The transition towards a sustainable future is increasingly understood to rely on further development of the bioeconomy. In this, both public and private sectors play pivotal roles. Government agencies and public institutions are instrumental in shaping the trajectory of the bioeconomy through strategic frameworks, regulatory measures, and policies. These instruments may create a conducive environment by clearing away bureaucratic impediments and establishing favourable conditions. Concurrently, private sector entities, including industry interest groups and companies, have the important task of advocating for these favourable conditions and driving the bioeconomy's growth through active involvement, strategic business decisions, capital investments, and bringing bio-based innovations to market. Throughout these processes, perceptions of the bioeconomy held by actors in both sectors shape the outcomes of their actions. Hence, this study delves into the perceptions of the bioeconomy among stakeholders from both the public and private sectors across nine European regions regarding barriers and supporting conditions impacting its development, particularly important bioeconomy value chains, and the willingness and perceived responsibility to advance the bioeconomy. Findings from 534 online survey responses (288 public sector and 246 private sector) reveal that key factors identified as propelling the development of the bioeconomy forward include access to investment and scientific knowledge, while obstacles such as limited cooperation among stakeholders and inadequate supportive policies and legislative environments were noted as primary hindrances. Among the value chains highlighted, bioenergy was frequently recognised as having high growth potential, while not necessarily being the one with the most significant environmental benefits. Both the public and the private sector demonstrated a high willingness to develop the bioeconomy, yet both also assigned more responsibility to the public sector in three main areas: enhancing societal awareness and communication about the bioeconomy, ensuring beneficial environmental and social impacts, and investing in the bioeconomy's growth.

Association of hospitalization costs with demographic, socioeconomic, and lifestyle characteristics: Population-based study in Sao Paulo city, Brazil, 2003-2015.

The COVID-19 pandemic accelerated the adoption of work-from-home (WFH) practices, raising important questions about their long-term implications for organisational performance. This issue is particularly salient for multinational enterprises (MNEs) and international small and medium-sized enterprises (SMEs), where digitalisation has significantly reshaped work arrangements. This study evaluates the advantages and disadvantages of WFH and their differential impacts on MNEs and international SMEs. A comparative analysis was conducted using expert pairwise judgements, assessed through linguistic terms with weakened hedges (LTWHs) within the Best–Worst Method (BWM) framework. The LTWHs approach enables experts to articulate nuanced and flexible preferences, extending traditional linguistic scales by softening the strength of evaluations. This makes it particularly suited for capturing subjective assessments of WFH impacts under conditions of uncertainty. The findings indicate substantial variation in WFH adoption, with private sector organisations demonstrating approximately 50 % greater willingness to adopt WFH compared to public authorities. The analysis further highlights the distinct advantages and disadvantages that shape the performance outcomes of MNEs and international SMEs. By introducing a novel hesitant fuzzy linguistic preference approach, this study develops a comprehensive framework for assessing the organisational consequences of WFH. The results offer valuable insights for managers and policymakers seeking to strike a balance between flexibility, productivity, and resilience in the design of post-pandemic work strategies. • Paper investigates the implications of work-from-home using digitalisation. • This is done on the performance of multinational enterprises and international SMEs. • Findings reveal a difference between the public and private sectors in their adoption of WFH. • Study highlights pros and cons of WFH, demonstrating their varying impacts.

