Purpose: This study investigated the impact of capital structure and sales growth on the financial performance of micro, small, and medium enterprises in Medan City. Methods: The researchers utilized a quantitative approach with a causal-associative design. The study selected a sample of thirty business enterprises using purposive sampling criteria based on operational duration and the availability of financial records. The researchers extracted quantitative financial data from the annual reports of the selected enterprises. The data analysis involved classical assumption tests and multiple linear regression models. Results: The regression analysis revealed that capital structure negatively and significantly affected financial performance. Conversely, sales growth positively and significantly impacted financial performance. The statistical model accounted for approximately fifty percent of the variance in the financial performance of the enterprises. Conclusions: The study concluded that excessive reliance on debt diminished profitability due to high interest burdens, whereas robust sales expansion enhanced financial health through economies of scale. Originality/value: This research provided empirical value by demonstrating that enterprise owners must prioritize internal funding and sales optimization over aggressive short-term borrowing to ensure sustainable financial stability in emerging local markets.

Does a natural cycle result in higher clinical pregnancy rates (CPR) with foetal heartbeat compared to an artificial cycle for frozen-thawed embryo transfer (FET) preparation in ovulatory women? The CPR with foetal heartbeat did not differ between natural and artificial cycles in ovulatory women undergoing FET. Several protocols for endometrial preparation have been developed for the increasing number of FET cycles in reproductive medicine. In natural cycle FET (NC-FET), spontaneous ovulation is used to time the embryo thawing and transfer, while in artificial cycle FET (AC-FET), endometrial preparation involves sequential oestrogen and progesterone administration. Current evidence on pregnancy rates does not favour one regimen over the other in women with regular ovulatory cycles. We conducted a multicentre, open-label, randomised trial comparing NC-FET with AC-FET across five Belgian fertility centres. Between October 2018 and October 2024, 561 women were randomised (1:1) using a computer-generated allocation after written informed consent. The primary outcome was CPR with foetal heartbeat per cycle analysed on an intention-to-treat basis. Secondary outcomes included endometrial thickness, number of clinic visits for FET cycle monitoring and the rates of (biochemical) pregnancy, ongoing pregnancy, live birth, miscarriage, ectopic pregnancy, multiple pregnancy and cycle cancellation. Obstetric outcomes were recorded for all ongoing pregnancies. Women aged 18-45 with regular ovulatory cycles and normal uterine cavities undergoing FET after vitrification and warming of one or two day-3 embryos or blastocysts were included. In NC-FET, spontaneous ovulation was detected by serial ultrasounds and serum LH and oestradiol measurements. In AC-FET, oestradiol valerate (6 mg/day) was administered from cycle day 2 (increased to 8 mg/day after 1 week if endometrial thickness was <7 mm) and micronized progesterone (600 mg/day) was initiated once endometrial thickness reached ≥7 mm. Clinical pregnancy rates with foetal heartbeat were similar between NC-FET and AC-FET in both intention-to-treat (33.1% [94/284] vs 28.9% [80/277]; RR 1.15, 95% CI 0.89, 1.47) and as-treated analyses (34.3% [97/283] vs 31.8% [77/242]; RR 1.08, 95% CI 0.85, 1.38). Cycle cancellations were less frequent in NC-FET (3.9% vs 9.4%; RR 0.41, 95% CI 0.21, 0.82), but NC-FET required more monitoring visits (mean 3.0 vs 2.4; P = 0.0002). Caesarean section was more common after AC-FET (42.7% vs 20.2%; P = 0.003). Other reproductive, obstetric, and perinatal outcomes did not differ significantly between groups. The sample size was powered to detect a difference in CPR with foetal heartbeat, not for comparing live birth rates or obstetric outcomes. The study was performed in ovulatory women undergoing FET, and therefore, results may not be applicable to other populations. This RCT demonstrates no significant difference in CPR with foetal heartbeat in NC-FET and AC-FET in ovulatory women. Given recent data suggesting higher obstetric risks with AC-FET, NC-FET may be preferred in women with normal ovulatory cycles. The study was an investigator-initiated study supported by internal KU Leuven funding (Project number C14/18/106 and C14/24/152) and funding from the Research Foundation Flanders (G.084515N and G.0B1819N to J.V.). K.P. has received grants from Ferring. C.B. has received speaker fees from Gedeon Richter, paid to her institution; travel support from Gedeon Richter, Ferring Pharmaceuticals, and Intuitive; and holds a leadership role as Senior Deputy of the ESHRE SIG Endometriosis and Endometrial Disorders. C.T. has received grants from Merck SA, paid to her institution; consulting fees and speaker fees from Gedeon Richter; travel support from Ferring and Gedeon Richter; and holds leadership roles as Deputy Editor of JNIG and as a board member. A.V. has received speaker fees from Gedeon Richter, paid to his institution, and holds a leadership role as Senior Deputy of the ESHRE SIG Endometriosis and Endometrial Disorders. The other authors declare that there is no conflict of interest to disclose with respect to the content of this article. This trial has been registered at ClinicalTrials.gov (NCT03642665). 17 July 2018. 27 October 2018.

