Purpose This study investigates how China's judicial independence reform curbs local protectionism, thereby enhancing the efficiency and rational allocation of governmental resources, particularly among state-owned enterprises (SOEs) and local SOEs. Design/methodology/approach Based on the quasi-natural experiment of China's 2014–2019 judicial management reform, this study employs a difference-in-differences (DID) model to empirically examine the impact of judicial independence on the efficiency of government subsidies. To ensure robustness, a series of validation methods are applied, including alternative sample tests, cross–fixed effects estimation, controlling for confounding events (circuit courts), placebo tests and parallel trend tests. Findings The reform curbs local protectionism and significantly reduces government subsidies to SOEs, especially local SOEs. Three mechanisms explain this outcome: (1) eliminating resource allocation barriers, (2) enhancing resource allocation efficiency and (3) intensifying regulatory scrutiny towards resource allocation. Although R&D subsidies and expenditures declined, innovation outputs increased, indicating improved efficiency of innovation resource allocation. Furthermore, the reform generates positive abnormal stock returns around subsidy announcements, reflecting enhanced investor confidence in judicial impartiality and improved fiscal transparency. Originality/value This study makes three main contributions. First, it integrates judicial independence into the analytical framework of government subsidy allocation, emphasizing institutional quality as a determinant of fiscal efficiency. Second, it reveals a novel mechanism linking judicial reform to corporate innovation through subsidy restructuring, offering new insights into law–finance–innovation interactions. Third, it identifies the market announcement effect of judicial reforms, demonstrating how enhanced judicial impartiality fosters investor confidence and enterprise value.

Continuum of Crisis Care.

North Carolina's (NC) healthcare workforce shortages have been a major concern, as geographic health disparities become more pronounced and health outcomes decline in rural communities compared to those in urban areas. Rural residents face severe challenges accessing primary and specialized care and behavioral health services, especially in counties designated as Health Professionals Shortage Areas (HPSAs). NC will continue to experience these challenges as its overall population grows.Historically, NC had to pivot and reimagine policies and programs to improve its workforce crisis with federal assistance. Medicaid expansion and transformation, provider incentives, international labor recruitment, and innovative federal funding sources helped mitigate critical provider gaps and enhance access to care. However, in the wake of state budget challenges and fiscal restraints, persistent provider differentials remain.This article discusses how federal assistance has impacted the rural healthcare workforce crisis in North Carolina prior to the passage of the H.R.1 One Big Beautiful Bill Act (OBBBA) of 2025 (Congress.gov 2025). It also examines OBBBA's policy provisions and NC's plan for workforce improvements with the $213 million funding awarded through the Rural Health Transformation Program.

Objectives. To explore and quantify the potential effects of financial innovations aimed at increasing investments in social drivers of health (SDH). Methods. We built a simulation model in which individuals in a health care market are served by multiple Medicaid managed care organizations (MCOs). In our model, each MCO can spend money to make SDH investments that improve patient health and reduce costs to the MCO, but patients can switch between different MCOs. Results. While SDH investments improve patient health and increase the profitability of the investing MCO, the benefits also accrue to noninvesting MCOs because of the churn of patients between MCOs, resulting in a "wrong-pocket problem" where investing MCOs bear the costs but share the benefits with competitors, resulting in worse financial returns compared with making no investments and ultimately disincentivizing SDH investments. Outcomes can be improved when all MCOs participate in a financial structure-an SDH bond-which raises money from investors and distributes the proceeds to MCOs to make SDH investments. Conclusions. An SDH bond can improve patient health and increase profits for MCOs because of cost-savings. (Am J Public Health. 2026;116(S3): S210-S217. https://doi.org/10.2105/AJPH.2026.308479).

Culturally and linguistically diverse (CALD) communities have unique strengths, needs, and health seeking behaviours reflecting their cultural background. Therefore, top-down population-level health promotion initiatives with externally imposed performance indicators are frequently ineffective in CALD contexts. Accordingly, the Healthy New Communities (HNC) program implements an equity-based bottom-up commissioning model aimed at addressing socio-cultural factors impacting health seeking behaviours with people from refugee and migrant backgrounds. In the first phase of a comprehensive evaluation of the HNC program commissioning model, stakeholders involved in the implementation of commissioned activities and programs shared their experiences with this innovative funding model pioneered by the Queensland Health Metro South Hospital and Health Services, Health Equity and Access Team. Their perspectives were gathered in focus groups and interviews and analysed using an inductive approach to thematic analysis. The findings demonstrate the effectiveness of the HNC program commissioning model in engaging CALD communities in health promotion initiatives. Flexibility, responsiveness, trust, relationships, shared commitments, and cultural representation facilitated community members' participation in the commissioned activities. The impacts of the HNC program commissioning approach extend beyond the adoption of healthy lifestyles and include positive social, emotional, cultural, and physical impacts across a range of life domains and the creation of employment, training, and career pathways. The HNC program demonstrates how socio-cultural determinants of health can be influenced by commissioning models that prioritise community engagement, relationships, co-design, and the culturally shaped health-seeking behaviours of CALD individuals, families, and communities in the funding, design, and implementation of health promotion initiatives. SO WHAT?: Phase one results are promising and lay the foundation for an in-depth investigation of the potential of equity-based commissioning models for improving health and wellbeing outcomes for CALD communities across Queensland and beyond.