Psychiatric consultant-liaison nurses play a crucial role in ensuring prompt and effective mental health care, though the volume of empirical research on nurse-led consultant-liaison models in the private sector is limited. This study evaluated the service activity and immediate service-level outcomes of a nurse-led Psychiatric Consultant-Liaison service within an Australian metropolitan private hospital. The study aimed to explore: (1) consumer case-mix; (2) trends in consumer referrals and outcomes; and (3) the perceived usefulness and acceptability of the service among referring nurses. A prospective, observational descriptive approach was employed, comprising evaluations of service activity between 2020 and 2023 and surveys of clinical nursing staff. The service was widely utilised, with 789 consumers referred for various mental health, neurological or psychosocial concerns. Depressive symptoms, anxiety, substance and self-harm risks were common and nurses reported positive perceptions of the service, particularly in the provision of enhanced support for behaviours of concern. Periods of state-wide COVID-19 restrictions were associated with increased presentations involving depressive symptoms, post-traumatic stress disorder and increased referrals to external providers. While the service facilitated effective management of complex mental health cases, general nursing staff reported continuing gaps in their mental health competencies. This study demonstrated that a nurse-led PCLN service was a highly utilised and valued model of care within the private acute hospital setting, supporting the assessment and management of complex mental health presentations. These findings highlight the expanded scope and relevance of the PCLN role in private healthcare and underscore the importance of ongoing mental health capability development among general nursing staff to maximise the effectiveness of liaison services.

In recent years, major technological advances have significantly improved our ability to assess the distribution and health status of marine habitats and their associated biodiversity. Yet, comprehensive overviews of how these innovations are being applied across public and private sectors remain scarce. One reason for this gap is partly due to still scarce interdisciplinary research and to the rapid pace of technological evolution, which often renders tools quickly obsolete, making it difficult for the scientific community to stay up to date. Also, despite their enormous potential, the high costs of advanced technologies still limit their accessibility and widespread use in marine monitoring. This review addresses these challenges by providing a comprehensive overview of the methodologies currently used to monitor and map marine biodiversity across diverse marine ecosystems, with a focus on technological developments from the last decade (2014-2024). By synthesizing approaches spanning marine robotics, remote sensing, and automated sensing systems, the review highlights both the expanding observational capabilities enabled by these tools and the limitations that hinder their effective operational uptake. By adopting an integrated and application-oriented perspective, this work aims to foster and pave the way for collaboration and knowledge exchange across disciplines and sectors, especially between ecologists, engineers, and stakeholders from private and public sectors, as well as to support the development of accessible, comparable, and actionable technological pathways for marine biodiversity monitoring and conservation.

Emerging Technologies, Education, and Governance in Latin American Dentistry: Perspectives from Venezuela and Nicaragua.

Systematic reduction of negative laparoscopy for pelvic pain is crucial to reducing surgical morbidity, improving diagnostic accuracy and minimising cost. This study aims to determine the incidence and consider the underlying causes of negative laparoscopy in women presenting with pelvic pain. A 5-year, retrospective cohort study was undertaken for women undergoing laparoscopy for pelvic pain. Patient selection was from an Australian tertiary public hospital with both non-fellowship trained gynaecologists and an Australasian Gynaecological Endoscopic Surgery (AGES) accredited training programme (fellowship trained) as well as one private clinic comprising two fellowship trained gynaecologists. Data was collected from the medical records. A 'negative' laparoscopy was defined either visually or by vision and negative biopsy on histology. The rate of negative laparoscopy in the public and private sector was compared using an odds ratio. Of 1309 women, 174 (13%) had a negative laparoscopy. The negative laparoscopy rate was significantly higher amongst non-fellowship trained gynaecologists compared to those with fellowship training (OR = 2.48; 95% CI: 1.76-3.43, p < 0.05). Visually negative laparoscopy was made in 48/174 (28%) of cases, all from the public sector, with 41/48 (85%) of laparoscopies without biopsy performed by non-fellowship trained gynaecologists. A 56% discordance between intraoperative visualisation and histopathological findings was identified. Overall, negative laparoscopy rates are low compared to previously reported data. The discrepancy between the healthcare sectors likely relates to patient factors, surgical training, and clinician bias. Peritoneal biopsy for symptomatic patients undergoing laparoscopy should be considered due to the potential to miss superficial disease.

