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).

Emerging infectious diseases are one of the biggest challenges in a globalized world. To date, resources have been allocated to prevent and control the spread of zoonotic and livestock pathogens. We argue that, in line with the One Health approach, equitable efforts, financial resources, attention, and coordination are required for wildlife-only pathogens to halt biodiversity loss. Deploying the amphibian fungus Batrachochytrium salamandrivorans as a model, we demonstrate the unbalanced efforts among countries in Europe regarding surveillance, disease response, prevention, public outreach, and research. We compare investments with B. salamandrivorans l-free countries such as the United States, concluding that structural resources are urgently needed to curb the effects of this fungus within Europe and beyond. We encourage dialogue among authorities, researchers, and stakeholders and propose a coordinated European Union-level program of €6-10 million over 5-7 years to implement B. salamandrivorans action plans and define structural funding requirements for future wildlife disease mitigation.

Existing evidence suggests that mortality remains disproportionately high across Africa, where gains in life expectancy continue to lag behind global progress. While health financing is central to health-system performance, its relationship with mortality in African settings remains insufficiently characterized, particularly when public spending, household out-of-pocket (OOP) payments, governance conditions, and demographic pressures are considered jointly. Our objective was to use a non-linear regression method to evaluate how health financing structures are associated with mortality and whether the association depends on the mode of financing. We use generalized additive mixed models (GAMMs) to allow for potential non-linear relationships between crude mortality rates and public health expenditure, out-of-pocket payments, political stability, and age dependency across 51 African countries from 2002 to 2022 (N = 1,071 country-year observations). A tensor-product interaction assessed whether financial protection modifies the effect of public health spending. Region-specific models were fitted for Central, East, West, Southern, and Northern Africa. Public health spending was associated with lower mortality across Africa, with the steepest reductions below approximately US$80 per capita and diminishing returns thereafter. Out-of-pocket (OOP) spending modified these returns: OOP burdens below 15% of total health expenditure strengthened the estimated mortality benefit of public investment by about 60%, whereas burdens above 40% substantially eroded it. Regionally, the spending-mortality association was strongest in Central, Eastern, and Western Africa, but weaker in Southern and Northern Africa, where age dependency and governance quality were more prominent predictors. The expenditure-OOP interaction was most pronounced in Eastern Africa (EDF = 9.45, F = 4.45, p < 0.001). The continent-wide model showed strong explanatory performance (adjusted R2 = 92.8%; deviance explained = 93.4%; N = 1,009). Increasing public health spending alone is unlikely to maximize mortality gains in Africa. Its impact depends on financial protection: reducing household out-of-pocket costs through pooled financing should be accompanied by expanded public investment. In Southern and Northern Africa, policy emphasis should also shift toward governance efficiency and demographic pressures. Subregion-specific strategies are therefore essential.

What are the perceived barriers and facilitators to physiotherapists adopting a prevention-based walking and education program (WalkBack) in routine practice for patients with recurrent low back pain? What refinements to the WalkBack program could enhance future implementation efforts? This was a qualitative study using individual, online, semi-structured interviews. Twenty registered physiotherapists practising in Australia, including 10 with previous experience delivering the WalkBack program and 10 without prior exposure. Purposive sampling was used to capture insights from physiotherapists across geographic settings, roles and experience levels. Interview questions were informed by the RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance) framework and analysed using an inductive framework analysis. Themes were iteratively developed through team-based discussions. Four themes were identified. First, the WalkBack program is relevant and acceptable to physiotherapists, aligning with the profession's shift towards prevention-based care and further supported by its endorsement by research and professional bodies. Second, the WalkBack training is important for effective delivery and implementation. Its flexible online and face-to-face format facilitated engagement, and forming communities of practice was viewed as critical for sustaining future implementation. Third, flexible delivery and structured resources were seen as critical to enabling scalable implementation. This included developing ready-to-use resources such as referral communication templates and advertising materials. Fourth, successful adoption hinges on system-level enablers, including supportive leadership, funding structures and alignment with service settings. Physiotherapists viewed WalkBack as relevant, acceptable and clinically valuable. Future implementation will need to address training needs, enhance resource provision and explore system-level support. Each clinic's unique service and funding structures may support or deter adoption of the WalkBack program. The findings offer transferable insights to inform implementation of similar clinician-delivered programs, particularly in contexts that share similar clinical and organisational characteristics. https://osf.io/t3xbc.

