Soil testing and formulated fertilization technology can effectively solve the problem of the excessive and inefficient use of chemical fertilizers. Previous studies have found that the use of the Internet can increase the adoption of soil testing and formulated fertilization technology among farmers. However, they do not distinguish between the effects of the different uses of the Internet (with or without productive use) on the adoption of soil testing and formulated fertilization technology. This study investigates the Internet use of 5341 professional farmers in rural China in 2019, finding that 18.97% of them still use the Internet for only communication and entertainment and do not use any agricultural productive services on the Internet. The adoption rate of soil testing and fertilization technology among these farmers is only 23.77%, which is approximately 10 percentage points lower than that of farmers who use the Internet for productive purposes. The double robust model shows that the probability of the adoption of soil testing and formulated fertilization technology by farmers with productive use of the Internet increases by six percentage points, which is both statistically and economically significant. In the future, China should train more farmers to use the Internet for productive purposes; this will help more farmers, particularly those with low skills and low educational attainment, to use the Internet and play a positive role in promoting the Internet for green agricultural production techniques. Furthermore, the fertilizer utilization rate with the three major food crops, rice, maize, and wheat, was only 39.2% in 2019 [Agricultural green transformation and sustainable development are important elements of the UN Sustainable Development Goals and the transformation of agri-food systems. Fertilizer use is an important indicator of green agricultural development. China is the largest fertilizer user worldwide . Fertili in 2019 , one of Soil testing and formulated fertilization technology comprise environmentally friendly technologies promoted by the United Nations and supported by the Chinese government through financial subsidies since 2005. Soil and field fertilizer testing can effectively avoid excessive inputs of nitrogen, phosphorus, potassium, and other elements by formulating fertilizers according to crop categories and soil conditions. Through soil testing and formulated fertilization technology, the utilization rates of nitrogen, phosphorus, and potassium fertilizers for the three major food crops in China were 33%, 24%, and 42% in 2015, which are increases of 5, 12, and 10 percentage points, respectively, compared to the pre-project period in 2005 [Farmers are the main operating entities of agricultural production and operation, and many scholars have conducted rich discussions on the behavior and influencing factors of the adoption of soil testing and formulated fertilization technology  by farmers. The factors influencing the adoption of green production technologies are three categories: One is the individual characteristics of farmers, such as gender, age , educatiSome scholars have found that Internet use has increased fertilizer expenditures  and the This study examines the impact of different uses of the Internet on the adoption of soil testing and formulated fertilization technology by Chinese farmers. This study divides Internet use into two categories according to the presence or absence of productive agricultural use. By using data from 5341 professional farmers in China in 2019, we find that the adoption rate of soil testing and formulated fertilization technology in the total sample of farmers is 33.36%. However, farmers with productive Internet use have an approximately 10-percentage point higher adoption rate than those without productive use. Results from double robust models show that productive use of the Internet can lead to at least a 5.92 percentage point increase in the adoption of soil testing and formulated fertilization, which is both statistically and economically significant.The contributions of this study are two-fold: First, it differentiates Internet use and examines the different effects of the different uses on the adoption of soil testing and formulated fertilization technologies by farmers. Second, the Internet use and adoption of green production technologies among professional Chinese farmers are studied. Professional Chinese farmers are different from small farmers in general because they have specific skills, are engaged in large-scale agricultural production and operation activities, and are more market-oriented . HoweverThe remainder of this paper is organized as follows: The data used in this study were obtained from the 2019 Farmer Quality Development Tracking Survey organized by the Central Agricultural Broadcasting and Television School . In 2019, the number of professional farmers in China reached 16 million, accounting for 8.23% of China′s agricultural labor force. This survey has the largest sample size and was the most representative national survey of professional farmers. In 2018, the survey questionnaire collected information on basic personal and family information, education and training, agricultural production and operation, product sales, and cooperative production of professional farmers. The survey also covers farmers’ use of the Internet through smartphones, computers, or tablets. This survey provides a solid database for studying the impact of different Internet uses by professional farmers on their adoption of green production technologies.The survey was conducted in 30 provinces, cities, and autonomous regions of mainland China (excluding Tibet), with the following sampling principles: Within each province (city and region), all counties were divided into three tiers of high, medium, and low according to the gross domestic product (GDP) per capita ranking of each county, and two counties (or districts) were randomly selected from each tier. Thus, six counties (or districts) were selected in each province. Within each county (or district), all townships were divided into three tiers according to the per capita disposable income of farmers, and two townships were randomly selected in each tier, for a total of six townships. Ten farmers were randomly surveyed in each township.In total, 9227 farmers from 168 counties and districts in 30 provinces of mainland China participated in this survey, of which 6404 were certified as professional farmers by local agricultural departments. Given that this study adopts soil testing and formulated fertilization technology, 664 farmers engaged in only animal husbandry were excluded. After excluding those with missing variables, the final sample included in the analysis was 5341 professional farmers who had obtained a professional farmer certificate and were engaged in planting or combined planting and animal husbandry.To estimate the effect of different Internet uses on the adoption of soil testing and formulated fertilization technology by farmers, the following model was constructed:iy is a dummy variable that indicates if the i respondent used soil testing and formulated fertilization technology . Considering that the dependent variable was a dummy variable, the econometric regression models used in this study are Logit, Probit, and linear probability (LPM) models.In Equation (1), the dependent variable iproduction_use is a dummy variable that indicates if there is productive use of the Internet by individuals . iX is a control variable that mainly includes the individual characteristics of respondents, i.e., gender, age, the square of age, education level, whether they are technically skilled or not , if they have participated in agricultural training, and if they are village cadres. Furthermore, it includes household characteristics, such as the type of household entry road, number of household members, and number of household agricultural laborers. Furthermore, it includes agricultural production and operation characteristics, such as the total area of land operation, type of production and operation, main crops, whether they are family farms or not, if they participate in farmers′ cooperatives, and if they have cooperation with agricultural companies. Additionally, this study controlled for province-fixed effects.The core independent variable The group of farmers with productive Internet use may be selective, perhaps with specific characteristics that influence both the productive service functions of the Internet used by farmers and their adoption of soil testing and formulated fertilization technology. However, it is difficult to observe and measure these characteristics. Therefore, estimations using Logit, Probit, or LPM regression models may suffer from endogeneity problems owing to sample selectivity bias. In this study, the endogeneity problem was addressed using inverse probability weighted regression adjustment (IPWRA) and augmented inverse probability weighted (AIPW) treatment effect models. The sample of professional farmers with productive Internet use was considered the treatment group, and the sample of professional farmers without productive use was considered the control group. The selection model and outcome model are constructed as follows:iZ in the Internet use equation denotes the variables that may influence individual productive Internet use; β1 is its estimated coefficient. iW in the green technology adoption equation denotes the variables that may influence the individual adoption of soil testing and formulated fertilization technology; δ1 is its estimated coefficient.Equation (2) is the selection model (or Internet use equation), which is used to estimate the probability of productive Internet use by individuals, and Equation (3) is the outcome model (or the soil testing and