To establish research priorities for Australian Nurse Practitioners and develop a robust research agenda. A descriptive, exploratory approach was used and conducted in two stages. Data were collected over two stages. Data for Stage 1 were collected from 14 December 2023 to 16 February 2024. For the Delphi rounds (Stage 2), data were collected from 11 March to 24 March 2024 for Delphi Round 1 and from 12 June to 26 June 2024 for Delphi Round 2. An exploratory survey was used in Stage 1 to identify clinical challenges and research themes perceived as important for Australian Nurse Practitioners. In Stage 2, a two-phased modified Delphi survey was conducted to prioritise the research themes identified in Stage 1. A total of 315 participants responded to the exploratory survey, with a majority being female (77%), aged between 30 and 75 years. Participants were primarily employed in the public healthcare sector (60%), the private sector (23%), while 17% practised across both sectors. A total of 1335 challenges facing Australian Nurse Practitioners were identified. Sixty-nine participants completed the first Delphi round, and 33 the second, giving response rates of 21% (69/315) and 48% (33/69), respectively. The first Delphi round yielded 11 research themes. Seven of these yielded Content Validity Indices of < 0.90. Four research priority areas remained and were ranked in order of importance. The identified Australian Nurse Practitioner research priorities will play a pivotal role in shaping policies, fostering the efficient integration of Nurse Practitioners into the healthcare system and advancing research capacity. Nurse Practitioners are established providers of high-quality care internationally; however, they face persistent integration challenges in Australia. This study delivers a nationally relevant, consensus-based research agenda that identifies key priorities across clinical, educational and leadership domains. No patient or public contribution.

This study aimed to collect data of national dental associations (NDAs) on workforce composition, employment patterns, academic representation, specialization, and women's participation in leadership roles. A validated online-questionnaire was distributed to 189 NDAs across 133 countries within the FDI World Dental Federation-section Women-Dentists-Worldwide. Responses were categorized into five geo-areas. χ² tests and multivariate multinomial logistic regression analyses were used to examine the independent correlations between sex distribution, specialization, pay disparities, and career progression. Forty-four NDAs from 37 countries participated (23.3%). In 80% of NDAs, women represented >50% of dental students; in 44.5% enrolment exceeded 60%. Female specialization rates varied by region (Europe 24.6%, Central/North America 19.1%, Asia 15.3%), while women remained underrepresented in surgical fields (1.5%-2.9%). Leadership representation was limited: 34.2% of NDAs reported 0% to 20% female professors and 24.4% reported 21% to 40%. Female deans were reported in 41.5% (0%-20%), 19.5% (21%-40%), and 12.2% (81%-100%) of NDAs. In scientific associations, 43.2% reported 0% to 20% female presidents, 11.4% reported 81% to 100%. Council representation clustered at 0-20% (22.7%) and 21-40% (31.8%); assemblies at 13.6% (0%-20%), 29.5% (21%-40%) and 22.7% (41%-60%). Regarding gender-based pay, 67.6% of NDAs reported no differences, 29.7% report no data, only one NDA reported a 35% pay gap in private sector. Despite high female student representation, women remain underrepresented in academic and professional leadership. Reported barriers included uneven family responsibilities and limited mentoring. These findings highlight the need for structural measures that support equitable career development and inclusive policies in dentistry. Although women increasingly study dentistry worldwide, they remain underrepresented in specializations and leadership positions, potentially affecting workforce composition, academic career, and organizational structures. Structural measures are essential to promote equitable career development and inclusive policies within the dental profession.

