Disparities in access and three-year survival of patients with ST-elevation myocardial infarction treated in percutaneous coronary intervention-capable hospitals within the Brazilian public and private healthcare systems: The VICTIM extended registry.

Municipal services are rarely evaluated systematically for their environmental impacts. This study introduces an innovative life-cycle-based methodology for calculating emission factors for 21 municipal services, thereby filling a critical gap in public-sector impact assessment. Services are classified into administrative office services (e.g., identity card issuance, residence changes, marriage licenses) and macro-services (e.g., school canteen management, green maintenance, bulky waste collection). While administrative office services are often considered intangible and underestimated in environmental terms, both types require significant resources and generate measurable impacts. The methodology quantifies Carbon Footprints (CFs) of municipal services, producing emission factors per functional unit. Unlike previous fragmented assessments focused on specific sectors or public activities, this study applies a unified, systems-based framework. The results are consolidated into a structured database made of standardized emission factors (EFs), which serve as proxies when site-specific data are unavailable and facilitate replication across different institutions and geographic contexts. Applied in the Municipality of Grosseto (Italy), results show that macro-services account for 78.55 % of total emissions (particularly from school canteens and green maintenance), while site inspections and document processing are the most impactful administrative functions. The approach helps local authorities identify emission hotspots and align services with strategic planning tools such as Sustainable Energy and Climate Action Plans (SECAPs). By providing a flexible and transferable evaluation framework, this study advances environmental accounting practices in the public sector and supports evidence-based climate strategies with broader policy relevance. • A dataset of life cycle-based emission factors for 21 public services is provided. • Structured framework adaptable for municipalities to evaluate service emission. • The emission factor dataset helps emission calculation and policy identification. • Macro services contribute 79 % of emissions, with school canteens as the top source. • Results guide municipal strategies and plans to reduce service-related emissions.

This article analyzes how public policies implemented by the State of Santa Catarina have incorporated the perspective of racial equality and identifies the main challenges and advances pointed out by the Santa Catarina State Court of Accounts (TCE/SC) in addressing institutional racism within public institutions. The theoretical framework is based on studies on structural and institutional racism, public policies for racial equality, and diversity management in the public sector. Methodologically, this is a qualitative documentary study grounded on the analysis of the Operational Audit Report DAE No. 46/2023, complemented by secondary data from IBGE, IPEA, and DIEESE, as well as a specialized literature review. The results indicate the persistent underrepresentation of the Black population in the state public administration, weaknesses in the production and use of race-disaggregated data, the absence or incipient development of structured racial equality policies in several public agencies, and the existence of institutional barriers that hinder substantive equality of opportunities. On the other hand, relevant advances were identified, especially within the TCE/SC itself, such as the implementation of affirmative action in public service examinations, racial literacy programs, and the creation of permanent bodies dedicated to promoting racial equity. It is concluded that, although promising initiatives exist, the incorporation of the racial perspective into state public policies remains fragmented and requires greater institutionalization, strategic planning, and strengthening of external control as a driver of anti-racist practices in public administration.

Financial auditing is fundamental to financial reporting, as it lends credibility to the documents. Therefore, financial auditing is widely established in the private sector, being, for example, mandatory for companies listed on the Brazilian stock exchange. However, in the public sector, it is still in the implementation phase. In this sense, this study is pioneering in mapping the circumstances under which financial auditing is carried out in Brazilian subnational Courts of Accounts, analyzing the impact that this type of audit has had on the assessment of annual financial statements in these courts. Through a specific questionnaire, an auditor from each subnational Court of Accounts was asked whether their respective court has implemented financial auditing and, if so, what their personal perception is of the value the court places on it, whether it is included in the annual financial statement assessment process, and whether there has been any rejection of annual accounts due to a financial audit opinion. The results reveal that about half of the courts still do not conduct financial audits and, among those that do, the impact of the financial audit opinion is practically nil on the assessment of annual accounts. Therefore, it can be concluded that, despite being indispensable in the analysis of financial information, the Brazilian public sector has not fully benefited from the advantages that this type of audit provides.

Hybrid threats require hybrid solutions: A roadmap for healthcare security.

The social media turn in medicine: platform-based marketization of health care, ethics, professionalism, and lessons from Turkey.

This study addresses the optimization of medical waste collection (MWC) in Ho Chi Minh City, Vietnam, where increasing waste volumes pose challenges for efficiency and sustainability. Using real-world operational data from Citenco, we formulate the problem as a capacitated vehicle routing problem (CVRP) with stochastic demand, solved through a combination of constraint programming and chance-constrained programming. The proposed model reduces total travel distance by 22%, travel time by 10%, and increases vehicle load utilization by 6%, while lowering the number of daily trips to treatment facilities. Sensitivity analysis confirms robustness under varying service levels and expanded coverage. These results provide evidence-based insights for policymakers and public waste management agencies, supporting sustainable decision-making in urban medical waste collection. • Medical waste collection is a challenging problem that can lead to hazardous impacts on environment. • Inefficiency in collecting route, which is also known as Waste Collection Vehicle Routing Problem, can be minimized by Chance-Constrained Programming. • Optimization model was developed to improve efficiency and test for robustness vs demand fluctuation. • Medical waste collection of Citenco Ltd., a major waste collector in Ho Chi Minh City, Vietnam, was optimized using the optimization model. • Sensitivity analysis for two scenarios, increased waste demand and increased collection points, were done.