formulated fertilization technology adoption equation), which is used to estimate if an individual adopts soil testing technology. The selection model can be estimated by the Logit model. The outcome model can be estimated by Logit, Probit, or LPM models. As suggested in the literature ,37,38,39In the IPWRA model, the first step is to estimate the Internet use equation and calculate the inverse probability weights. The second step is to use the inverse probability weights calculated in the first step to estimate the adoption equation for soil testing and formulated fertilization technology and calculate the predicted irrigation rate of the individual adoption of soil testing technology. The third step is to calculate the mean probability of the adoption of soil testing and formulated fertilization technology for different treatment groups (productive Internet use group and no productive use group). The first step in the AIPW model is the same as that in the IPWAR model; in the second step, the adoption equation is estimated without using the inverse probability weights calculated in the first step. In the third step, the adoption equation is estimated using the inverse probability weights calculated in the first step. Further, the inverse probability weights calculated in the first step are used to weigh the estimated predicted probabilities of adoption of soil testing and formulated fertilization technology for different treatment groups (productive use of the Internet and unproductive use). Furthermore, the difference between the mean of predicted probabilities of the two groups is the effect of the productive use of the Internet on the adoption of soil testing and formulated fertilization technology .For the selection model, two instrument variables (IV) were used, including the mean value of the productive agricultural use of the Internet by farmers in the respondent′s district and county and if the household has broadband access. These two variables affect Internet use directly, but do not affect the adoption of soil testing and formulated fertilization technology. All the control variables used in the selection model are the same as those in Equation (1). All the control variables used in the outcome model are also the same as those in Equation (1).This study determined if farmers use soil testing and formulated fertilization technology, measured by “1 = yes, 0 = no”. We understand that there are some farmers who did not carry out the formula for soil testing. There are also some farmers who carry out the formula for soil testing but do not apply fertilizer according to the results. In this paper, we define those who both carry out the formula for soil testing and apply fertilizer according to the results as “the adoption of soil testing and formulated fertilization technology”. In the total sample, only 31.54% of professional farmers used soil testing and formulated fertilization technology, indicating that the proportion of professional farmers using soil testing and formulation is still relatively low.The core explanatory variable in this study was the different uses of the Internet, which were divided into two categories based on whether or not farmers use the Internet for information service functions that contribute to agricultural production and operation. The first category was unproductive use, and the second category was productive use. The unproductive uses mainly include the communication functions of the Internet  and the leisure and entertainment functions . The productive uses (related to agriculture) include learning functions , information acquisition (obtaining product market information), and e-commerce . If a farmer does not use any of the productive agricultural functions and uses only the communication and entertainment functions, it is classified in the first category; if the farmer uses any of the productive agricultural functions, it is classified in the second category.According to existing literature, farmers′ characteristics, family characteristics, and production and business characteristics are important factors that determine if farmers adopt green production technologies. Based on data availability, the influencing factors that affect the adoption of green technologies in agriculture by farmers were selected as control variables. They included personal characteristics  ,9 and hoConsidering the different uses of the Internet, only 23.4% of farmers without productive use used soil testing technology, while 33.36% of farmers with productive use used soil testing technology, which was 9.96 percentage points higher than the former. The descriptive statistics showed that there was a significant difference between the two, and econometric models will be used later to control for other possible variables to see if a significant difference still exists between the two.Furthermore, there were significant differences in some control variables between the two categories of farmers with and without productive Internet use . For exaWhether farmers adopted soil testing and formulated fertilization technology was a dummy variable; thus, the Logit model  to watch and learn green production technologies. Furthermore, peers get to know and communicate with each other, expanding social capital through “Internet capital” and forming a heterogeneous social network that is different from the surrounding environment and embedded in social relationship networks. The interaction, demonstration, driving, and following between farmers online and offline reduces the uncertainty of green production technology adoption and increases the willingness and behavior of green production technology adoption.Third, farmers using the Internet to engage in e-commerce have relatively few sales transaction links, low transaction costs, increasing economic returns, and increasing willingness to make productive investments. The Internet market is significantly competitive, with complete information and transparent prices, which promotes the “high quality with high price” of green agricultural products, thereby increasing farmers′ willingness and behavior to invest in green and high-quality agricultural products and production technologies. In the survey sample, 80.12% of farmers who productively use the Internet think that the quality of agricultural products is important, which is 9.56 percentage points higher than the percentage of farmers who do not productively use the Internet. It can be shown that farmers who productively use the Internet were more willing to demand green agricultural products and green production technology. Farmers with productive Internet use can directly use the Internet to obtain product market information and services, including market services for soil testing and formulated fertilization technology.Soil testing and formulated fertilization technology are green production technologies in agriculture that effectively addresses the problem of the excessive and inefficient use of chemical fertilizers. Many studies have found that the use of the Internet positively influences the adoption of soil testing and formulated technology; however, they have not distinguished between the different impacts of the different uses of the Internet on the adoption of soil testing and formulated technology. By using data of 5341 professional farmers in China in 2019, we found that 19.48% of professional farmers in China still use the Internet only for communication and entertainment functions and do not use any productive agricultural service functions of the Internet, such as acquiring knowledge and technology online, searching for product market information, and engaging in agricultural e-commerce. The percentage of farmers adopting soil testing and formulated fertilization technology is 33.36% among farmers who productively use the Internet, which is 9.96 percentage points higher than the percentage of farmers who do not productively use it. The regression results obtained using Logit, Probit, LPM, IPWRA, and AIPW models are stable and consistent. The double robust model shows that the probability of adopting soil testing and formulated fertilization technology among farmers with the productive use of the Internet increased by nearly six percentage points, an 18% increase in the probability of adoption of soil testing and formulated fertilization technology. The result indicates that the productive use of the Internet can increase the adoption of soil testing and formulated fertilization technology both statistically and economically.The Internet is a skill-biased technical change that requires users to have specific skills. Since Chinese farmers generally have low educational attainment, their use of the Internet is still lacking. In the future, even if the Internet becomes widespread among Chinese farmers, not all farmers know “how to use” the Internet. The “information divide” created by Internet use is more pronounced, not only for the adoption of green agricultural production technologies but also for economic returns to farmers. China should increase training in Internet use so that more farmers, particularly those with low skills and educational attainment, can learn to use the Internet well. Thus, the Internet can play a positive role in promoting the adoption of green production technologies in agriculture.The shortcoming of this study is that, due to limited data availability, only the impact of the different uses of the Internet (with or without productive use) on farmers′ green production technology adoption was analyzed, and the impact of the frequency and timing of the different uses was not included. We also did not have details about the adoption of soil testing and formulated fertilization technology, which prevents us from analyzing it in-depth. Future studies should address those two data issues.