Branched broomrape is of growing concern to the California processing tomato industry, with integrated management strategies needed to reduce the impact of the current infestation and mitigate the spread of this highly regulated parasitic weed. Herbicide efficacy research was conducted in 2020 and 2021 in a field known to be highly infested with branched broomrape; however, no broomrape emerged during the 2021 study. Because the 2020 and 2021 field trials had different tomato cultivars, subsequent research was conducted to evaluate the effects of cultivar on broomrape emergence. In the same broomrape-infested field site, several commercial processing tomato cultivars and grafted combinations were evaluated from 2022 to 2024. In addition to field studies, greenhouse cultivar screening studies were conducted from 2022 to 2025, evaluating 25 cultivars for broomrape sensitivity. Results from the 2022 greenhouse screening indicated that all tested cultivars, including the cultivar planted at the infested site in 2021, were susceptible to parasitism after inoculation with preconditioned broomrape seed, but that there was only minor variation in temporal emergence. The results from 2023 greenhouse study supported the 2022 results, with all tomato cultivars parasitized and only minor differences in broomrape emergence. In the 2024 greenhouse study, there was no broomrape emergence in any of the tested cultivars, possibly due to hot conditions in the greenhouse. In the 2025 greenhouse study, there were no significant differences in days to broomrape emergence among the tomato cultivars. Field cultivar studies conducted in 2023 and 2024 showed no significant differences in broomrape emergence among conventional or grafted cultivar combinations ( P = 0.23, 0.74); results for the nongrafted cultivars were consistent with greenhouse studies. Taken together, these experiments suggest that there is negligible variation in broomrape resistance among the tested currently available commercial cultivars; there is now considerable effort in the public and private sectors toward breeding for resistance to broomrape targeting several pathways. In addition, with the advent of high-throughput grafting technology, there is potential for using novel genetics from rootstocks in commercially planted processing tomatoes.

The historical context of gender-affirming healthcare (GAH) in Morocco presents a paradox. While Casablanca emerged as a global hub for such medical procedures from the 1950s to the 1970s, access to care was not available to local Moroccan citizens. Currently, transgender and gender non-conforming (TGNC) individuals experience what can be described as a "ban by silence." Although there is no explicit legal prohibition against GAH, its accessibility is effectively undermined by institutional neglect, inadequate medical education, and pervasive socio-religious biases among healthcare providers. This research aims to generate empirical evidence to inform advocacy and programming related to TGNC healthcare rights. This qualitative participatory action research study is grounded in in-depth, semi-structured interviews with 13 TGNC individuals who have sought GAH in Morocco. Participants were recruited in collaboration with a local transgender activist to foster trust within the community. A thematic analysis of the interviews was conducted to identify significant barriers and personal experiences related to accessing care. This analysis was further contextualized through a comparative review of informal care networks in Egypt and Lebanon. The findings indicate a complete absence of GAH within both the public and private healthcare sectors in Morocco. The healthcare environment is characterized by hostility, with inadequately trained providers often refusing care, attempting conversion therapy, or erroneously citing legal prohibitions. Consequently, participants are compelled to resort to unsafe, unregulated hormone therapies without medical oversight, such as the use of birth control pills. Systemic discrimination in education and employment results in considerable economic precarity, with many individuals engaging in survival sex work. Compounded by familial rejection and social stigma, these conditions render life in Morocco untenable, compelling migration as the sole viable option for safety and access to essential medical care. The legislative void in Morocco operates as a "ban by silence," a phenomenon that remains underrepresented in academic literature. This study seeks to address this gap by documenting the lived experiences of TGNC individuals navigating this de facto prohibition. The research advances a participant-led call for urgent reform, prioritizing three key areas: the establishment of legal and accessible pathways for medical transition; mandatory training for medical staff to eliminate discrimination; and the creation of affirming mental health services. Future research should continue to illuminate these invisible barriers to dismantle the systemic neglect that denies TGNC Moroccans their right to health. • Morocco’s ‘ban by silence’ effectively restricts healthcare access for transgender individuals. • State neglect forces TGNC people to seek care through unsafe and unregulated medical networks. • Providers often deny care by citing non-existent and inaccurate legal prohibitions. • Migration is seen as the only way to safely obtain essential medical care and safety.