Global climate change is set to create a future where natural hazards become more catastrophic and more frequent, with impacts on real estate expected to be substantial. At the same time, the transition to a low-carbon economy is reshaping asset values, with high-emission assets becoming less attractive. We adopted a systematic map approach to assess how the impact of climate risks, i.e., physical climate risks and transition climate risks, has been assessed in the academic and grey literature related to real estate valuation, published between 2014 and 2023. The retained corpus of 130 documents was coded according to a pre-defined coding framework, covering geographic distribution, evaluation methods, the type of real estate assets and impact assessment methods. Across the 130 included documents (peer-reviewed and grey literature), the evidence base is dominated by studies that quantify physical climate risk effects on real-estate values, most often using econometric capitalization approaches (e.g., hedonic regressions, DiD, repeat-sales). The most frequently studied hazards are hydrological ones, especially coastal and fluvial floods, typically operationalized using official hazard maps (particularly in US case studies) or through proxies such as elevation and distance to from the shoreline. A smaller subset of studies evaluates adaptation-relevant outcomes (e.g., damages via depth-damage functions) or uses alternative valuation variables such as asking prices, appraisals, or operating and maintenance costs in retrofit-focused works. Evidence on transition climate risks is present but much smaller in volume and is concentrated on a limited set of drivers, notably minimum energy performance requirements, energy labels and local externalities linked to renewable-energy deployment. This patterns partly reflects the study's focus on transition risks explicitly linked to decarbonization. In terms of geography, the literature is heavily concentrated in the United States, while European studies cluster in a few large economies (notably Germany, Italy, and the United Kingdom). The corpus is overwhelmingly focused on one- and two-family housing, with comparatively fewer studies examining multi-family housing and commercial real estate. A small number of papers touch on ecosystem or environmental amenities changes affecting values, including cases linked to invasive or alien species (e.g., algae blooms), but these studies remain relatively rare in the overall corpus. The systematic map highlights several priority gaps for future research and evidence synthesis. First, transition risks remain underexplored beyond a narrow focus on energy-performance regulation, energy labels and renewable-energy proximity; more work is needed on additional channels such as disclosure regimes, financing and insurance repricing, changing tenant demand, and stranded-asset dynamics. Second, compound and cascading risks are rarely analyzed explicitly, even though real-estate exposure often reflects interacting hazards and changing baselines; advancing datasets and methods that represent multi-hazard interactions is therefore a key priority. Third, the geographic evidence base is skewed toward the United States, and more comparable, data-rich studies are needed across Europe to strengthen external validity. Fourth, research remains focused on single-family housing, limiting transferability to urban contexts where multi-family and commercial assets, and different ownership, tenancy, and financing structures, are central. Finally, ecosystem-related valuation impacts appear in only a small portion of the academic corpus and are limited in grey literature, suggesting a need for clearer conceptualization and more systematic integration of biodiversity and ecosystem mechanisms in real-estate climate-risk assessment.

This paper examines existing funding structures and options for cost savings in the healthcare sector from the perspective of fairness. Funding via wage-related contributions with an income ceiling is criticised since other forms of income are not taken into account and the wealthy are relatively spared. The separation of statutory and private health insurance creates inequalities. Three options for savings are examined: avoiding unnecessary measures, increasing the efficiency of effective services, and prioritisation based on need, benefit, and cost. The advantages of the first two options over prioritisation are outlined, as are the respective responsibilities.