Our results show a significant, positive relationship between the corporate governance index and stock liquidity, suggesting that well-governed firms have high liquidity. The results show that the Institutional Quality index has a positive moderating impact on the relationship between corporate governance and stock liquidity, suggesting that corporate governance in Pakistan is weak. Our results are robust to a series of endogeneity checks using alternative proxies of stock liquidity.The main aim of this study was to empirically analyze whether Institutional Quality moderates the relationship between corporate governance and stock liquidity through the light of agency and information asymmetry theory. To the best of our knowledge, this is the first finance study. The sample consists of 230 non-financial firms listed on the Pakistan stock exchange during the period of 2009–2019. We used an instrumental variable approach and our new Institutional Quality index composed of world governance indicators and a corporate governance index, developed  The financial assets’ liquidity has been recognized as an essential component of the smooth operation of the capital markets. It supports market contestants to meet sudden financial requirements without any unbearable losses. Liquidity plays an essential role in asset pricing and has recognized the great interest of researchers worldwide. A completely liquid market may immediately turn every quantity of a particular stock in that market into cash and at no expense. To find ways to improve the liquidity of the shares, it can be either regulators or financial analysts to build a significant focus on academic and professional concerns.Regulators contribute to protecting minority investors, apart from the possibility of expropriation, and facilitating their robust business participation that raises liquidity marginally ,b. BiswaThe company governance notion has been established in numerous ways. Given this claim, there is less empirical evidence of the correlation between interior quality corporate governance and stock liquidity for emerging economies like Pakistan. The quality of corporate governance enhances stock liquidity in the United States . HoweverThis study uses a sample of 230 non-financial firms listed on the Pakistan Stock Exchange (PSX) during the period of 2009–2019. To the best of our knowledge, this is the first finance study to investigate the moderating effect of Institutional Quality on the relationship between corporate governance and stock liquidity. This is also the first study to analyze the relationship between corporate governance and stock liquidity in Pakistan and to establish new Institutional Quality and corporate governance indexes (CGI) using principal component analysis (PCA).Our study contributes to the literature of Institutional Quality, corporate governance, and stock liquidity in several ways; specifically, this study complements the previous literature of corporate governance and stock liquidity from Malaysia , China , ThailanFirstly Pakistan has highly concentrated firm ownership, with most families holding firms. Most corporate boards are merely “rubber stamps,” with the family owning the bulk of the shares. Pakistani firms rely primarily on bank loans for financing. The public capital market has a passive role in financing as compared to developed markets. As Pakistani firms depend much more on capital market financing than firms in developed countries, stock liquidity plays a different role in Pakistan. Furthermore, its capital market does not efficiently communicate information but instead has weak corporate governance, which results in information asymmetry and agency problems. Therefore, the Pakistan market is significantly less liquid than the United States market and other developed markets.Second, to the best of our knowledge, this is the first study to analyze the moderating role of Institutional Quality on the relationship between corporate governance and stock liquidity. Our study contributes to the literature by showing how Institutional Quality can moderate this relationship by following the resources complementary phenomenon. Third, our study contributes to the literature by using the PCA for both CGI and Institutional Quality index, which has never been covered before in any study, and the advantages of PCA are explained in the analysis section of the study.via PCA. We found evidence that Institutional Quality positively moderates the relationship between corporate governance and stock liquidity, suggesting that corporate governance is weak, and by following the resource complementary phenomenon, Institutional Quality positively moderates the relationship between corporate governance and stock liquidity. Our results show a significant and positive relationship between corporate governance and stock liquidity, suggesting that well-governed firms have high liquidity. Our results are robust to a series of endogeneity checks using alternative proxies for stock liquidity.We have used an instrumental variable (IV) approach and established corporate governance and Institutional Quality indexes The remaining paper is structured as follows. The Various studies on liquidity have been conducted globally, and various opinions have been documented. The study by The relationship between liquidity and information asymmetry was examined for unexpected disclosure occasions of Australian mining firms . The autCorporate governance value has increased in firms because of the division of management and ownership rights of modern companies. Shareholders’ interests are contradictory to administrators’ interests. The principal-agent concern is due to the diverse interests of the owners in the company’s management and directional issues. Corporate governance has no specific definition; instead, it is seen from various points of view .Many researchers have examined the importance of institutions’ quality, especially the impacts of the legal and regulatory climate on making operational and economic markets. The legal and regulatory framework concerning the protection of property rights, contract compliance, and accounting control standards has been established as importance for better liquidity.The scope of internal corporate governance quality in assessing stock liquidity is illustrated in classical studies. This throws doubt upon the generalization of the findings to other countries from the United States, in which there are no generally pro-accounting rules and high-frequency liquidity measures. Further studies on corporate governance quality and stock liquidity were conducted in developing countries like Malaysia , China , ThailanStrengthening corporate governance increases the company’s information transparency and eliminates information asymmetry between insiders  or external entities . When less critical asymmetric information, investors are less vulnerable to unfavorable specific risks . TherefoThis theoretical argument is supported by several empirical studies showing that firms with better corporate governance have a better information environment and improved liquidity in stock . Daadaa In developing countries like Pakistan, corporate governance tends to be weaker. For all these reasons, findings based on developed countries cannot be extended to emerging markets. Moreover, evidence is mixed and inconclusive from developed countries, with a range of distinctive features. For example, equity markets are much less developed because most companies rely on bank loans. The equity is much less liquid. Therefore, according to the discussion, we hypothesized thatH1: Corporate governance index and stock liquidity are positively related.According to the established market analytical studies, corporate governance increases liquidity in the financial markets . Ajina eCurrent finance literature moved the focus of the study from corporate-level governance to Institutional Quality indicators of the country . Asongu Institutional theory suggests that institutional features, rules, regulations, and principles in the exterior environment will restrain the arrangement and behavior of the firms . Instituvia PCA composed of six world governance indicators (WGI) as country-level complementary assets that will affect the relationship between corporate governance and stock liquidity.Scholars have noticed the influence of new terms and the combination of prevailing resources with modest compensations . The intBased on H2: Institutional Quality strengthens the positive relationship between corporate governance and stock liquidity.The main aim of this study was to analyze the moderating role of Institutional Quality on the relationship between corporate governance and stock liquidity of 230 non-financial companies listed on the PSX for the period of 2009–2019, approximately 11 years. Financial firms are excluded from this study because they vary from non-financial firms in financial structure .Secondary data are used for empirical analysis as well as financial data predominantly from the business recorder, the PSX database, and the State Bank of Pakistan (SBP) database for the stock prices, share traded or stock price, and market capitalization. Data related to Institutional Quality are collected from the World Bank portal. Institutional Quality is measured by WGI. Corporate governance data are hand collected from 230 non-financial firms listed on the PSX annual reports. The The main motivation of this study is to analyze if the Institutional Quality moderates the relationship between corporate governance and stock liquidity. This topic is not yet addressed in the finance literature to the best of our knowledge. It is essential to understand how corporate strategies affect the microstructure, and if this relationship can be moderated by Institutional Quality, as this can help monitors to design relevant trade regulations and help shareholders and investors to set comprehensive strategies for their stock trading.Studies by First, Institutional Quality is measured by an independent index composed of six WGI. According to the transparency international report 2021, Pakistan’s current corruption index rank is so high and is at 140th position as compared to other developed or developing countries. We are having a lake of political stability that from the day of independence till now, none of the prime ministers has completed his tenure. Recently on 03 March 2022, the president of Pakistan dissolved the national assembly of Pakistan again. Furthermore, Pakistan has the lake of government effectiveness as well as the rule of law. Second, Pakistan has highly concentrated family ownership. The corporate boards of such organizations act as a rubber stamp, and one family holds the bulk of the shares. Such companies are owned by individuals, the state, and international executives, and these stakeholders actively participate in the companies’ affairs and weaken the objectivity and discretion of the board.Third, Pakistani firms rely mostly on loans from banks as a major source of financing; thus, capital market financing plays a more passive role than in developed markets. As Pakistani firms rely much on capital market financing, stock liquidity also plays a different role in Pakistan. Fourth, the public capital market is not developed as in the United States and displays weak financial transparency. This causes information asymmetry and problems of adverse selection, resulting in a significantly less liquid market. More specifically, Pakistan’s financial markets are not sophisticated and have yet to gain the level of information transparency found in the developed markets. Its financial analysts do not provide the same level of information to investors, making it difficult for Pakistani investors to depend on information disclosed directly by firms.An information environment depends on the quality of corporate governance . The impStock liquidity is used as a dependent variable in this study. In the financial field, liquidity is very critical. We have used four stock liquidity measures, i.e., Amihud Illiquidity Estimate, Zero Return Measure, Liquidity Ratio (AMIVEST), and Turnover-Adjusted Zero Daily Volume.