How is endometrial and systemic immunity modulated throughout the menstrual cycle and are there changes in women with endometriosis? Endometriosis is associated with reduced endometrial early natural killer (NK) cells and increased mucosal-associated invariant T (MAIT)-like CD8+ T cells, with cyclical variation. The endometrial mucosa contains innate and adaptive immune cells that fluctuate across the menstrual cycle. Immune dysregulation is found in endometriosis, however few studies have broadly assessed endometrial immune single-cell proteome phenotypes. This observational cross-sectional immune phenotyping study included 40 participants (28 with surgically confirmed endometriosis and 12 controls). Endometrial and peripheral blood samples were analysed by spectral flow cytometry using a 36-parameter immune phenotyping panel and a 13-parameter MAIT-specific panel. Totals of 1950292 circulating and 1023215 endometrial immune cells were profiled. Full-thickness uterine biopsies (n = 3) underwent multiplex immunohistochemical imaging to assess spatial organization across the menstrual cycle. Compared with controls, patients with endometriosis exhibited decreased endometrial early NK cells (P.adj = 0.006, log2FC = -1.369) and increased MAIT-like CD8+ T cells (CD161+CD8+CD3+) (P.adj = 0.033, log2FC = 1.415). The MAIT cells (CD161+Va7.2+CD3+) peaked during ovulation and the implantation window (P.adj < 0.05). Peripheral immunity also showed cyclical variation with increased early NK cells (P.adj = 0.001, log2FC = 1.052) and decreased effector CD4 T (P.adj = 0.002/log2FC = -2.010) and effector CD8 T cells (P.adj = 0.002, log2FC = -1.180) in the endometriosis group. The cytometric panel design was biased towards acquired immunity, and the endometriosis patient sample size prevented subtype analysis. MAIT cell dysregulation represents a novel feature of endometriosis, potentially contributing to subfertility and providing new avenues for therapeutic development. This study was funded by the Nuffield Department of Women's and Reproductive Health, University of Oxford, and also supported from the University of Oxford Medical Sciences HIDI Internal Fund Award (0010398), Academy of Medical Science Award (SBF007\100078) and, British Society for Immunology Career Enhancing Grant. C.M.B. has a consultancy role with ObsEva, Theramex, Roche Diagnostics, Sumitovant, Gedeon Richter, Gesyntha, and they have Research Grants from Bayer, Gesyntha, and Serac Life Services. K.Z. is a Board member (non-remunerated) of the World Endometriosis Research Foundation. She has consultancy status with Roche Diagnostics and Gedeon Richter. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. N/A.

The so-called One Big Beautiful Bill Act signed into law by President Trump on July 4, 2025 will cut $1 trillion from federal health care programs over the coming decade and cause 10 million individuals to become uninsured according to the Congressional Budget Office. Most analyses of the bill's impacts have assumed they would be the inverse of those documented from previous coverage expansions. An examination of past coverage cuts might yield additional insights into the probable impacts of this legislation on the medical care and health of the needy. We reviewed studies of four prior large scale coverage contractions: Reagan-era Medicaid cuts, the 2005 Tenncare Disenrollment, the 2019 implementation of work requirements in Arkansas, and the postpandemic "Unwinding" of Medicaid. The experience of these prior coverage contractions complements evidence from analyses of coverage expansions in predicting that widespread insurance loss will lead to a reduction in care utilization, an increase in household financial strain, and worsened physical and mental health for low-income individuals. These coverage contractions additionally suggest that most who lose Medicaid coverage will not find alternative coverage; that work requirements will impose burdensome administrative costs on states; that states are unlikely to offset reductions in federal Medicaid funding with internal funds; and that the second-order effects of coverage losses may, in some instances, be greater (in magnitude) than the benefits seen after coverage expansions. Cuts to federal health care programs will produce sharp contractions in public coverage that will worsen existing problems in US health care such as insurance churn, degrading care, and worsening health inequality. While states may take some steps to mitigate harmful impacts, better protection of the medically needy would require repeal of the legislation, while full protection would require universal, seamless coverage.