Patient involvement in clinical research: An explorative interview study on researchers' perspectives, barriers, and support needs

Tax aggressiveness remains a persistent concern for fiscal authorities and stakeholders, as it directly diminishes public revenue and complicates regulatory compliance. While firm-level attributes such as capital intensity, leverage, and corporate social responsibility (CSR) frequently inform discussions on tax planning, empirical consensus regarding their influence remains elusive, particularly within the Indonesian manufacturing sector. This study investigates the impact of these three determinants on corporate tax aggressiveness among manufacturing entities listed on the Indonesia Stock Exchange (IDX). Utilizing a quantitative framework, we applied panel data regression analysis to a purposive sample of 93 manufacturing firms observed between 2019 and 2024. Our analysis reveals that neither capital intensity nor CSR exerts a statistically significant influence on tax aggressiveness. Conversely, leverage demonstrates a significant negative association with tax aggressive behavior. This inverse relationship suggests that firms maintaining higher debt levels benefit from substantial interest tax shields; these deductible expenses effectively lower taxable income, thereby reducing the firm's overall tax liability. These findings indicate that leverage serves as a primary mechanism for tax management in this context. Rather than pursuing aggressive avoidance strategies, highly leveraged firms appear to prioritize the inherent tax advantages derived from their financing structures. These results offer critical implications for policymakers, investors, and corporate managers navigating the intersection of capital structure decisions and fiscal compliance.

Somalia's health system remains severely fragile, characterized by a critically low Universal Health Coverage Service Coverage Index (UHC-SCI) of 25 and an acute shortage of health workers (0.11 clinicians per 1,000 population). These structural weaknesses coincide with a growing dual burden of noncommunicable diseases (NCDs), responsible for approximately 42% of total mortality, and widespread mental health disorders with available regional studies suggesting a substantial but incompletely quantified burden of common mental disorders. This study evaluates the health system requirements, financing needs, and policy frameworks necessary for integrating NCD and mental health services into primary health care (PHC) to advance universal health coverage (UHC) in Somalia. We conducted a mixed-methods health systems analysis and prospective economic review using a targeted evidence synthesis approach informed by PRISMA-adapted reporting principles. Data were synthesized from the Essential Package of Health Services (EPHS) 2020 Strategic Plan, Global Burden of Disease (GBD) 2019 estimates, and 2024 National Health Accounts (NHA). The One Health Tool (OHT) was applied using a deterministic bottom-up costing approach to estimate the resources required to achieve 80% service coverage by 2030. The model incorporated a 10% drug wastage assumption and a 3% discount rate. The analysis identified major structural financing and service delivery gaps within Somalia's PHC system. Out-of-pocket expenditure remains critically high at 46.1%, exceeding the WHO threshold for catastrophic health spending. Economic projections indicate substantial long-term investment requirements for progressive PHC expansion and chronic care integration, with medicines and supplies representing the largest cost driver due to the long-term demands of chronic care. Integrating NCD and mental health services into Somalia's PHC platform is technically feasible and represents a critical strategy for strengthening health system resilience and accelerating progress toward UHC. Economic projections indicate that achieving the national 80% coverage target will require approximately US$3.1billion by 2030. The OHT-based projections provide an evidence-informed roadmap for sustainable health financing, workforce restructuring, and chronic care delivery in fragile settings. Not applicable.