“Zero-return measure”  is the number of zero daily return days reported in a year. ZRit is the number of zero-return day in year t for firm i, and TDit is the number of trade days in year t for firm i. A higher value indicates lower stock liquidity.where The certain return on trading in Pakistani rupees  is measured as the total stock return collected on numerous trade days through the financial year. It measures the extent to which the actual stock price varies with the volume of trading, calculated as follows:idt stands for the absolute stock return of firm i for the year t, VOLDidt is the volume of firm i on the d of year t, and Diy is the number of days available for company i on the d of year t. As ILLIQ rises, stock liquidity decreases.where The liquidity ratio (AMIVEST) is calculated as the volume of trading associated with a stock price change unit used in a number of studies . Datar eVOLit and in the year t.where the limit is exchanged and where the average total stock returns are, respectively, for NoZVit is the number of zero-day volumes for the company i in the year t; turnover (T) is the inventory of company i in year t; NoTDt is the total number of days of trading in the year t; and deflators are set at 480,000  composed of WGI, i.e., political stability, rule of law, regulatory quality, control of corruption, government effectiveness, and voice and accountability. By following To test H2, we have used the subsequent model, where SL stands for stock liquidity measured This Amihud is calculated as the ratio of daily absolute stock return to volume in Pakistani rupees averaged over a number of trading days in the financial year. The mean value for Amihud is 0.00153 followed by a SD value of 0.00868. Amihud minimum value is 1.11e−09 to the maximum value of 0.189 for 2009–2019. The mean value of the liquidity ratio (Amivest) is 1.0050 with a SD of 9.99100. Amivest ranges from the minimum value of 0 to the maximum of 4.36300. The moderator of the study is Institutional Quality index, which has a mean value of 1.10e−09 that ranges from a minimum value of −2.747 to a maximum value of 1.521 with a SD of 1.000.We have used PCA to develop a CGI. The main objective of PCA is to decrease the number of variables in uncorrelated mechanisms. There are certain advantages of incorporating PCA, i.e., it enables us to integrate information about the specific set of corporate governance appliances into a solo index . Besidesp-value < 0.001).In via PCA, including 11 governance measures.We have used a two-stage least squares (2SLS) method to address the issue of reverse causality. This approach demands an IV, which is highly correlated with the endogenous variable (CG) but does not have a direct effect on the dependent variable (stock liquidity) . The tabFollowing the studies by via PCA composed of six WGI, i.e., control of corruption, government efficiency, political stability, regulatory quality, the rule of law, and voice and accountability. These variables contribute positively to the Institutional Quality index.The Institutional Quality index is developed p-value < 0.001).Before reporting the index, two concerns have been addressed, as suggested by via PCA including the control of corruption, government efficiency, political stability, regulatory quality, rule of law, voice, and accountability. We also controlled for firm size, leverage, firm age, stock price, volatility, and industry fixed effects. The table shows positive relationship between Amihud and interaction terms of CG_Index and IQ_Index and is significant at 1%, which states that the strong Institutional Quality in a year will boost the relationship between corporate governance and stock liquidity.In And after controlling for industry fixed effects, we found the same results. The third column of the table shows a positive and significant coefficient for LM and interaction term of CG_Index and IQ_Index, which states that the relationship between corporate governance and stock liquidity is positively moderated by the Institutional Quality, and we found the same results for this relationship after controlling the industry fixed effect which is significant at 1%. Our results support the hypothesis of the study that Institutional Quality positively moderates the relationship between corporate governance and stock liquidity.The 2SLS analysis is an alternate way to deal with potential endogeneity. This approach includes IVs that is highly correlated with CGI but not with liquidity. By following The second IV is the interaction term between Indus_CG_Index and IQP_Index. The intuition behind using the interaction term of Indus_CG and IQP_Index as an IV is that the endogenous variable CG is included individually in the basic model as well as in the interaction term. The table shows dependent variables in the second stage that Amihud illiquidity estimate (Amihud) and turn over adjusted zero daily volumes (LM). We have also control for leverage, firm size, firm age, stock price, and volatility.via PCA, including 11 governance measures. The table depicts the IV’s positive significant at 1% and the second variable’s negative significant at 5%, stating that IVs are not weak. The table shows that the interaction term of CG_Index and IQ_Index is positively significant with stock liquidity (Amihud). In the end, For robustness, we used alternative proxies to measure stock liquidity ; these measures are widely used in the literature. These two proxies are commonly used in previous literature. We have used these measures for robustness. Our model is estimated by these measures using 2SLS method, as reported in the table. The coefficients reported in The results are robust to explain the positive moderating role of Institutional Quality on corporate governance and stock liquidity as reported in This study empirically analyzes the moderating effect of Institutional Quality on the relationship between corporate governance and stock liquidity for non-financial firms listed on the PSX. The study uses a sample of 230 non-financial firms listed on the PSX during the time period of 2009–2019 to analyze whether corporate governance practices affect stock liquidity in Pakistan. Whether Institutional Quality moderates the relationship between corporate governance and stock liquidity is still unclear. We provided analytical proof of stock liquidity in the context of information asymmetry and agency theory.via PCA. This study further contributes to the existing literature and policy in different ways. We have tried to fill this void and give a comprehensive picture of stock liquidity in the previous literature. This is the first research for the PSX to shed light on the issue through 230 non-financial companies.To the best of our knowledge, this is the first study in the field of finance to analyze the moderating role of Institutional Quality on the relationship between corporate governance and stock liquidity. This is also the first study to develop a new index for Institutional Quality and corporate governance The emerging market corporate governance structure differs from the established markets in rising economies like Pakistan, where most firms are owned and monitored by family members and managers. Also, between the marginal investors and the administration (the governing family), there is a big agency problem. These companies are normal in their corporate governance quality in a different legal setting, business, and institutional facilities than in developed countries. This study is therefore an attempt to overcome this void. The results of the study show how Institutional Quality moderates the relationship between corporate governance and stock liquidity and at which point it influences Pakistani stock markets and contributes significantly to Pakistani stock market literature.The findings of the study suggest a highly significant, positive moderating role of Institutional Quality in the relationship between corporate governance and stock liquidity. It means that an increase in the country’s government efficiency, political stability, control of corruption, and rule of law will boost corporate governance, which will lead to an increase in stock liquidity, as the whole improvement in the Institutional Quality index positively moderates the relationship between corporate governance and stock liquidity, which is in line with hypothesis 2 of the study.via alternative proxies of stock liquidity. Our results are in line with the previous literature on corporate governance and stock liquidity.The findings regarding the impact of corporate governance on stock liquidity in Pakistani firms were found to be highly significant and positive. As Pakistan has weak corporate governance, this research will help the sector to improve governance to enhance stock liquidity. The study observed a positive and significant impact of corporate governance on stock liquidity; the results are consistent with agency and information asymmetry theory. The results are robust The findings of this study can be applied to such emerging economies where the stock market is not developed and has weak corporate governance. This can also be applied to emerging markets where ownership is highly concentrated and mostly family ownership like Pakistan. Furthermore, the results of this study can also be applicable to such emerging countries lakes political stability, high corruption index and the lake rule of law. The results of this study have significant implications. The findings of this study will help regulators to formulate policy protocols that enhance stock liquidity. Additionally, this finding might help traders and investors plan their trading approaches by considering the corporate governance mechanisms of this research closely. These results also have administrative implications, as listed firms may adopt the best Institutional Quality to enhance stock liquidity that improves information asymmetry between share traders.The long time period will permit the study to explain major events like financial crises and the introduction of the first corporate governance code. This study analyzes data from only one developing country. However, considering cultural and legal distinctions in a story, the results can be applied to other developing economies. This study can also be performed on an international sample using data from multiple countries to analyze the impact of individual corporate governance channels on stock liquidity. Future research could study the impact of shareholder protection and disclosure quality on stock liquidity. The findings of this study encourage the proposal that corporations, managers, and investors be harsher in the supervision of corporate governance structures, with the aim of enlisting trade laws and developing the corporate atmosphere and trading system. In addition, the study focuses on the fundamental role of audit committee independence in market liquidity. It is critical to evaluate the value of this variable by precisely recognizing the independent non-executive board directors in the Corporate Governance Code, and the regulators pay specific attention to this information.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.SA presented the idea and analysis and wrote the manuscript. WZ and GF supervised and reviewed the article. ZA helped sort out data, helped in methodology, and reviewed the article. MC helped in write-up. All authors contributed to the article and approved the submitted version.