Early pathogen detection is crucial in sepsis. We hypothesized that detection of microbial circulating cell-free DNA by metagenomic next-generation sequencing (mNGS) improves clinical outcomes and health-related quality of life without increasing healthcare costs. This randomized, controlled, interventional, open-label, multicenter trial was conducted in 24 intensive care units across Germany. The intervention group (n = 200) received mNGS diagnostics in addition to standard-of-care microbiology, compared with standard-of-care microbiology alone (control group; n = 189). The primary endpoint was the Desirability of Outcome Ranking/Response Adjusted for Duration of Antibiotic Risk (DOOR/RADAR) score. The DOOR/RADAR score was not significantly improved at 28days after sepsis onset (intervention group: 3.21 ± 1.54; control group: 3.49 ± 1.51; 95% CI - 0.58 to 0.03). However, other secondary endpoints were improved, including a reduced duration of mechanical ventilation (intervention group: 6.6 ± 9.4days; control group: 9.3 ± 10.6days; 95% CI - 5.03 to - 0.34) and faster shock resolution (intervention group: 6.9 ± 7.4days; control group: 8.8 ± 8.5days; 95% CI - 3.75 to - 0.04). Health-related quality of life at 90days (EQ-5D-5L) was improved in the intervention group (0.312 ± 0.386) compared with the control group (0.208 ± 0.373; p = 0.047). In the subgroup with available claims data (33.2% of participating patients), healthcare costs over 180days did not differ. The DOOR/RADAR score as primary endpoint was not significantly improved by mNGS. Exploratory secondary analyses revealed improvements in secondary endpoints. (Funding: German Innovation Fund; ClinicalTrials.gov number, NCT04571801, registration: 25.8.2020).

ABSTRACT Doctoral education in Sub-Saharan Africa has expanded rapidly, yet evidence on post-PhD career trajectories remains limited. This study examines employment outcomes, career pathways, and structural constraints shaping doctoral graduates’ experiences in Kenya, Ethiopia, and Rwanda. Using a mixed-methods design, the study integrates survey data (n = 154), key informant interviews (n = 27), and multi-stakeholder policy dialogues under the Regional Scholarship and Innovation Fund. Guided by identity–trajectory theory and academic precarity, the analysis explores how individual aspirations intersect with institutional conditions and broader structural dynamics. Findings show that while career advancement and research engagement motivate doctoral training, graduates navigate fragmented and uncertain career pathways. Academic employment is often characterized by low remuneration, limited research funding, and weak institutional support, prompting engagement in consultancy and externally funded projects. Policy dialogues highlight systemic gaps, including weak research ecosystems, limited industry linkages, and the absence of structured postdoctoral pathways. Alignment between doctoral training and employment is stronger in Kenya and Rwanda than in Ethiopia. The study demonstrates that doctoral career trajectories are shaped by interactions across micro, meso, and macro levels, providing comparative evidence and policy-relevant insights for strengthening doctoral training, research systems, and sustainable academic careers in Sub-Saharan Africa.

Achieving the low-carbon transformation of energy consumption structure is central to carbon-neutral development, yet how artificial intelligence (AI) contributes to sustained structural change remains insufficiently understood. Addressing this gap, this study examines not only whether AI facilitates the green and low-carbon transformation of energy consumption structure in China, but also through which mechanisms and under what conditions this effect is sustained. Using provincial panel data for 2013–2022, we estimate the direct effect of AI and test the mediating role of green innovation resilience and the moderating role of green finance. The results show that AI significantly promotes the low-carbon transformation of energy consumption structure. Green innovation resilience serves as an important transmission mechanism, while green finance strengthens this relationship. These findings deepen understanding of the AI-energy transition nexus and provide policy implications for effectively coordinating digital technology, green innovation, and green finance.