Global goals are theorized to catalyze non-state actors' existing strategies and practices to promote sustainable development. This research examines whether and how the 2015 UN Sustainable Development Goals (SDGs) catalyzed the Global Movement for Voluntary Living Wages (GMVLW). The GMVLW encourages and empowers companies to voluntarily pay workers enough to meet their basic needs and save for emergencies. This “living wage” is, in most countries, above the legal minimum wage. The article first offers an original theoretical framework of seven types of steering effects: discursive, normative, institutional, relational, resource, problem-solving, and progress. This framework draws on, consolidates, and expands on existing research. It then draws on coded fieldnotes from 46 interviews and 54 events related to GMVLW to describe how the movement changed from 2004 to 2024, and to assess whether these changes correlate with the SDGs and how the SDGs may have steered them. This research finds that the SDGs quickly led several national development organizations and a few corporations to prioritize living wages. This support appears to have greatly accelerated the GMVLW. Most significantly, it seems to have enhanced the movement's capacity to solve problems related to living wage implementation, such as developing widely accepted methodologies and freely available estimates. At the same time, the SDGs do not appear to have steered the movement toward significant progress , as defined by the number of workers currently earning a living wage. New due diligence legislation and emerging ESG (environmental, social, governance) norms also appear to have supported progress in the GMVLW. • The SDGs may steer changes in discourse, priorities, institutions, relationships, resources, problem-solving, and progress. • Although the SDGs did not ignite the movement for living wages, the SDGs accelerated its advancement. • The SDGs are among several factors that contributed to the expansion of voluntary living wages. • The SDGs catalyzed private sector changes related to implementing the SDGs.

Agent-based modeling (ABM) is a unique tool for understanding social mechanisms and emergent phenomena. The paper presents an empirically grounded agent-based model that simulates how stakeholders embedded in flood governance networks facilitate community loss-sharing and post-flood recovery. The model is designed and calibrated using extensive empirical data from communities in Guangzhou, China. Modeled agents include multi-level government agencies, NGOs, private sector entities, and local clans, among others. The model integrates core processes (rainfall and flood impacts, network-based loss sharing and recovery, and the implementation of resilience measures) with modules for trust evolution and resource constraints. The purpose of this model is to evaluate the effects of different network structures, inter-stakeholder trust, and the diffusion of flood resilience measures on community flood resilience, and to advance the understanding of how resilience emerges as a macro-level attribute from micro-level interactions. Innovations are twofold: First, it moves beyond static analysis to simulate the dynamic, network-based collaborative processes among diverse institutional stakeholders; Second, it implements a process-based framework to measure community robustness and adaptivity, using these metrics to evaluate overall community resilience to floods. Key parameters, derived from literature and empirical research, were validated and tested via sensitivity analysis. The model serves as an accessible tool for researchers and practitioners interested in stakeholder collaborations in community-level climate governance and identifying optimal intervention strategies. • The model is described using the ODD protocol. • Validation, sensitivity analysis, and the number of minimum simulation runs are explained. • Complete NetLogo code and a brief user guide are provided.

Introduction:Acute kidney injury (AKI) is a critical complication of COVID-19, yet disparities in outcomes between public and private healthcare systems remain underexplored. Brazil’s two-tiered healthcare system offers a unique setting to evaluate how resource allocation impacts AKI outcomes. This study compares AKI epidemiology in COVID-19 patients treated in two Brazilian hospitals, one publicly governed and the other of privately governed.Methods:This retrospective cohort study analyzed 2,333 ICU patients with RT-PCR–confirmed COVID-19 (public 1,041; private 1,292, March 2020–April 2022). AKI was defined per KDIGO criteria and recovery was classified using ADQI guidelines. Multivariate logistic regression and Cox models were used to assess predictors of AKI incidence and mortality. To account for competing risk of in-hospital death, a Fine-Gray model was used to evaluate renal recovery.Results:AKI incidence was high in both settings (private, 80.4%; public, 78.8%). Despite comparable baseline characteristics, public hospital patients had significantly higher mortality rates (46.7% vs. 31.3%, p < 0.001). After adjusting for confounders, public hospital admission remained an independent predictor of AKI incidence (OR 1.279, 95% CI 1.012 – 1.620) and mortality (HR 1.675, 95% CI 1.435–1.956). While crude recovery rates appeared higher in public hospitals, competing risk analysis revealed significantly lower recovery probability (SHR 0.650, 95% CI 0.554–0.762).Discussion:Despite comparable AKI incidence, public hospital patients had higher mortality and lower renal recovery, likely reflecting resource disparities. These findings underscore the need to address cost-effectiveness and equity between the public and private sectors healthcare systems.