In clinical practice and science, there is debate for which older adults the benefits of cardiovascular preventive medications (CPM) still outweigh the risks in older age. Therefore, we aimed to assess how various clinical characteristics influence the judgement of appropriateness of CPM in older adults.We assessed the appropriateness of CPM for adults ≥75 years with regard to clinical characteristics  using the RAND/ University of California at Los Angeles Appropriateness Method. A multidisciplinary panel, including 11 medical professionals and 3 older representatives of the target population, received an up-to-date overview of the literature. Using 9-point Likert scales , they assessed the appropriateness of starting and stopping cholesterol lowering medication, antihypertensives and platelet aggregation inhibitors, for various theoretical clinical scenarios. There were two rating rounds, with one face-to-face discussion in between. The overall appropriateness judgments were based on the median panel ratings of the second round and level of disagreement.The panelists emphasized the importance of the individual context of the patient for appropriateness of CPM. They judged that in general, a history of atherosclerotic cardiovascular disease strongly adds to the appropriateness of CPM, while increasing complexity of health problems, presence of hindering or severe side effects, and life expectancy < 1 year all contribute to the inappropriateness of CPM. Age had only minor influence on the appropriateness judgments. The appropriateness judgments were different for the three types of CPM. The literature, time-to-benefit, remaining life expectancy, number needed to treat, and quality of life, were major themes in the panel discussions. The considerations to stop CPM were different from the considerations not to start CPM.Next to the patients’ individual context, which was considered decisive in the final decision to start or stop CPM, there were general trends of how clinical characteristics influenced the appropriateness, according to the multidisciplinary panel. The decision to stop, and not start CPM, appeared to be two distinct concepts. Results of this study may be used in efforts to support clinical decision making about CPM in older adults.The online version contains supplementary material available at 10.1186/s12877-022-03082-8. World-wide, millions of older adults use cardiovascular preventive medication (CPM) to reduce their high risk of morbidity and mortality from atherosclerotic cardiovascular diseases (ASCVD). Numerous randomized controlled trials –4 have sChanges in physiology and clinical presentation due to ageing, may alter the balance between risks and benefits of CPM. Some changes, such as age- or disease related decline of organ functions, the co-existence of multiple morbidities, and polypharmacy increase the risk of medication related harms and burden –7. MoreoPeople of a very high age, with complex health problems, polypharmacy or with a short life expectancy are generally not well represented in randomized controlled trials , 12. ThiWe aimed to assess how various clinical characteristics, especially cardiovascular variables, age, life expectancy, complexity of health problems and medication related hindering side effects, influence the appropriateness of CPM in older adults.We used the RAND/ University of California at Los Angeles Appropriateness Method (RAM). The RAM is a validated scientific method which integrates scientific evidence with the collective judgment of experts. After a preparatory phase, the panelists assessed the appropriateness of clinical scenarios individually at home. Thereafter a face-to-face panel discussion supervised by an independent chairman was organized followed by a second individual rating round . See FigWe provided all panelists with an extensive information package, including an overview of recent literature , and no conflicts of interest. The panel included 1 cardiologist, 1 clinical geriatrician, 3 general practitioners, 2 elderly care physicians, 1 internal medicine specialist, 1 neurologist, 1 medical ethics expert, 1 pharmacist and 3 older representatives of the target population (recruited from the Older Persons Advisory Board ‘Care and Wellbeing’ South-Holland North) . The totn = 450 in total) the panelist rated the appropriateness of starting and stopping cholesterol lowering medication, antihypertensives and PAI on 1 to 9-point Likert scales . They were instructed to weigh the evidence and to use their expert opinion for the assessment of the appropriateness of starting or stopping CPM.Six weeks before the panel meeting the information package and rating sheets for round one were sent to the panelists. For each clinical scenario (At the beginning of the panel meeting June 2019) the results of the first round were reported back to the panelists on personalized forms, including his or her first-round rating, the panel median, and a frequency distribution. The individual ratings were blinded to the other panelists. The appropriateness judgments were based on the median panel rating and level of disagreement, using the following definitions: those with a median rating of 1 to 3, were classified as inappropriate, all scenarios with a median rating of 7 to 9, were classified as appropriate, the median rating of 3.5 to 6.5, were classified as uncertain. Disagreement was defined as: ‘for the same clinical scenarios, at least four panelists rated in the 1 to 3 range, and at least four panelists rated in the 7 to 9 range’. Results of round one merely serviced as discussion starters and were not part of the final appropriateness judgments of round two  the resu.The meeting started with a clarifying session in which the panelists discussed definitions. After the clarifying session the panelists discussed the appropriateness of starting and stopping of each CPM in context of the clinical scenarios. The panelists were invited by the chairman to share their arguments and perspectives, and were free to bring in additional literature. At the end of each discussion, they rerated the clinical scenarios (rating round two). Based on the outcomes of the first round, 24 extra clinical scenarios were added for the second round to evaluate the appropriateness of starting antihypertensive medication when SBP = 180 mmHg more in-depth, resulting in 474 clinical scenarios in total.The entire discussion was audiotaped, and two researchers  made field notes. A report was written, and sent to the panelists for their comments.The final appropriateness judgements for each scenario were based on the median panel rating and level of disagreement in the second round.We combined the appropriateness judgments for starting and stopping for each corresponding clinical scenario. Figure One panelist missed the deadline for completing the ratings of round one, and one panelist had to leave early in round two. The rating sheets of the other panelists were 100% complete.Outcomes of the appropriate judgements about starting and stopping CPM did not differ a lot between the two rounds. It appeared that after the panel discussion, the uncertainty was slightly decreased resulting in a slightly increased amount of ‘inappropriate’ judgements. The amount of scenarios which were assessed as ‘appropriate’ was almost the same in both rounds.We summarized the main results into three figures Figs. , 4 and 5During the clarifying session it was discussed that in clinical practice the decision on starting or stopping CPM is based on two elements: the scientific evidence (population level) and the individual clinical context of a patient . The panelists agreed to focus the discussions and ratings on the level of scientific evidence as much as possible. However, they emphasized that in practice, the individual context of the patient is leading. Therefore, the panelists noted that the individual context of a patient may alter the appropriateness of starting or stopping, in a way that the final clinical decision may be different than the panels’ judgement.There was a general trend that, with increasing complexity of health problems, the combined appropriateness judgments for CPM tended to shift from appropriate to start and inappropriate to stop, through uncertain to start and uncertain to stop, towards inappropriate to start and appropriate to stop Fig. . AlthougThe panelists reasoned that with increasing age, and accumulating health problems, older adults increasingly deviate from the average trial participant. Therefore, they especially questioned the generalizability of trials results for older adults with complex health problems. Regarding antihypertensives it was mentioned, that in general, for older adults the risk to develop side effects is higher, and this risk is often related to treatment intensity. Also, side effects are more likely to be more severe in older adults, especially when they are less healthy. This resulted in a trend to consider strict blood pressure regulation less appropriate with increase of complexity of health problems and age Figs. , 4 and 5Another argument was that time to benefit can conflict with remaining life expectancy. The panelists reasoned that complex health problems are related with shortened life expectancy, and they considered the time-to-benefit of cholesterol lowering medication relatively long. As results the panelists judged that for older adults with complex health problems, it was inappropriate to start, and uncertain or appropriate to stop cholesterol lowering medication Fig. . In contThe panelists argued that in old age, and in presence of complex health problems, a previous ASCVD event remains a strong risk factor for future ASCVD events. They expected most benefit for those with a history of ASCVD and noted that the number needed to treat is lower after an ASCVD event. This led the panelists to judge that for most clinical scenarios with ASCVD it was appropriate or uncertain to start, and inappropriate to stop CPM Fig. . RegardiSevere or hindering side effects and a life expectancy < 1 year, were both strong reasons to shift the judgement of CPM towards inappropriate to start/ appropriate to stop Figs.  and 5. TThe panelists concluded that the decision not to start medication is different from the decision to stop medication. They were generally more reluctant and uncertain about stopping compared to ‘not starting’. It was reasoned that for an 85 year old individual, evidence to newly start CPM is rather weak. However, if this person already has been using CPM since the age of 70, they were reluctant to stop because evidence