Effective management of tailings storage facilities, given their recurrent and harmful failures, depends on sophisticated data monitoring. However, a persistent digital divide creates an entrenched institutional problem: resource-constrained small and medium-sized enterprises have limited capability to adopt monitoring technologies. When coupled with data fragmentation and limited regulatory visibility, traditional enforcement and incentive-based policies lose their effectiveness. Public Sector Entrepreneurship (PSE) is proposed for such situations. However, while research has been prominent in retrospectively explaining the antecedents and outcomes of PSE, the actual design of tangible solutions (what to build and how) remains a black box. We ask: How can PSE facilitate the development of accessible digital solutions to enhance the safety and compliance of these facilities? Following a Design Science methodology and adopting a practitioner-academic team model with Chile's national regulator, we developed and validated "Tailing Closure". This digital platform artifact consolidates complex technical and regulatory requirements into a unified, accessible solution, including a failure occurrence potential index. Our research makes two primary contributions. First, we advance PSE theory by demonstrating a replicable mechanism through which public actors can catalyze a shift in regulatory technology from enforcement to enablement. Second, in response to the call for actionable guidelines, we contribute to a nascent design theory articulated as a set of generalizable design principles. These principles articulate how Design Science can be mobilized to develop shared technological artifacts that help address grand challenges by enabling collaboration and accountability across capability-divided, institutionally fragmented environments. • Enablement-based PSE, through DS, to tackle entrenched institutional problems and democratize access for technology to SMEs. • Tailing Closure consolidates regulatory and technical TSF data in one platform and validates with 113 TSFs. • Prescriptive design principles for regulatory digital platforms are advanced: Regulator-first, Data Traceability, Explicit Gap Management, Adaptive Modularization.

This study was based on the perceptions of students about their self-perceived SEC and its impact on mental health and academic achievements of 8th-grade students of public sector elementary schools of tehsil Sargodha. The objectives of study were to measure the level of Social and Emotional Competence of 8th Grade students, to assess the state of mental health of 8th grade students, to examine the academic achievements of 8th grade students, to measure the impact of SEC on 8th grade students’ state of mental health, and also on their academic achievements. In present study, 8th grade students were taken as population belonging to government elementary schools of tehsil Sargodha. A sample of 280, out of which 140 were boys and 140 girls were taken and obtained their perception about the SEC and mental health through self-developed questionnaire. It was found that social emotional competencies have an impact on academic achievement, girls are better in academic grades and mental health.

Purpose This study aims to explores why, how and when unethical peer behaviour influences employees’ ethical voice (EV) at work. It addresses a limited understanding of psychological processes linking unethical conduct and speaking up. Drawing on moral self-regulation theory (MSRT), this study explores the intervening roles of cognitive, emotional dissonance (ED) and how guilt moderates these effects, clarifying when employees express EVs. Design/methodology/approach This study uses a quantitative, cross-sectional survey design, using data from 243 employees in public sector (PS) organizations. Structural equation modelling (SEM) tested the proposed mediation and moderation effects within the conceptual framework. Findings Results show that unethical peer conduct indirectly affects voice behaviour through both cognitive and ED, with the latter emerging as the stronger pathway. Guilt further amplifies the effect of ED, encouraging employees to act in line with moral values and raise ethical concerns. Practical implications Findings show managers must foster a supportive, ethical climate where employees can voice misconduct concerns. Ethics training and accountability can strengthen ethical awareness, reduce misconduct and enhance organizational integrity in the PS. Originality/value This study provides insights by integrating emotional and cognitive dissonance to explain how unethical peer behaviour influences EVs. It highlights guilt’s role in promoting ethical actions within PS.

Comparative Trends in Statin Utilization and Expenditures in the Public and Private Healthcare Sectors in Malaysia: Insights From the Malaysian Statistics on Medicines, 2004-2022.

Purpose Co-creation is increasingly used in the public sector for the development of public policies and services. The purpose of this paper is to empirically establish a framework for ethical co-creation in the public sector. Design/methodology/approach A mixed-method approach was used to collect data and cross-analyse four pilots from a three-year EU-funded project. Findings The results from this study highlight the need for an ethics co-creation framework to be provided at the start of a project that can support the co-creation strategy, process and implementation of the outcome. Such an ethics framework must be flexible in order to address issues that vary according to public service, policy being developed and local context. Originality/value Current legal and ethical frameworks for the public sector do not cover all the activities in public sector co-creation. This work is original and important as the use of co-creation in the public sector becomes increasingly important.