BackgroundSurgical care in low- and middle-income countries (LMICs) remains underfunded despite representing a significant portion of the Global Burden of Disease. Understanding bilateral development assistance for surgery is crucial to address this disparity.MethodsWe conducted a narrative review and quantitative analysis of bilateral development assistance for surgery in LMICs from 2014 to 2022 using data from the Institute for Health Metrics and Evaluation and the Organisation for Economic Co-operation and Development Creditor Reporting System. Surgical projects were identified through keyword search. We report funding trends, key actors, project classifications, implementation channels and regional distribution, and examine trends through thematic analysis of key characteristics of bilateral aid.ResultsBetween 2014 and 2022, US$2.73 billion was disbursed to surgical projects. Surgical funding decreased as a proportion of total bilateral development assistance for health (DAH), from 2.13% in 2014 to 1.32% in 2022. Key donors were Canada, the USA, Australia, Italy and Korea. Obstetrics and gynaecology received the most funding among surgical subspecialties. Non-governmental organisations were the primary implementation channels (51.4%), which could undermine public sector development by bypassing national health systems, perpetuating fragmentation and limiting governments’ capacity to sustain surgical services independently. Sub-Saharan Africa was the principal recipient region, securing 55.17% of disbursements.ConclusionsDespite increasing commitments, surgical care remains underfunded, with an overall 1.84% share of bilateral DAH. Contributing factors include limited expressed public sector demand and absorption capacity in recipient countries, donor disbursement practices tied to performance indicators and shifting donor priorities. Recipient countries can enhance funding utilisation and donor attraction by strengthening national surgical plans, improving health system capacity, engaging stakeholders collaboratively, advocating for balanced funding across specialties and exploring innovative financing mechanisms. Addressing these challenges is essential to optimising surgical care funding and improving health outcomes in LMICs.

The rapid growth of Buy Now, Pay Later (BNPL) services has expanded consumer access to credit, but it has also raised concerns about user satisfaction, trust, and long-term sustainability. This study develops and validates the Experience–Interaction–Trust model to explain and predict user disengagement in BNPL platforms. A multi-stage research design was employed to explore and test the experiential dimensions that shape consumer interactions with BNPL applications. In the exploratory phase, a bilingual corpus of approximately 39,000 authentic Arabic and English app reviews was analyzed. Text preprocessing, sentiment analysis, and topic modeling uncovered eleven core constructs: Harmony, Effortlessness, Favorability, Neglect, Breakdown, Automation, Boundedness, Disparity, Friction, Churn Risk, and NWOM. In the confirmatory phase, PLS regression and XGBoost were used to test and predict the relationships among constructs. The EXIT model demonstrates theoretical robustness and predictive utility, offering practical guidance for BNPL providers seeking to minimize churn, enhance user trust, and support sustainable digital financial innovation.

Individualised duration of antibiotic treatment in culture-negative early-onset sepsis in late-preterm and term-born neonates in Denmark (DURATION): a multicentre, open-label, randomised, controlled, non-inferiority trial.

Prognostic value of the Duke Activity Status Index for preoperative cardiac risk stratification: an international pooled cohort study

The US public health system is facing an inflection point characterized by chronic underinvestment, workforce and service delivery challenges, outdated data infrastructure, growing health inequities, and increasing instability within the broader health care safety net including projected Medicaid coverage changes and continued rural hospital closures. Fragmentation across public health, health care, social services, and financing systems limits the nation's ability to address complex population health challenges and invest in prevention. This paper examines opportunities for state-led alignment of the public health system through a systems-oriented framework. Drawing on current policy developments, emerging evidence, national frameworks, and state-based examples, we identify and analyze five strategies through which states can strengthen population health: (1) aligning Medicaid and public health around shared population health goals; (2) developing more sustainable and flexible financing mechanisms; (3) expanding regional service delivery and shared-service models; (4) strengthening public-private partnerships; and (5) aligning technology and data modernization efforts with critical infrastructure needs. The analysis highlights how state governments can serve as system integrators and stewards of shared infrastructure by aligning governance, financing, service delivery, partnerships, and technology across traditionally siloed sectors. Examples from multiple states demonstrate the potential for Medicaid-public health integration, blended and braided financing approaches, regional service delivery models, public-private collaborations, and interoperable data systems to improve efficiency, expand access to services, strengthen workforce capacity, support population health outcomes, and increase system sustainability. These approaches are particularly important in rural and underserved communities, where workforce shortages, hospital closures, and limited resources threaten access to essential services. Addressing today's public health challenges requires moving beyond fragmented, program-specific approaches toward a more integrated, prevention-focused health system. States are uniquely positioned to lead this transformation by aligning public health with innovations in Medicaid, financing, service delivery, private-sector partnerships, and technology infrastructure. Strategic state leadership can improve efficiency, sustainability, and responsiveness while strengthening foundational public health capacity. In an era of resource constraints and rising health threats, state-led systems alignment positions states as integrators of shared infrastructure and represents a critical opportunity to improve population health and build a more resilient public health system.