for starting medication in the past was strong, and he endured it for 15 years already. Besides, high quality evidence about the safety of stopping is scarce, and stopping could be harmful. It was also mentioned that at the start of treatment it is unknown who will develop side effects, while for current users (in most cases) it is. An older representative mentioned that getting the advice to stop one’s medication can be perceived as ‘you have been given up’, and added that taking preventive medication can provide a sense of security. At the same time physicians expressed their reservations to ‘take away’ patients’ medication, and because of anticipated regrets if an ASCVD-event should occur following an advice to stop CPM.For some clinical scenarios it was judged that it was appropriate not to change  in different clinical scenarios.In addition to the panelists’ notion that the individual context is very important in the final decision to start or stop CPM, there were general trends in the appropriateness judgments. According to the panelists, history of ASCVD strongly added to the appropriateness of CPM, while increasing complexity of health problems, presence of hindering or severe side effects, and life expectancy < 1 year all contributed to the inappropriateness of CPM. Age had only minor influence on the appropriateness. The extent to which these factors influenced the appropriateness ratings depended on the type of CPM. In addition, the panelists discussed that there are different considerations when deciding not to start or to stop CPM, and sometimes it is appropriate not to change.When we compare the appropriateness judgments in this study with several influential international ASCVD prevention guidelines (hereafter ‘guidelines’), we noticed several differences –30. FirsBy using the RAM-procedure, we combined scientific evidence, clinical experience and client perspectives, to address a complex clinical dilemma. A strength of this study is that the results are not limited to the appropriateness judgments, but also contain arguments and considerations that add nuance to the debate. Another strength of this study is that it was innovative to include older representatives of the target population next to medical professionals in a multidisciplinary panel. Herewith the panel reflected the variety of specialties and older people involved in decisions on treatment.It could be seen as a limitation that the older representatives did not cover the full diversity of the target population, and that we only invited Dutch experts. To maximize the generalisability, we selected experts from throughout the Netherlands, of various ages, clinical disciplines and expertise, and instructed them to focus on the literature instead of the individual context. Moreover, compared to other countries, Dutch doctors may be more reluctant to prescribe CPM to older adults with complex health problems. Results from case-vignette studies showed considerable cross-country variation in general practitioners’ advice on cholesterol lowering and antihypertensive treatment of (frail) older adults , 21. It The result of this RAM is a weighing of the scientific literature by experts which will contribute to evidence-based treatment decisions regarding CPM in older adults. In the communication with patients this knowledge will be discussed and combined with the individual context of a patient. Our results could direct guideline committees, and may be used to develop decision tools. We recommend that in efforts to improve the decision making about CPM, questions about complexity of health problems, ASCVD history, side effects, remaining life expectancy, and quality of life, are explicitly discussed in the decision-making process.For future research, we revealed two interesting topics. First, we noticed that the current focus of deprescribing research is on barriers and enablers of stopping medication. However, studies on the decision not to start medication are needed. Second, the finding that for older adults it may sometimes be preferred not to change medication (not to start or to stop) to maintain the sense of internal balance, should be further investigated.According to the multidisciplinary panel, the patients’ individual context was considered decisive in the final decision to start or stop CPM. In addition, there were general trends of how the clinical characteristics influenced their appropriateness judgments. The scientific literature, quality of life, time-to-benefit, number needed to treat, and remaining life expectancy were major themes in the panel’s argumentation. The decision to stop, and not start CPM, appeared to be two distinct concepts. Results of this study may be used in efforts to support clinical decision making about CPM in older adults.Additional file 1. Full search strategy and references for the information package. This file includes the elements of the literature search strategy that was performed to provide the panelist with an overview of the latest relevant literature, and the resulting list of references that were included in the information package.Additional file 2. Construction of the rating sheets: detailed information. This file includes a detailed description of how the rating sheets were constructed, and an example of a rating sheet.Additional file 3. Additional considerations mentioned in the discussions. This text file contains additional considerations that were discussed regarding the appropriateness of platelet aggregation inhibitors and cholesterol lowering medication in older adults.Additional file 4. Appropriateness scores of starting and stopping cardiovascular preventive medication. This file includes twelve tables (3.1–3.12) that display the appropriateness scores (panel medians) of rating round 2.


Polypharmacy is associated with a risk of negative health outcomes. Potentially inappropriate medications, interactions resulting from contradicting medical guidelines, and inappropriate monitoring, all increase the risk. This process evaluation (PE) of the AdAM study investigates implementation and use of a computerized decision-support system (CDSS). The CDSS analyzes medication appropriateness by including claims data, and hence provides general practitioners (GPs) with full access to patients’ medical treatments. We based our PE on pseudonymized logbook entries into the CDSS and used the four dimensions of the Medical Research Council PE framework. Reach, which examines the extent to which the intended study population was included, and Dose, Fidelity, and Tailoring, which examine how the software was actually used by GPs. The PE was explorative and descriptive. Study participants were representative of the target population, except for patients receiving a high level of nursing care, as they were treated less frequently. GPs identified and corrected inappropriate prescriptions flagged by the CDSS. The frequency and intensity of interventions documented in the form of logbook entries lagged behind expectations, raising questions about implementation barriers to the intervention and the limitations of the PE. Impossibility to connect the CDSS to GPs’ electronic medical records (EMR) of GPs due to technical conditions in the German healthcare system may have hindered the implementation of the intervention. Data logged in the CDSS may underestimate medication changes in patients, as documentation was voluntary and already included in EMR. Life expectancy around the world has risen as a result of improvements in the diagnosis and treatment of chronic and acute diseases, and better living conditions and hygiene . Longer The use of computerized decision-support systems (CDSS) to prevent or manage problematic polypharmacy has been evaluated in previous studies, and been shown to improve prescribing quality and reduce the prescription of potentially inappropriate medication ,12. HoweTo circumvent these problems in the AdAM study, a process evaluation based on data logged by a CDSS named “eMMa” (a detailed explanation of the functioning can be found in the Methods section) was carried out with the aim of gaining an insight into how and why the AdAM intervention works the way it does. The study protocol has been published elsewhere a priori . This pan = 351, 34%) and practices , if they agreed to participate in the trial  showed up in the software . The remaining 33,451 patients (78%) did not enroll in the study and made up the non-enrolled potentials (NEP), along with their respective GPs . The alerts were stratified by category. On a GP level, no participant fulfilled the Fidelity criteria in any given category for all their patients.The “Fidelity” intervention dimension evaluates how frequently the intervention was implemented in such a way that it was actually possible to achieve the aim of the intervention. As in the case of the Dose dimension findings, duplicate prescriptions and allergies received little attention in comparison to the other categories.As far as the more highly prioritized categories are concerned, the GPs acknowledged and dealt with all the severe alerts in fewer than 30% of patients, indicating that the intervention goal was only moderately fulfilled.Summarizing over all categories, severe alerts were only fully resolved or justified in 889 patients. 