Medical students often receive limited practical nutrition education, despite the important role of dietary modification in chronic disease management and prevention. Cooking with the Curriculum is an extracurricular program developed at the Larner College of Medicine to teach nutrition tenets through a culinary medicine lens while fostering leadership and teaching skills. The program uses a longitudinal learning and leadership development model. First-year medical student participants attend 5 sessions focused on dietary counseling for chronic disease. Participating second-year medical students serve as teaching assistants and facilitate sessions. Third and fourth-year medical students can continue to participate as leaders, training teaching assistants, taking responsibility for the administrative responsibilities of the program and facilitating case-based discussions in the session. Program evaluation included post-program surveys for first- and second-year students, pre- and post-program knowledge assessments for first-year students and a follow-up survey distributed to students from the 2023 pilot cohort during their third year of medical school. Seventy first-year medical students participated across 2024-2025, with a total of 33 students completing the post survey. Of those respondents, 97% agreed or strongly agreed that others in medical school would benefit from taking the program during their medical education training. All respondents who served as TAs reported that their participation enhanced their knowledge of culinary medicine. Among pilot cohort respondents now in their third year of medical school, 80% reported continued application of concepts during clinical rotations, with 90% reporting use of skills covered in the curriculum to guide patient counseling. Cooking with the Curriculum supports that a peer-teaching model can serve as a sustainable approach to enhancing nutrition education in medical training. Participants demonstrated increased confidence in nutrition-related knowledge and leadership skills, supporting the value of incorporating targeted educational initiatives into medical training. Limitations include a small sample size, and low post-program response rates, which may have introduced response bias, as well as reliance on internal funding which limits generalizability and scalability. Despite these limitations, the program provides encouraging preliminary evidence that nutrition-focused leadership training can help prepare future physicians to address nutrition-related health challenges.

Subject. Dynamics of the liquidity of the banking system and the government debt of Russia. Objectives. Identification of trends and structural shifts in the dynamics of the liquidity indicators of the banking system and the government debt of Russia. Methods. Comparative and trend analysis, statistical analysis methods, including calculation of averages and medians, as well as mathematical approximation are used. Results. In the field of liquidity, cyclical patterns have been identified, characterized by periods of significant increases in the provision of liquidity by the Bank of Russia to credit institutions against the background of stressful situations with a subsequent normalization phase. A tendency has been established towards an increase in the dependence of the banking system on refinancing by the Bank of Russia. In the field of public debt structure, a downward trend has been identified in the share of non-residents in the ownership of both domestic and foreign debt obligations. Trends indicate a structural shift towards internal sources of financing. Banks are expected to remain highly dependent on the liquidity of the Bank of Russia and reduce the participation of non-residents in the government debt market. The structural transformation of the financial system is revealed, characterized by the increasing role of the regulator as a key provider of liquidity, and the transition to a model of internal financing of public debt. Conclusions. The results of the study will be useful to regulators, financial institutions, and the scientific community in developing and implementing a set of coordinated measures aimed at diversifying funding sources, developing the domestic capital market, and maintaining monetary policy flexibility.

Competency-based medical education has long been considered the cornerstone of medical education. In psychiatry, structured competence evaluation in students' clerkships has been shown to enhance learning and feedback. This study aimed to develop, introduce and evaluate the use of competence cards in Danish psychiatric clerkships. Adopting Kern's six-step curriculum development model, we conducted questionnaire surveys, observations and interviews with students and faculty to identify learning needs. Three competence cards - psychiatric interview, documentation and coercive measures - were developed and introduced in two hospitals. Students and staff received written and oral instructions. The process was evaluated through interviews, which were analysed thematically. Only one of the 16 interviewed students had used the competence cards. Three themes emerged: 1) Missing educational scaffolding, 2) Student passivity and perceived guest role, and 3) Barriers to direct supervision. Students observed doctors rather than conducting independent interviews themselves. They reported receiving limited supervision due to staff shortages and experienced uncertainty about their role, rendering feedback difficult to obtain. Despite relevant preparation, competence cards were not integrated into psychiatric clerkships. Students requested mandatory implementation due to structural and supervisory barriers. Rethinking the clerkships and faculty development are essential prerequisites to the successful implementation of competence cards. Copenhagen University provided a grant, otherwise this study relied on internal funding. Not relevant.