Efficacy of a hybrid psychoeducational and skills-based therapy (Trauma PORTAL) for adults with PTSD related to childhood interpersonal trauma: a parallel-group, randomised controlled trial

Gene therapy and cost-effectiveness analysis: Current issues and future research.

Carbon footprints in the context of financial innovation and human capital transformation: A low-carbon transition or new emission growth points?

The global community proved remarkably resilient in protecting the progress in and commitment to eliminating HIV in children in the face of the COVID-19 pandemic. However, sudden disruptions in 2025 in donor support for HIV assistance have posed new and existential threats to the hard-fought gains in global paediatric HIV control. Since the early 2000s, the reductions in paediatric HIV acquisitions, in deaths in children with HIV and in the number of children orphaned by HIV/AIDS have been breathtaking, but in recent years, progress has stalled, and gaps remain. The disruptions in political and financial support from the U.S. government obligate us to reframe our plans for ending HIV as a threat to children and also enable us to implement overdue changes in strategy to overcome barriers to success. Pillars for success include: robust integration of HIV into strengthened general healthcare systems; reassertion of national government leadership; prioritizing reduced donor funding for research and innovation; stronger partnership between private sectors and public health programmes; amplified community voices; and bold determination and creative solutions from global paediatric HIV stakeholders. The time is right for the global paediatric HIV community to consider the key factors that have enabled the tremendous progress towards ending the threat of HIV in children, the critical barriers to overcoming remaining gaps and a framework no longer so dependent on donor support for getting back on the path to eliminating HIV in children. The diverse and talented global HIV stakeholder coalition will find the opportunities for transformation and innovation in paediatric HIV care and boldly chart a lasting, evidence-based, person-centred, community-informed, national health system-aligned path to ending HIV as a threat to children.

Rethinking preparedness for re-emerging filovirus diseases in Africa: Integrating governance, policy, and health security innovation.

This study assesses how a country’s digitalization impacts sustainability indicators as measured by unmonitored environmental, social and governance (ESG) risks, which serve as a proxy for the development of financial technology (FinTech). The study employs a cross-country approach using data for up to 163 countries, going beyond the firm-level focus of previous studies. The DiGiX Digitalization Index and the ICT Development Index are used to measure digital maturity, while pillar-level indicators and Sustainalytics ESG country risk scores are used to assess ESG indicators. With evidence of nonlinear, threshold-type effects at higher levels of digital maturity, the regression results suggest a strong negative correlation between digital maturity and ESG risk. Different country typologies are further identified using unsupervised cluster analysis, which reveals a continuous digital and ESG gradient in environmental, social and governance aspects. The analysis proves digital maturity serves as a systemic enabler of ESG risk management by strengthening data availability, governance capacity and policy enforcement. These findings provide policy-related guidance for coordinating digitalization strategies in line with the Sustainable Development Goals.

On-site sewage systems (OSS) serve as critical wastewater treatment infrastructure for hundreds of thousands of households across the Puget Sound region. However, aging systems present mounting challenges for public health, environmental protection, and household financial stability. This study examines the economic burden borne by homeowners to address failing OSS through comprehensive case studies in King County and across twelve Puget Sound counties. Using data from Public Health—Seattle & King County, Washington Department of Health, and Craft3, we estimate that King County homeowners face a collective $3.7 billion burden to address OSS older than 20 years, with nearly $3 billion needed immediately for systems exceeding their 30-year lifespan. Regionally, assuming a 3% annual failure rate, repair and replacement costs approach $500 million annually, with $77.5 million attributed to systems within Marine Recovery Areas that directly impact water quality. Location and infrastructure availability create significant cost disparities, with homeowner expenses ranging from $4,000 for basic OSS maintenance to $124,000 for sewer connections. These findings underscore the “wicked” nature of OSS management, where individual property owners bear responsibility for infrastructure providing significant public benefits. We also examine innovative financing mechanisms, including green bonds, community-based partnerships, and Chile’s Subdirectorate of Rural Health Services, offering potential pathways for addressing this critical infrastructure challenge.