Mutual-help groups (MHGs) are an effective resource in improving health for emerging adults in addiction recovery. Collegiate recovery programs (CRPs) have the infrastructure to support mutual help meeting implementation for this high-risk priority population for substance misuse. Despite their established role as an addiction recovery resource, the implementation of MHGs within CRPs is inconsistent and highly variable across institutions. To address this gap, we explored barriers and facilitators to planning and implementing MHGs within CRPs. We conducted qualitative interviews with 18 program director and college administrator participants from five CRPs across the United States in 2023. The guide focused on four domains of the Consolidated Framework for Implementation Research 2.0: Innovation, Inner Setting, Outer Setting, and Individuals. Thematic analysis was conducted using an iterative coding approach to identify key facilitators and barriers to MHG implementation. Four cross-cutting themes shaped MHG implementation within CRPs: (1) recovery-aligned leadership and facilitation, (2) institutional positioning and infrastructure, (3) sustainability and resourcing, and (4) inclusivity and pathway fit. Across these themes, leadership advocacy and lived-experience credibility facilitated implementation, while limited staffing capacity constrained delivery. MHGs were more accessible when embedded within visible campus infrastructure aligned with student success priorities. In addition, domain level facilitators included the credibility and perceived effectiveness of MHGs (Innovation), strong institutional support from high-level leaders (Individuals), donor engagement and established recovery spaces that fostered peer connections (Inner Setting), and alignment of CRPs with broader university missions related to student retention and well-being (Outer Setting). Barriers included concerns about the accessibility and inclusivity of traditional 12-Step models (Innovation), administrative misalignment with development offices (Inner Setting), and limited institutional awareness and funding instability (Outer Setting). Implementation strategies to enhance MHG adoption in CRPs include diversifying MHG offerings, integrating CRPs into university financial structures, strengthening external treatment and recovery housing partnerships, and fostering inclusive recovery environments. Addressing these barriers could enhance accessibility and sustainability of MHGs, ultimately improving recovery support for college students with substance use disorders.

BackgroundThe ARON trial demonstrated the (cost-)effectiveness of a multifaceted antimicrobial stewardship intervention including C-reactive protein (CRP) point-of-care testing (POCT) for children with acute illness in Belgian general practice and community-based paediatrics. However, little is known about how CRP POCT is experienced in paediatric practice in the community, particularly in the absence of structural support and a formal legal framework. The objective of the study was to explore how paediatricians use, interpret, and adapt CRP POCT in real-world community-based practice and to identify factors influencing its sustained implementation.MethodsWe conducted semi-structured interviews with Belgian paediatricians experienced in using CRP POCT, either through participation in the ARON trial or as part of routine care, allowing us to capture both protocol-guided and routine practice implementation experiences. Participants were recruited using a mixed sampling approach, combining convenience and snowball sampling. Data were analysed thematically, guided by two complementary implementation science frameworks: the Consolidated Framework for Implementation Research and Normalization Process Theory.ResultsFifteen paediatricians were interviewed. Participants generally viewed CRP POCT positively, but reported navigating substantial implementation challenges, including the absence of reimbursement and unclear logistical routes. Use frequently extended beyond its intended diagnostic purpose, with CRP POCT employed to support communication with parents, provide reassurance or legitimise treatment decisions. Interpretation and confidence evolved through repeated use and informal peer exchange. In the absence of formal feedback or training, clinicians relied primarily on experiential learning to refine their practice.ConclusionsThese findings illustrate both the flexibility and fragility of self-directed implementation in the absence of system-level support. While paediatricians valued CRP POCT, translating early adoption into sustained and equitable routine use in community paediatric care will require formal guidance, financing structures, and shared interpretative frameworks.

ABSTRACT Prevailing multi-order frameworks treat orders as bounded units clustered around a hegemonic or institutional core, leaving regions that are institutionally sophisticated but materially constrained inadequately theorized. This article introduces the concept of “ordering outside an order”: a stable configuration in which African actors shape the rules of multiple overlapping orders from a structurally subordinate yet imaginatively assertive position. Building on subaltern realist and African agency scholarship, and drawing on critical geopolitics and Susan Strange’s structural power theory, the article argues that pan-African norms and institutions function as a disciplining normative project, even as limited control over security, production, finance, and knowledge structures restricts viable strategies. Three mutually reinforcing practices characterize this ordering: continental institutions as aggregative platforms, strategic engagement across external orders, and rhetorical bridging between pan-African ideals and structural necessity. The analysis challenges hegemon-centred understandings of order(s) and demonstrates how regions can organize politically without dominant powers.