Metallic tension-band wiring with K-wires and cerclage: tension-band wiring (TBW) remains the gold standard for surgery for patella fractures. Re-operation due to symptomatic implants is common. Non-metallic options, such as suture tension-band fixation (STBF), could be a solution. This study aimed to compare an STBF group with a TBW group with respect to complications and implant removal, and to describe the clinical results of the STBF group. All patient files with a patella fracture operated at our institution from 1 January 2016 to 19 August 2019 were reviewed on 1 May 2023. The prospective STBF group included all patients consecutively enrolled between 1 November 2018 and 19 August 2019. The historical TBW group included all patients consecutively enrolled from 1 January 2016 to 31 October 2018. The mean follow-up for the STBF (n = 24) group was 49 (44-54) months; for the TBW (n = 37) group, 74 (54-88) months. Seven of 23 patients in the STBF group and 19 of 36 in the TBW group had complications (p = 0.11). The STBF group had fewer adverse events than the TBW group, including fewer re-operations for symptomatic implants and fewer early secondary displacements (p = 0.06). No deep infections occurred in the STBF group. At the six-month follow-up, the STBF group had 23/24 unions. STBF was not associated with higher complication rates than TBW fixation. Department internal funding exclusively. Not relevant.

BackgroundDepression and anxiety frequently emerge during late adolescence and young adulthood; however, many conventional and app-based interventions struggle to sustain engagement. Virtual reality (VR) exergaming, music-based activities, and social interaction each show promise for supporting young people’s mental health, but their combined therapeutic value remains insufficiently tested.ObjectiveThis study aims to evaluate the effectiveness of a 6-week VR-based social musical exergame for reducing depressive and anxiety symptoms in young adults. The secondary objectives are to explore whether changes in basic psychological need satisfaction are associated with symptom change and to assess the effects on loneliness, presence, cardiorespiratory fitness, and in-game music-movement synchronization.MethodsThis study is a 3-arm, parallel-group randomized controlled trial. A total of 110 participants aged 18 to 25 years with mild to moderate depression or anxiety will be recruited and randomized in a 1:1:1 ratio to (1) a VR social musical exergame, (2) a matched VR solo musical exergame active control, or (3) a waitlist control receiving standardized mental health guidance. Assessments will be completed at baseline, at the postintervention assessment (week 6), and at the 1-month follow-up assessment (week 10). The primary planned comparison is the experimental group vs the active control group.ResultsThis study was approved by the ethics committee of Hunan Traditional Chinese Medical College on September 8, 2025 (YXLL202509006) and prospectively registered at ClinicalTrials.gov on March 15, 2026 (NCT07482852). Internal institutional funding had been secured. As of April 2026, the trial status was “not yet recruiting;” no participants had been enrolled, and no data analysis had been conducted. Recruitment is anticipated to begin in May 2026, with primary completion on March 1, 2028, study completion on May 1, 2028, and publication of the primary findings expected in late 2028.ConclusionsThis protocol describes a self-determination theory–informed, multicomponent VR intervention designed to evaluate whether adding a bundled social layer to a matched solo exergame improves short-term mental health outcomes. The trial is expected to provide initial evidence on efficacy, safety, and potential mechanisms while generating hypotheses for future dismantling and longer-term trials.Trial RegistrationClinicalTrials.gov NCT07482852; https://clinicaltrials.gov/ct2/show/NCT07482852International Registered Report Identifier (IRRID)PRR1-10.2196/83737