0 was triggered for patients, i.e., when the first GP assessment appeared in the software. In The “Tailoring” intervention dimension describes how participating GPs handled the intervention, and gives an indication how the intervention could be adapted to fit better into daily routines. These analyses show when GPs preferred or had the chance to conduct medication reviews. The vast majority of cases (89%) were initiated between Monday and Friday, with peaks on Tuesdays and Thursdays. Only a small portion (11%) were initiated on Saturdays, Sundays, and public holidays, when practices are usually closed. In terms of months, the CDSS was used more often in the second half of the year, and especially in September and December. This pattern remains similar when the whole intervention period is examined, except for 2020, when the rise in patient cases was dampened by the COVID-19 pandemic.Since the intervention software was in a test phase and on several occasions had to be updated, we initially planned to conduct sensitivity analyses to account for major software releases and lengthy software inaccessibility due to technical problems. However, as no error logbook was available, these analyses could not be conducted.Our process evaluation showed no relevant selection bias on either a patient, GP, or practice level in the participants included in the AdAM trial, compared to the eligible population in the study region (Intervention Reach). The reduction in the number of alerts was minimal (Intervention Dose) and all severe alerts were dealt with in only a modest number of participating patients, which was the final measure of a successful intervention (Intervention Fidelity). An analysis showed that the CDSS was most frequently used on days with long practice hours (Intervention Tailoring).The inclusion criteria for our study were broad and the patient group correspondingly heterogeneous. Unlike other similar studies, the group was not preselected according to medication, disease, or age group ,24. As aExisting research into time-consuming documentation has shown that time efficiency is crucial for GPs, which was an implementation barrier in our study . It is tFurthermore, a recent systematic review found that physicians considered most alerts generated by CDSS to be unhelpful or inappropriate and therefore ignored them , which iDifficulties in making medication changes arise when specialists are involved, as GPs are unwilling to interfere with their colleagues’ decisions , not leaThe fact that the design of the AdAM study included an underlying process evaluation that had been planned and published beforehand, improves the methodological quality of the trial. Furthermore, this process evaluation addresses each step of the CDSS application process and responds to the urgent need for a deeper understanding of CDSS uptake reported in a recently published systematic review . We coulOur analyses also help understand the characteristics of participating GPs, and the kind of patients whose medication reviews they prioritized. Participating patients had a slightly lower average level of nursing care, indicating a barrier to the use of the intervention tools in nursing home patients and for home visits.Overall, the documented changes were rather small, and all severe alerts were removed or justified in only few patients (Intervention Fidelity). However, it was not possible to distinguish between a patient’s medication having been left unchanged, or a change not having been documented in the software. As both the intended intensity of the intervention (Intervention Dose) and the desired intervention goal (Intervention Fidelity) were rarely fulfilled, conclusions about the potential risk reduction attributable to the intervention can only be drawn to a limited extent. Since the CDSS could not be linked with the practice management systems, GPs had to document all changes twice, which time constraints may have prevented, resulting in an underestimation of the use of eMMa.Results in the Intervention Tailoring dimension showed that in the beginning of the intervention period, when updates and technical difficulties frequently occurred, the enrollment of patients in eMMa was low. GPs that were involved in the early stages of the intervention may have given up on the software after encountering technical problems early on. Furthermore, only few patients enrolled in the early months of each year, which coincided with the flu season. To the best of our knowledge, little research has been conducted into the impact of seasonal fluctuations on implementing a real-world study, so further analysis of the data gathered in the AdAM study may help in the planning of future interventions in clinical settings. Additionally, the COVID-19 pandemic struck during the intervention period. This unforeseeable event was a major, but certainly not the only disruption to the daily care of patients with polypharmacy that was observed during the course of this intervention, which makes the interpretation of results even more difficult.It is necessary to conduct more in-depth training before beginning such an intervention. An integration of the intervention tool in the practice management system and further measures to increase time efficiency would also facilitate adaptation and implementation for GPs and generate more robust data for scientific analysis. It is necessary to investigate whether the integration of further healthcare professionals, such as specialized physicians and pharmacists, would result in more effective medication reviews, especially in complex cases.Anwendung für ein digital gestütztes Arzneimitteltherapie- und Versorgungsmanagement”, or “application of digitally supported drug-therapy and care management”) is described in detail elsewhere [The approach of the AdAM intervention  and type of potential inappropriateness. The alerts that could be seen by GPs and that were analyzed in this study are displayed in The process evaluation is based on consensus recommendations in accordance with MRC guidance and the MRC process evaluation framework  and asseThe GP confirmed in the software that an anamnesis had been completed (referred to as “completed anamnesis”).The software was used to print a medication plan.At least five medications were entered into the software.All patients to whom one of the following criteria applied, were included in the analysis of data extracted from the AdAM software:0. If this was never the case, criterion 2 and, if necessary, criterion 3 were treated analogously. Duplicates, i.e., patients whose pseudonym was included twice, were excluded after verification. In addition, patients were excluded if their GP only participated in the piloting test phase or had ceased to participate in the study before randomization . Patients that enrolled in eMMa after completion of the project were also excluded.The inclusion criteria were prioritized in descending order: The first day on which criterion 1 was met was defined as TThe Intervention Reach compares participants that fulfil the criteria to those that do not. All potentially eligible participants are therefore included in the analyses for that dimension.(a)Intervention ReachThis dimension deals with the “reach” of the intervention, i.e., whether the selection and inclusion of study participants was carried out as foreseen in the study protocol, and how the study population differed from the defined population in terms of the variables given in Study participants that had enrolled but did not receive the intervention ;Persons that fulfilled the entry criteria for the intention-to-treat population and were on the list of patients provided to participating GPs but did not take part in the intervention .For this purpose, all patients receiving the eMMa intervention  were compared to:Enrolled GPs and practices that cared for at least one IP patient, but no AP patient;Enrolled GPs and practices that cared for at least one NEP patient, but no AP or IP patient.Analogously, all GPs and practices enrolled in the AdAM study that cared for at least one AP patient, irrespective of whether they also treated patients in the IP or NEP groups were compared to:An overview can be found in Pseudonymized data for patient comparisons originated from BARMER’s data warehouse . Comparisons at GP and practice level were carried out using pseudonymized data from the association of statutory healthcare physicians in the study region (KVWL). Group comparisons were carried out using logistic regression and two-sided tests carried out with a significance level of alpha = 5%. Group membership was defined as the dependent variable.(b)Intervention Dose0 is triggered, and automatically two months later (referred to as T1).This dimension applies to the AP group only and assesses the extent of reductions in alerts in patients that received the AdAM intervention two months after patient data were originally entered into the software. In addition, prioritization associated with the severity and categories of alerts were also analyzed . The ale0 and T1, stratified by severity and the category of alerts. In addition, sensitivity analyses were performed that only included unjustified alerts at T1.In this dimension, the main analysis is of the reduction in alerts between T0 was to be triggered in the software by pressing a button, and only then was it possible to deal with alerts. Before release, the software developers decided against making this process compulsory.Further sensitivity analyses only included the population for which GPs had confirmed that the anamnesis of the patient had been completed and that all medication been entered into the software. This was the original plan, whereby T0 and T1 were the predictors. All models were stratified by age and sex.In order to adjust for clustering at a GP level, a multilevel Poisson model was calculated using the pseudonymized GP ID as a random effect. The total number of alerts was the dependent variable in the model, and T(c)Intervention FidelityThis dimension applies only to the AP group and examines the trustworthiness of the intervention, i.e., whether the software was used in such a way that a successful intervention  was possible. Alerts rated at the highest severity level were used to operationalize this dimension, as they were considered strongly indicative of a need for action. Furthermore, the GP had to have completed the anamnesis to show the software was being used as intended.1, they were considered to have been successfully dealt with in terms of Fidelity.As long as all alerts at this level had been resolved or justified at T1. In addition, the analyses were stratified according to alert category.For this dimension, we reported the proportion of patients whose serious warnings were completely resolved at T(d)Intervention TailoringIn contrast to the other dimensions, the focus here was on the individual adjustments GPs made in order to better integrate the intervention into daily practice routines. For this purpose, the temporal dimension of software use was investigated. Consequently, data are only analyzed for the AP group. Specifically, we looked at the number of patients whose data were called up for the first time on particular days of the week or in particular months, and looked for a concentration of such events during certain periods , or seasonal dependencies.There are indications that the CDSS helped participating physicians prescribe fewer high-risk medications by encouraging them to adjust dosages, and to modify prescriptions to take account of renal function impairment. However, the intervention does not appear to have been used intensively, whereby it should be taken into consideration that utilization may have been under-reported in the log data. Overall, the results of the process evaluation indicate that the extent of the implementation of the AdAM intervention was weaker than anticipated.