Purpose: This study analyzes the political economy and fiscal implications of the Jakarta–Bandung High-Speed Rail (Whoosh) project within the framework of China’s Belt and Road Initiative (BRI). Research Method: This study employs a qualitative explanatory case study approach using document analysis of government regulations, Ministry of Finance reports, KCIC publications, academic journals, and reports from international institutions. Results and Discussion: The findings show that the project’s financing structure increased fiscal exposure for Indonesian state-owned enterprises, particularly PT KAI, due to cost overruns and debt servicing pressures. The study also indicates that concerns about geopolitical dependency should be interpreted with caution, as domestic governance capacity, financing structures, and institutional risk management strongly influence the project outcomes. Implications: The study emphasizes the importance of transparent fiscal governance, stronger risk-sharing mechanisms, and comprehensive ex-ante fiscal evaluation for strategic infrastructure projects. Originality: This study integrates political economy and public financial management perspectives to explain the fiscal consequences of debt-financed infrastructure projects in developing countries.

While science and evidence are paramount to the quality of risk studies, there is an increasing recognition that risk studies can be influenced by factors such as conflicts of interest, coercion, organizational hierarchies, funding structures, and many others. Those factors can then influence how the risk study’s integrity is evaluated and also impact the integrity of the risk analysts and the institutions funding the risk study. In this paper, we investigate the relationship between aspects of risk study quality and non-scientific factors, including elements of power and ethics. These aspects, whether intentional or inadvertent, may influence how risk is perceived/understood, communicated, and managed. As an illustration, we examine the taxonomy of power sources in relation to aspects of the risk study and consider how the risk study may impact the balance of power. We argue that the risk analyst has a crucial role in considering these aspects when designing and implementing risk studies. We then demonstrate the taxonomy of this paper using the Boeing 737 Max Crisis, drawing on publicly available reports and news articles. The results of this paper suggest that established risk study quality characteristics can be supplemented by considering aspects of ethics and power. This paper will be of interest to risk analysts, policymakers, and risk communicators.

This paper investigated how entrepreneurial activity within Nigeria’s micro, small and medium enterprise (MSME) sector contributes to job creation, income growth and structural poverty reduction over the period 2014–2024. Drawing on national datasets from the National Bureau of Statistics and SMEDAN, programme evaluations (YouWiN, N-Power and GEEP) and relevant empirical studies, the analysis is grounded in Schumpeterian innovation theory, the Resource-Based View and Institutional Theory to explain how firm capabilities and the enabling environment shape inclusive development outcomes. The evidence indicates that MSMEs account for 46.3% of GDP and 87.9% of formal employment in Nigeria, and that entrepreneurial engagement is positively associated with poverty reduction (r = 0.62, p &lt; 0.01). Notwithstanding these contributions, the sector is constrained by a structural financing gap estimated at US$32.2 billion, with only 4% of firms accessing formal bank credit. Although initiatives such as GEEP and the Development Bank of Nigeria have improved liquidity, persistent institutional fragmentation, limited regulatory coherence and weak monitoring and evaluation systems continue to impede scale and the durability of poverty-reduction gains. While digital and AI-enabled tools are strengthening enterprise capabilities, uneven infrastructure and access risks reproducing existing inequalities. The paper concludes that short-term grants like TraderMoni, farmermoni, conditional cash transfers and other governmental interventions, though important for relief, are insufficient for structural transformation; sustained poverty reduction requires ecosystem-oriented policy that integrates blended finance and fintech partnerships, targeted gender and youth inclusion, and regulatory simplification and evidence-based monitoring and feedback systems.