This article examines inclusive work models in Russian cultural institutions, documenting institutional models of work with the blind and visually impaired in Russian museums and theaters against the backdrop of a broadening inclusion agenda and a shift toward results-oriented management approaches in the cultural sector. The goal is to classify models of interaction with this group of visitors and highlight their strengths and weaknesses in terms of management, resources, and sustainability. Modeling and comparative analysis of empirical data are used, drawing on monitoring data conducted by the VER.SIA LAB Laboratory for Social Research and Analytics in 2024 as part of the "Special View" Program of the Art, Science, and Sport Foundation. Three successive stages of inclusive policy development in cultural organizations are identified, also known as models of inclusive policy: episodic, project-based, and program-based. The episodic model is based on one-time actions and the enthusiasm of individual employees. It is not formally documented and lacks its own budget, making inclusion vulnerable to staffing and financial changes. The project model relies on grants, sponsorship, and team expansion, enabling more regular practices, but remains dependent on external funding and a shortage of staff dedicated to inclusion. The program-based model assumes inclusion is integrated into the development strategy, with stable internal funding and specialized positions allocated. However, it faces the risk of bureaucratization and loss of priority when the management agenda shifts. The transition from the episodic to the project-based and then to the program-based model requires management support, inclusion being anchored in strategic documents, regular budgeting, developing partnerships with NGOs and communities of people with visual impairments, and their inclusion in participatory program design. For cultural institution managers, a typology of inclusion models is important as a tool for assessing the current level of development of inclusive work, planning a transition to more sustainable models, and minimizing risks associated with human factors and funding instability. The authors formulate practical conclusions for managers: the need to institutionalize inclusion in the institution's mission and strategy, create cross-functional teams, develop partnerships with communities of blind and visually impaired people, and gradually transform successful projects into permanent services. The article is addressed to museum and theater directors, program curators, and inclusion and cultural policy specialists.

This research enhances the literature on bank capital structure by combining financial intermediation theory with technological innovation to analyse the impact of FinTech adoption and liquidity management on leverage choices in South African banks. Utilising panel data spanning 2015 to 2024 and applying the Generalised Method of Moments (GMM) to tackle endogeneity and dynamic persistence, the research presents new findings from an overlooked emerging market setting. The results show a diverse effect of technology on leverage. Conventional banking systems, represented by automated teller machines (ATMs), show a positive relationship with the total debt ratio (TDR), suggesting a capital-intensive nature of tangible assets. Conversely, digital technologies such as mobile banking and a composite FinTech Index display a notable negative correlation with leverage, indicating that digital transformation improves efficiency, strengthens internal funding capacity, and reduces dependence on external debt. Moreover, increased liquidity levels are negatively correlated with leverage, suggesting that well-capitalised banks with robust liquidity rely less on debt funding. By examining FinTech and liquidity dynamics, the research contributes to both theory and practice, emphasising digital innovation as an alternative to external funding and stressing the importance of sound liquidity management amid evolving regulatory environments such as Basel III.

In Santa Barbara County, the Youth Empowerment Services (YES) Program brought together several government and community‐based organizations, as well as a university‐based evaluation team, to provide pre‐adjudication diversion to youth ages 12 to 17. The primary goals of this program were to reduce the number of misdemeanor arrests and reoffending rates in the county's juvenile justice system, and to support the strengths and needs of youth in a trauma‐informed and culturally sensitive manner. This first‐person account article shares the experiences of a community‐university partnership with the implementation of this program. A history of collaboration, flexibility in the face of a global pandemic, and clinically useful evaluation tools supported the program during its initial external funding period and its continued success with a sustainable infrastructure and internal funding.

ABSTRACT This paper investigates how education and training institutions in Portugal fund internationalisation, moving beyond the traditional focus on higher education. Employing a convergent parallel mixed‐methods design through a nationwide survey and interviews, it reveals a two‐tiered system shaped by funding availability and diversity. Higher education institutions leverage a diversified portfolio of internal, national, and European funds to fuel ambitious, competitive agendas that reflect their complex missions. In contrast, the non‐tertiary sectors (School, Adult and Vocational Education) are critically dependent on a single source, Erasmus+, a dependency that channels their efforts primarily towards mobility, constraining their strategic autonomy and creating a structural inequality within the national system. The study argues that funding is not a neutral facilitator but a powerful force that influences the scope and nature of internationalisation. It concludes by proposing future research avenues and policy actions to foster more equitable international engagement across sectors.