The smart manufacturing revolution: how industrial robotics reshape supplier networks

Acute kidney injury (AKI) is a critical complication of COVID-19, yet disparities in outcomes between public and private healthcare systems remain underexplored. Brazil's two-tiered healthcare system offers a unique setting to evaluate how resource allocation impacts AKI outcomes. This study compares AKI epidemiology in COVID-19 patients treated in two Brazilian hospitals, one publicly governed and the other of privately governed. This retrospective cohort study analyzed 2,333 ICU patients with RT-PCR-confirmed COVID-19 (public 1,041; private 1,292, March 2020-April 2022). AKI was defined per KDIGO criteria and recovery was classified using ADQI guidelines. Multivariate logistic regression and Cox models were used to assess predictors of AKI incidence and mortality. To account for competing risk of in-hospital death, a Fine-Gray model was used to evaluate renal recovery. AKI incidence was high in both settings (private, 80.4%; public, 78.8%). Despite comparable baseline characteristics, public hospital patients had significantly higher mortality rates (46.7% vs. 31.3%, p < 0.001). After adjusting for confounders, public hospital admission remained an independent predictor of AKI incidence (OR 1.279, 95% CI 1.012 - 1.620) and mortality (HR 1.675, 95% CI 1.435-1.956). While crude recovery rates appeared higher in public hospitals, competing risk analysis revealed significantly lower recovery probability (SHR 0.650, 95% CI 0.554-0.762). Despite comparable AKI incidence, public hospital patients had higher mortality and lower renal recovery, likely reflecting resource disparities. These findings underscore the need to address cost-effectiveness and equity between the public and private sectors healthcare systems.

While the majority in the Global North have enjoyed modern drinking water systems for nearly a century, powerful actors including the World Bank and the OECD are pushing for innovations aimed at addressing access gaps in the world’s poorest communities. These efforts seek to revive private sector involvement in the water sector, which has declined significantly over the past two decades. This paper situates the drive for innovation within a broader restructuring of international development cooperation that positions private finance and technological innovation as central to achieving Sustainable Development Goal 6 (SDG 6). I conceptualize this restructuring as part of a climate-sustainable-development industrial complex (CSDIC): an assemblage of state institutions, multilateral agencies, and financial actors mobilizing sustainability discourses to open new frontiers for capital accumulation. Drawing on political ecology, water justice scholarship, and theories of racial capitalism, I examine how Africa has been constructed as both a site of humanitarian crisis and a frontier for investment, and how techno-financial reforms rescale water governance, discipline public provision, and convert racialized precarity into opportunities for private investment. The analysis combines a critical document review of global water policy interventions with solidarity-based research in Cape Town, South Africa. I show how innovations advanced under the banner of climate resilience and sustainable development contribute to ’water apartheid’, disproportionately burdening Black working-class communities while consolidating new financial claims over water infrastructure in the Global South. Drawing from a case study of grassroots resistance in Cape Town, the paper also highlights pathways for solidarity and underscores the need to reassert collective, public, and anti-colonial approaches to water governance.