The article carries out a comprehensive criminological study of persons who commit criminal offenses in the sphere of activity of non-banking financial institutions. It is substantiated that the social danger of such offenses is largely determined by the set of socio-demographic, status-role, moral-psychological and criminal-legal characteristics of the offender’s personality, which are formed under the influence of the social environment and are implemented in illegal behavior. It is determined that the personality of the criminal is a complex interdisciplinary phenomenon that combines social, psychological and legal features and is considered as a carrier of anti-social orientation. It has been established that persons who commit criminal offenses in the field of non-banking financial institutions are characterized by a high level of education, the presence of special knowledge in the field of finance and lending, professional competence, as well as developed communication skills, the ability to persuade and manipulate. It has been proven that their behavior is mainly rational, self- motivated in nature and is implemented through the use of official position, trust relationships and gaps in legal regulation. It is substantiated that criminal offenses in this area are mostly organized in nature, committed in groups with a clear division of roles and functions, which makes their detection and investigation difficult. The author’s approach to the classification of offenders is proposed, which involves their division into internal, external, associated and intermediary entities depending on the degree of involvement in financial and credit activities. It is emphasized that the key role in the mechanism of criminal activity is played by persons who occupy managerial and supervisory positions in non-bank financial institutions or related structures, since it is they who have access to financial resources, management tools and the ability to influence decision-making. The conclusion is made about the need to improve criminological prevention measures taking into account the typological characteristics of the offender, as well as strengthening internal control, compliance and regulatory supervision in the financial sector.

BackgroundHealth care access plays a central role in reducing inequities across populations. Virtual care can mitigate these inequities by facilitating more inclusive and accessible health care delivery. In residential aged care homes (RACHs), virtual care has the potential to enable timely and efficient access to general practitioners (GPs) for residents. However, as context, technologies, and users are complex, the implementation, acceptance, and use of virtual care technologies in RACHs remain challenging.ObjectiveThis study aimed to evaluate the barriers and facilitators to implementing, accepting, and using virtual care technologies to connect residents with GPs for health care delivery in RACHs, and to identify benefits, unintended consequences, and opportunities for optimization.MethodsWe conducted a pragmatic, cross-sectional qualitative study guided by interpretivist principles. Semistructured interviews were undertaken with 32 participants (11 GPs, 11 RACH nurses, 3 practice managers, 5 residents, and 2 carers). Data were analyzed inductively using reflexive thematic analysis and mapped deductively to the Systems Engineering Initiative for Patient Safety model to examine sociotechnical interactions influencing virtual care delivery.ResultsOur investigation revealed that barriers to implementing, accepting, and using virtual care technologies to deliver care to RACH residents were more pervasive and salient in participants’ accounts than enablers. While barriers were found across all Systems Engineering Initiative for Patient Safety domains for GPs, most of the barriers for residents and carers were identified in the “people” and “organizational” domains, and in addition to these, “technology and tools” domain for RACH nurses. Although many barriers are common across the people (eg, resistance to using new technology), technology (eg, inadequate system integration), and organization (eg, logistical challenges) domains for RACH nurses and GPs, our study revealed unique barriers to virtual care delivery for residents and carers (eg, interruptions and potential to exclude residents from conversations) whose views are often absent from existing literature. Our findings also revealed that there is no standardized virtual care consultation process between RACHs and GPs—a key concern strongly associated with the identified work system barriers. While virtual care was seen as beneficial, participants identified some unintended consequences to patients (eg, loss of doctor-patient relationship), clinicians (eg, additional workload), and health care organizations (eg, infection control).ConclusionsVirtual care can improve access to timely, high-quality general practice services in RACHs, but its potential is constrained by sociotechnical, organizational, and workflow challenges. Addressing system integration, usability, staffing, training, and policy gaps, including funding and billing structures, will be crucial to realizing the benefits of virtual care. This study provides new evidence to inform design, implementation, and policy decisions supporting equitable virtual care delivery aligned with Sustainable Development Goals 3 and 10.