Objectives/Goals: CTSA programs’ requests for applications (RFAs) can be hindered by misalignments with grantees’ needs and expectations. Using a customer discovery approach, we identified real and perceived barriers to conducting pragmatic EHR-embedded trials (PEET) to inform RFA optimization, demonstrating how this funding opportunity addressed barriers. Methods/Study Population: Using Colorado Profiles, a research networking tool, we identified investigators who engaged in PEET-type research across the Colorado Clinical and Translational Sciences Institute (CCTSI) partnering institutions. We invited 33 investigators representing key centers and departments to participate in 30-minute, virtual customer discovery interviews about their experiences conducting PEET-type research within CCTSI’s PEET health system partner, UCHealth. Interviews were conducted using a semi-structured interview guide and were synthesized using a Value Proposition Canvas to identify relevant investigator “jobs-to-be-done,” pain points and potential benefits and strategies to optimize our internal RFA (now in its third year) to address these. Results/Anticipated Results: Twenty-one investigators participated in interviews, including five previous applicants. Two key “customer segments” emerged from interviews: 1) early-career investigators, who wanted to build connections and competencies related to PEET-type research and were often transitioning to independent funding; and 2) experienced investigators, who were focused on larger grants, but valued support in interfacing with UCHealth around both research implementation and informatics. For both groups, while the research funding was seen as beneficial, the true value of the PEET support was the facilitation of a relationship with the health system. Potential changes to the PEET RFA include eligibility clarifications, increased emphasis on health system liaison support, and increased budget flexibility. Discussion/Significance of Impact: In PEETs, alignment of the health system, research infrastructure, and investigators is essential to trial success. Through this process, we identified key unmet needs for investigators and opportunities to optimize this internal RFA to enhance overall alignment between institutional capacities and investigator needs.

Financing, as the cornerstone of enterprises' funds, is the core support for its long-term operation and development. Researchers have conducted a scientific and systematic analysis of the main financing channels. However, some enterprises lack a comprehensive understanding of the financing channels and the space for optimizing the financing structure, resulting in a series of problems such as unreasonable financing structure and high financing costs. Therefore, this paper aims to summarize the advantages, disadvantages, and actual performance of various financing channels by collecting relevant research materials and data. And combining them with practical case analysis as well. At present, it is known that external financing is the main financing for enterprises. Although enterprises should take certain risks, it is more conducive to financing and long-term development. Inside it, equity financing and debt financing each have their own advantages and disadvantages. In contrast, internal financing has the opposite advantages and disadvantages in the development of enterprises. The financing risk is relatively low, but at the same time, excessive internal financing can also easily squeeze the development space of enterprises.

This paper investigates financing and operational decision-making in dual-channel fresh produce supply chains under conditions of asymmetric demand information. We develop a game-theoretic framework that jointly integrates freshness investment, dual-channel operations, and financing strategy choice. Equilibrium outcomes for freshness effort, wholesale pricing, and supply quantity are derived under four scenarios corresponding to internal financing and bank financing across high- and low-demand volatility regimes. The analytical results demonstrate that demand volatility plays a pivotal role in shaping both operational decisions and profit allocation between suppliers and retailers. Under relatively stable demand conditions, internal financing enhances supply chain coordination, whereas heightened volatility undermines its feasibility for capital-constrained retailers and shifts financing preferences toward bank credit. Moreover, changes in demand volatility systematically redistribute profits along the supply chain, underscoring financing design as a critical strategic instrument under uncertainty. To strengthen practical relevance, we conduct a case study based on Company A's annual report data. Through forecasting the share of online channels, the proportion of bank loans, and profit margins, combined with calibration using real parameters, the credibility of the theoretical model is empirically validated.

A collaborative approach to curriculum transformation (CT) ensures that higher education programmes remain inclusive, future-ready and responsive to societal needs. Guided by Stakeholder Theory and Clark’s Triangle of Coordination, this study examined how a multistakeholder approach shapes CT in a South African Open Distance e-Learning (ODeL) university. The study addressed the question: how does collaborative stakeholder engagement influence CT in an ODeL context? While transformation efforts aim to integrate Afrikan epistemologies, pedagogical renewal, online teaching and innovative assessment, challenges persist. Using a qualitative critical ethnographic case study, the research drew on participant observation, field notes, document analysis and interviews with 15 purposefully selected participants – one CT head, five champions, six lecturers and three students. Findings show that Department of Higher Education and Training (DHET), institutional management, champions, lecturers and students each played distinct roles in advancing transformation principles such as Afrikan epistemologies, pedagogical renewal, online teaching and innovative assessment. While stakeholder involvement strengthened collaboration, significant barriers emerged, including epistemological resistance, uneven digital competence, increased workload, misaligned expectations and declining momentum after DHET funding ended. Addressing these challenges is crucial for effective CT. Contribution: The study concludes that sustainable curriculum transformation in ODeL settings requires continuous dialogue, stronger institutional support, internal funding mechanisms and dedicated capacity-building for champions and lecturers. These conditions are essential for embedding Afrikan epistemologies and promoting meaningful, long-term pedagogical renewal.