Prevention, detection, and response to pandemic-prone diseases involve collecting, analyzing, and applying data swiftly at scale. Achieving these goals requires adequate information technology and a skilled public health workforce capable of translating data into action. While public health informatics and data science programs are established in parts of the Western world, Eastern Europe and Central Asia (EECA) face significant gaps in educational pathways. This study mapped the educational and labor market structures in Georgia, Kazakhstan, and Moldova, identified barriers to training and retaining professionals in public health informatics and data science, and proposed sustainable models for integrating training into national systems. A mixed-methods approach included a review of 111 policy and regulatory documents, labor-market analysis, 147 semistructured interviews, seven focus groups, and two expert workshops (n = 72) that validated findings and prioritized policy options. Although all three countries demonstrate strategic commitment to digital transformation, investment in human capital remains insufficient. Educational programs are isolated, with no accredited degrees in these professions, and accreditation processes delay educational innovations. Employers lack awareness of the value of these professions, and salary gaps between the health and information technology sectors, as well as between public and private sectors, weaken workforce retention. The absence of occupational recognition in national regulations further constrains workforce development. Stakeholders endorsed modular, competency-based training-integrated into Master of Public Health programs and in-service certificates-as the most feasible way to scale capacity. Building a sustainable workforce requires short-term measures such as problem-based and continuing training, along with long-term policies that (i) prioritize human capital development in national digital health strategies, (ii) adjust educational and occupational classifications, (iii) modernize accreditation processes for modular credentialing, and (iv) align incentives to attract and retain talent. Together, these actions could enable EECA health systems to harness digital innovation for better health outcomes.

Using evidence from nine countries (Democratic Republic of Congo, Dominica, Egypt, Kazakhstan, Kenya, New Zealand, Thailand, Tunisia, and Uruguay), we analyze the political economy dynamics that emerged during implementation of primary health care (PHC)-oriented reforms. Across these cases, we identify 10 recurring health-system "shifts" toward stronger PHC orientation, which serve as a descriptive framework for examining the political economy challenges reformers faced and the strategies they used to navigate them. Primary data were collected from 356 participants through key informant interviews, focus groups, and expert consultations and were triangulated with document review. Using deductive mapping and inductive thematic analysis, we identify 10 PHC-focused health-system shifts present in some or all of the cases. These entailed shifts from: (i) short-term initiatives with limited scope to long-term, system-wide transformations; (ii) centralized control to devolved multilevel governance; (iii) hospital-centric resource allocation to strategic reallocations favoring primary care; (iv) physician-dominated care to multidisciplinary teams including non-physician providers; (v) siloed disease-focused services to integrated models of comprehensive care; (vi) peripheral, minimally regulated private sectors to their integration and actively state-stewarded participation; (vii) passive input-based budget allocations and provider payments to strategic purchasing; (viii) perceiving citizens as passive recipients of care to building active community engagement; (ix) ad hoc data collection to embedded learning and accountability; and (x) externally driven changes to local ownership for reforms. Reforms routinely triggered political economy dynamics-opposition from physicians, hospitals, specialists, and central bureaucracies; citizen skepticism; and capacity and patronage challenges under devolution. Strategies to address these included: high-level endorsement and passage of legislation; use of political and economic windows of opportunity; local capacity-building; decentralized autonomy; formal engagement with physician associations; regulated private sector participation; strategic purchasing to incentivize a PHC approach; strong data systems and assessments; community engagement; and locally grounded design with domestic capacity and financing. The paper underscores the value of anticipating political economy dynamics for designing and implementing PHC-oriented reforms.

ABSTRACT PhD careers have diversified over the last decade. Working in academia has become a less prominent career target for PhD graduates, and variations in careers across disciplines have grown. The private sector is the largest employer of STEM PhDs outside academia, whereas the public and para-public sectors primarily employ HSS PhDs. Academic careers emphasise research-focused tasks and scholarly outputs, while non-academic careers prioritise interdisciplinary collaboration, innovation, and practical application of research skills. Limited research on PhD careers beyond academia leaves doctoral educators ill-prepared to support PhD candidates pursuing non-academic careers. This study contributes to the literature by providing a comparative analysis of academic and non-academic career trajectories of PhD holders using national cohort data from Finland. By examining the employment status of PhD graduates, the sectors in which they work, and their job profiles, this study bridges gaps in the literature on PhD careers. The results of the study show that PhD holders often undertake expert-level tasks requiring advanced research skills. Academic roles typically align with research-intensive profiles, whereas non-academic roles emphasise multi-skilled profiles that demand broader competencies. These insights contribute to a research-based understanding of PhD career paths and support tailored career guidance for PhD candidates during doctoral education.