Abstract Background and aims Psychedelic therapies are moving from the margins of medicine into clinical practice, bringing unresolved ethical questions to the forefront. Among them, ketamine-assisted psychotherapy (KAP) has gained the widest medical acceptance, particularly for treatment-resistant depression (TRD). In August 2025, this development reached a new stage as Norway became the first country to approve reimbursement of generic ketamine for TRD. This study uses a principlist framework to examine ethical challenges related to administering KAP during the formative period preceding this policy shift, when provision was largely private. Methods Sixteen physicians and clinical psychologists in Norway were interviewed about ethical challenges in practice. Data were analyzed abductively through thematic analysis, using Beauchamp and Childress' principlist bioethics as a framework. Results Findings are structured around three themes: (1) Access to care , where injustice stemmed from cost, geography, and limits on public communication; (2) Informed consent , where the unpredictability of ketamine's effects complicated autonomy, leading practitioners to rely on flexibility and experiential familiarity; and (3) Therapeutic integrity , where beneficence and non-maleficence depended on sustaining psychotherapy, with risks of fragmented care, unrealistic expectations, and ketamine treated as a stand-alone cure. Conclusions While principlist ethics acted as a useful scaffold, systemic factors such as funding structures and biomedical norms of consent shaped KAP in ways the framework could not fully capture. For KAP to develop into ethically robust psychiatric care in Norway and beyond, it must balance expanded access with the therapeutic depth that grounds the practice, supported by refinement of consent processes.

This study examines the influence of liquidity and leverage on firm profitability in property and real estate companies listed on the Indonesia Stock Exchange during the 2021–2024 period. The property sector represents a capital-intensive industry characterized by long project cycles, high financing requirements, and sensitivity to macroeconomic fluctuations. These characteristics make financial structure and working capital management critical determinants of corporate performance. Profitability is measured using Return on Assets (ROA), while liquidity and leverage are proxied by the Current Ratio (CR) and Debt to Equity Ratio (DER), respectively. A quantitative research design was employed using secondary data derived from audited annual financial reports. The sample consisted of 18 companies selected through purposive sampling, resulting in 72 firm-year observations. Following classical assumption testing and outlier adjustment, 62 observations were deemed suitable for regression analysis. Multiple linear regression analysis was conducted using IBM SPSS version 27. The empirical findings reveal that liquidity exerts a significant negative effect on profitability, indicating that excessive current assets may reduce asset utilization efficiency. Similarly, leverage demonstrates a significant negative relationship with profitability, suggesting that higher debt levels increase financial burdens that suppress net income. Simultaneously, liquidity and leverage jointly influence profitability, highlighting the importance of balanced financial management strategies. These results emphasize that both overinvestment in liquid assets and excessive reliance on debt financing may weaken firm performance. Overall, the study underscores the necessity for property companies to optimize working capital allocation and maintain a sustainable capital structure to enhance profitability and asset efficiency.

Following major changes to sexual health provision in England in the past decade, monitoring and evaluation of population-level interventions require re-examination to ensure quality and visibility of key communities. We make the case that sexual health data sources might be used synergistically to improve sexual health and tackle inequalities. We conducted a purposive narrative review to (1) describe national sexual health policy and provision changes in England in the past decade (2012 onwards), (2) map key sexual health data resources and (3) demonstrate how integrated data-driven approaches can be used to understand and evaluate population-level sexual health policy. There have been major changes at a national and regional level in the availability, targeting and implementation of HIV and sexually transmitted infection (STI) interventions, including through high-level shifts in funding structures, expansion of online services and pathogen-focused policies. Synergistic use of the many data sources available takes advantage of their different features. For example, for HIV, integration of nationally representative behavioural surveys that include people not accessing care (eg, National Surveys of Sexual Attitudes and Lifestyles), targeted surveys (eg, Reducing inequalities in Sexual Health surveys for gay, bisexual and other men who have sex with men (GBMSM)) and national STI/HIV surveillance for people accessing care (eg, GUMCAD STI Surveillance System) can be used to inform progress towards HIV elimination in England through assessment of online and postal-based self-sampling and inequalities in HIV testing uptake in populations and key communities such as GBMSM. In the face of rapid change, approaches that integrate complementary data sources have the potential to harness the strengths of individual assets and mitigate limitations to form a more complete assessment of population-level interventions and should guide sexual health policy and practice in the decade to come. Effective data integration requires addressing a range of methods, mandates and challenges to strengthen contemporary research, monitoring and evaluation.