The objective of this study is related to a holistic approach underscoring the decisions of SMEs to apply for bank loans. A hybrid or triangulation approach research design was used to achieve the objective of the study. Questionnaires were used to collectdata from 450 SMEs sampled using convenience sampling technique. Logistic regression statistical technique was used to analyse collected data. The results of the study showed that ageof SMEs, sizes of SMEs, number of years in business, business plan, accounting practice, network and relationship with bank(s), internal funds, level of education, business experience, control aversion, optimistic view, interest rate, and collateral significantly influence the decisions of SMEs to apply for bank loans. By implication, to reduce the financing lacuna, it is important to incentiviseSMEs to apply for bank loans by targeting and implementing policies related to characteristics of SMEs, characteristics of owner/managers, and lending conditions.

Local public services are central to the collective well-being and community development. Identifying sustainable success factors in managing public services is crucial. Drawing on Public Value Theory, this study investigates the key factors enabling public service operators to produce value simultaneously for citizens (social value), the environment (environmental value) and themselves (economic value), as well as the elements that make the management of public services unique to companies with entirely publicly owned capital. Through an in-depth analysis of four Italian, fully municipality-owned public service companies operating in different sectors, we found that four interconnected key success factors enable the production of such a multi-dimensional value: responsible corporate governance, high-quality and stable management, commitment to research and innovation, and stakeholder engagement. Moreover, two elements seem to distinguish the management of public services offered by companies with wholly publicly owned capital from those with mixed or entirely private capital: lower pressure for dividends, which supports investments through self-financing, and the lack of perceived competition, which fosters knowledge sharing beyond the served territories. Points for practitioners This study provides useful suggestions to policymakers and public managers on how to enhance public value creation for citizens and stakeholders, the environment and the company itself through municipally owned corporations offering public services. This is expected to occur through pursuing responsible and cohesive forms of governance, hiring high-quality, autonomous managers, engaging citizens and stakeholders and making a commitment to innovation, as well as having a parsimonious dividend policy aimed at internal funding of investments and fostering openness to knowledge sharing beyond the served territories.

While philanthropy, multilateral support and innovative internal funding approaches remain important to address surgical healthcare needs, there is increasing demand for efficiency models that maximise the impact of available resources. Cost-saving strategies are attractive to governments. We sought to answer the scoping review question: 'What are documented and transferable system-level cost-saving strategies in the provision of surgical healthcare services applicable in limited-resource settings?' The scoping review was guided by the Arksey and O'Malley framework and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines; 642 studies were screened from PubMed, EMBASE, Global Index Medicus, Africa Journals Online and Google Scholar (2015-2024), without language or article type restrictions. Following title, abstract and full-text screening by 2 independent reviewers, we identified 63 records that met inclusion criteria: documented cost-saving strategies in surgical systems from community to national levels. Strategies were extracted into a theoretical framework adapted from the Procter and Gamble's cost optimisation model and the Triple Aim Framework using Jabareen's eight-step method. Most literature on cost savings for surgical healthcare was from high-income countries (81%), at national levels (48%), and focused on orthopaedic/cardiothoracic/vascular surgery. Most (25%) were retrospective observational studies or economic modelling (21%). We synthesised 125 distinct cost-saving strategies into 32 transferable strategies across five thematic areas, prioritised using a sustainability and scalability lens-preventative healthcare management (9%), surgical healthcare guidelines and pathways (31%), payment model transformation (19%), lean principles (25%) and technology adoption (16%). Strategies focused on governance, standardisation and process redesign were more likely to be sustainable and scalable with minimal resources, whereas interventions requiring coordinated delivery models or advanced digital infrastructure were more scale-dependent CONCLUSIONS: We identified an integrated portfolio of contextualisable surgical cost-saving strategies that eliminate system waste, improve efficiency and result in savings. Policymakers and health system stakeholders in low-income and middle-income countries can use this structured evidence to prioritise, implement and scale cost-saving strategies.