This paper aims to further solve the risks encountered by college students in the process of employment and entrepreneurship in rural areas and improve the success rate of employment and entrepreneurship. It presents a method of social environment analysis based on college students' rural employment and entrepreneurship. This method deeply understands the employment and entrepreneurship environment of college students, deeply analyzes and identifies the constituent elements of college students' rural employment and entrepreneurship environment, and takes the social environment of college students' rural employment and entrepreneurship as the research object. With the help of questionnaire survey and data analysis, the survey shows that, in the channel selection of job hunting in the future, up to 77.20% choose to apply for a job through job fairs, and 69.60% will use advertising media such as networks and newspapers; 26.50% will apply for jobs through the talent market; 31.30% will apply for a job through relatives and friends; 15.40% will apply for jobs through independent entrepreneurship. This paper constructs the evaluation model of entrepreneurship and employment environment from the perspective of subjectivity and puts forward the optimization strategy of entrepreneurship and employment environment from four fields: policy environment, capital environment, education environment, and cultural environment. Since the beginning of the new century, with China's accession to the World Trade Organization and the deepening of reform and opening up, China's industrial economy has developed very well. At the same time, the industrial scale has been continuously expanded and China's economic structure has been gradually improved. It can be said that the market economy under the socialist system with Chinese characteristics has undergone earth-shaking changes under the trend of stable growth . The empV Bhatt and others found that there are numerous scholars studying the employment of college students in China, and a hundred schools of thought contend . Mert anObschonka and others found that western developed countries have also experienced or are experiencing the social problems of high unemployment rate of college students in the stage of popularization and popularization of higher education. All countries have made a series of fruitful explorations . For exaR-type factor analysis and Q-type factor analysis. In this paper, R-type analysis is selected as the main analysis method. Its mathematical model is as follows:Factor analysis is one of the commonly used dimensionality reduction analysis methods in multivariate statistics. It describes the relationship between index variables by constructing some unobservable random variables, to achieve the purpose of dimensionality reduction, simplification, and comprehensive evaluation. There are two types of analysis: And the previously mentioned formula meetsF and ε are irrelevant.In the previously mentioned formula, F1…Fm is irrelevant and the variance is 1.That is, formula ε1...εm is irrelevant and the variance is different, of whichThat is, formula p-dimensional random vector composed of P indexes directly obtained through observation.The previously mentioned formula is a aij is called factor load, that is, the load of the i-th variable on the j-th common factor; ε is a special factor of X, and the covariance matrix of ε is a diagonal matrix in theory . 21. 2123]. In the survey, in terms of employment relevance, the proportion of choosing “work in this major,” “work related to this major,” “work has nothing to do with your major,” and “flexible employment” are 7.20%, 53.50%, 23.60%, and 15.70% respectively see . This alThe survey shows that 47.20% of the students think it is most suitable to apply for a job one year before graduation; 38.30%, half a year before graduation; 14.20%, in the first two months. But, at the same time, 0.30% of the students are uncertain see . This shThe survey shows that 77.20% of people choose to apply for jobs through job fairs and 69.60% through advertising media such as Internet and newspapers; 26.50% will apply for jobs through the talent market; 31.30% will apply for a job through relatives and friends; 15.40% will apply for jobs through independent entrepreneurship see .The level of business development is good for education. They are inextricably linked. They limit and encourage each other. First, the growth of higher education is influenced by the level of industry development. The industry, standards, and all scales of higher education define systems, models, and all scales. The supply and demand of higher education depends on the supply and demand of the market. The reaction of the development level of higher education to economic development can not be ignored. Only when the social economy develops rapidly, the total scale and speed expand, and a high-level development state is presented, can the demand for the scale and development speed of higher education expand rapidly . TherefoTo formulate an economic development policy that gives priority to the employment of returning college students, we should first break the urban-rural dual structure and coordinate the urban-rural economic development policy. The overall planning of urban and rural economic policies does not mean that urban and rural areas should implement the same economic development policies to make the policies universal but refers to the establishment of a unified, open, and fair competitive labor market suitable for the requirements of rural industrialization and urbanization based on the existing conditions. Expand the degree of opening up, strengthen investment attraction, develop characteristic economy, people-oriented, and develop a technology intensive economy that needs scientific and technological talents.College graduates should change the traditional concept of employment. Through independent entrepreneurship, they can not only solve their own employment problems but also create more jobs for the society and solve the employment problems of more graduates. Therefore, the government should introduce relevant supporting policies. We can start from the following aspects. First, we should give certain preferential treatment to the economic entities created by college students in terms of taxation. Second, in order to ensure that college students have the start-up funds needed for entrepreneurship, the government should set up a college students' entrepreneurship guarantee fund and provide small loan guarantee for entrepreneurial college students. Moreover, the government should set up a special department to examine and approve college students' entrepreneurship projects, give policy help to college students, answer the relevant difficult problems encountered by college students, reduce the fees of relevant certificates as much as possible, and give more green lights in procedures. Finally, regularly carry out entrepreneurship service training, recommend projects within their ability to unemployed college students according to local conditions, and provide technical support and follow-up training in the later stage to help them solve their difficulties and actively guide college students to start their own businesses.Now that the university has entered the level of interest, the quality of university graduates in the industry is gradually declining. In this environment, colleges and universities should continue to deepen the teaching modification of courses and formulate professional standards to meet the needs of the market in different situations: improving the professional competitiveness of graduates by adapting to the market, improving the curriculum, improving the quality of teaching according to each student's interests, and developing skills that are combined with unique and more talents. On the one hand, pay attention to strengthening the guidance of graduates' employment skills; on the other hand, pay attention to strengthening students' psychological counseling. Ensure that graduates have a good attitude in the process of employment and grasp the coincidence point between employment expectations and social needs.Foreign advanced experience tells us that while colleges and universities strive to improve themselves, they are also inseparable from the support of all sectors of society. First, the government should give priority to the role of colleges and universities in promoting social and economic development, increase investment in colleges and universities, meet the funding needs of colleges and universities for scientific research projects, and improve college education programs. Only when the level of colleges and universities is improved, can they be prompted to provide higher-level educational resources for students and improve the ability of graduates to meet the needs of the labor market. Use sufficient funds to build a comprehensive employment service and build a bridge between graduates and businesspeople. Second, job companies need to build relationships with colleges and universities and allow colleges to develop professional skills that meet their needs, as their needs come from training. Avoid unnecessary friction and waste due to lack of understanding of graduates and the workplace. Not only does this help college students get good grades, but it also avoids the frustration of working in fields where skills are difficult to acquire.College graduates have just left school, and their understanding of society is still in the blank stage. First, they should learn to accumulate their own social capital, start from the simplest, and start from their own side. Everyone lives in a relationship network and has their own social relations, such as relatives and friends, villagers, and classmates. These are the social capital that must be paid attention to and are the most stable social capital. These social capital will be of great help to obtain important information and good opportunities in the future.In addition, we should pay attention to the cultivation of social skills, strengthen exchanges with people from all walks of life, and make all kinds of friends. Everyone is a part of the social network and does not exist independently. In social communication, we can not only cultivate the ability of all aspects but also expand the scope of our influence through social communication. Accordingly, we will increase our own social capital and expand the social relationship network. Due to the complex connections in the relationship network, a relatively stable network structure is formed between individuals. Due to the interaction of various actors in the structure network, social capital such as trust relationship can be generated, and the scope of this relationship network will be larger and larger, and social connections will be wider and wider. Good social capital will be of great help to graduates' employment and future career.Career planning is very important for everyone. It is related to one's lifelong career path and role in society. Career planning should not start with a single interest but also consider the needs of the society and the constraints of the actual situation. Only the career planning that integrates various factors is scientific and conducive to their own development. For a newly enrolled freshman, there are many things to learn during college, but in the long run, planning their career should start from student age, which is more conducive to the pertinence of learning. Foreign universities attach great importance to the education of students' career planning. The first president of Stanford University even emphasized the importance of career planning at the opening ceremony. College is an important turning point in life. At this stage, a person gradually grows from a child to an adult with social responsibility. Most people are easy to fall into confusion at this stage, which is inevitable, but to realize their ideals and aspirations, they must quickly get out of confusion, which requires college students to formulate reasonable career planning at the beginning of enrollment. In today's social background of difficult employment, college students should formulate realistic career planning and cannot blindly follow suit. We should know how to start from the grass-roots level and not be high-profile and impetuous. This will not only help our employment but also greatly help our future development.In general, from the perspective of rural entrepreneurship environment support, through empirical and typical case studies, combined with the personalized needs of college students in rural entrepreneurship, this study further clarifies the impact of entrepreneurship environment on college students' rural entrepreneurship. Solving these problems requires the joint efforts of the government, colleges and universities, students' families, and myself. On the one hand, the government and colleges and universities should introduce corresponding policies and measures to ensure the smooth employment of rural returned college students. On the other hand, college students should change their thinking, set their position according to reality, and create conditions to realize employment. Finally, family members and relatives should also take an inclusive attitude to reduce the psychological pressure of college students. With the increasingly fierce employment competition and the continuous accumulation of the number of new college students to be employed, more and more college students will choose to return home for employment. In the face of this grim prospect, all parties should make joint efforts to help rural returned college students get rid of the employment difficulties they face and realize their ideal employment.