the region. Conversely, the fiscal rules within the EU, designed to manage budgetary deficits and debt-to-GDP ratios, may pose challenges to the implementation of fiscal measures targeted at achieving environmental quality objectives. These regulatory constraints potentially curtail the fiscal space available for policies aligned with the environmental goals set forth by the EU. To address this issue, using a panel of …