This study aims to explore the role of sustainable leadership (SL) in enhancing employee subjective well-being (SWB) within healthcare settings during pandemics like COVID-19 emphasizing the mediating influence of compassion and the moderating role of burnout. Data were collected from 365 frontline health-care workers (i.e. doctors and nurses) working in public and private sector hospitals. A quantitative research design was employed, and the data were analyzed using Hayes' PROCESS macro to test both direct and indirect effects, specifically focusing on mediation and moderated mediation models. The study's findings validate the hypothesized relationships. SL positively influences employee well-being through compassion; however, this indirect effect diminishes under high levels of burnout, indicating a conditional compassion pathway. Healthcare leaders should adopt SL approaches that cultivate compassion while actively addressing employee burnout. Such efforts can preserve and enhance staff well-being, especially in high-stress healthcare environments during crises, particularly pandemics. This study contributes to the emerging literature on SL by introducing compassion as a key mediating mechanism in enhancing employee SWB. It further extends existing models by identifying burnout as a boundary condition that weakens the compassion-well-being link. The findings offer a nuanced understanding of how SL can foster well-being in healthcare settings, particularly during crisis contexts such as the COVID-19 pandemic.

This study examines the implementation of the Follow-Up of Supervision Results policy (TLHP) in North Gorontalo Regency within the framework of bureaucratic reform and good governance. Effective follow-up of audit recommendations is essential to ensure accountability, prevent corruption, and improve public sector performance. The research aims to evaluate the policy context, particularly the adequacy of the legal basis, the clarity of objectives and targets, and the alignment of programs and activities supporting TLHP completion. A mixed-methods approach with an exploratory sequential design was employed. Qualitative data were collected through observation, in-depth interviews, and document analysis, then strengthened by quantitative weighting using the Analytical Hierarchy Process (AHP). The evaluation framework applied the CIPP model developed by Stufflebeam. The findings reveal that policy objectives and targets have been clearly formulated in the Inspectorate’s planning documents and meet SMART criteria. However, major constraints remain in the regulatory and institutional aspects. There is no comprehensive derivative regional regulation, particularly concerning recovery of losses involving third parties. Moreover, most regional apparatus organizations do not integrate TLHP into their performance targets due to budget limitations and sectoral ego, causing weak cross-agency commitment. Strengthening local regulations, establishing supporting institutions, and integrating TLHP into all agencies’ planning documents are crucial to improving effectiveness.

ABSTRACT Whether, how, and when entrepreneurial leadership is related to entrepreneurial behavior among subordinates remain underspecified. Building on theories of public sector entrepreneurship, entrepreneurial leadership, and motivation crowding, this study examines whether entrepreneurial leadership is related to entrepreneurial behavior through the mediating role of an innovative climate. Furthermore, the potential accentuating role of extrinsic motivation satisfaction in this process is also examined. Analyses of data from the Australian Public Service Commission (2019 survey, n = 87,510) provide support for the proposed moderated mediation model, in which the innovative climate induced by entrepreneurial leadership works together with extrinsic motivation satisfaction to boost entrepreneurial behavior. This study integrates romantic and utilitarian perspectives on enhancing entrepreneurial behavior among public employees by highlighting how entrepreneurial leadership, innovative climate, and motivational conditions jointly induce public sector entrepreneurship—an outcome that is in great demand yet difficult to achieve for public managers.

Employee performance is a crucial factor in supporting the success of public sector organizations, including the Airport Operating Unit (UPBU), which plays a vital role in ensuring aviation safety, security, and service efficiency. Although the average performance achievement of the UPBU D.C. Saudale Office reached 97.01% based on the 2024 LAKIP report, significant challenges remain—particularly in the realization of Non-Tax State Revenue (PNBP), which fluctuated and achieved only 39.73% of the 2024 target. This gap indicates the need to examine factors influencing employee performance more comprehensively. This study applies a quantitative approach with an explanatory design to analyze the relationships among variables. The research involved 77 employees of the UPBU D.C. Saudale Office as respondents. The independent variables are competence and educational qualifications, the dependent variable is employee performance, and organizational commitment serves as a mediating variable. Data were analyzed using Structural Equation Modeling (SEM) to statistically test the proposed hypotheses. The findings reveal that competence and educational qualifications both have a positive and significant direct effect on employee performance. Competence also positively and significantly influences organizational commitment, while educational qualifications do not significantly affect organizational commitment. Organizational commitment has a positive and significant impact on employee performance and mediates the relationship between competence and performance; however, it does not mediate the relationship between educational qualifications and performance. Therefore, the organization should prioritize competency development programs, integrate education with practical training, and strengthen organizational commitment to enhance overall performance.

This study aims to examine how auditor competence, supervisory independence, and internal control systems influence internal audit quality and fraud prevention in Indonesia's public sector, with particular focus on the moderating role of auditor integrity in shaping the effectiveness of these oversight mechanisms. Using Partial Least Squares Structural Equation Modeling (PLS-SEM), this study analyzes data from 53 auditors at the Buleleng Regency Inspectorate to test six direct relationships and six moderating effects of auditor integrity on internal audit quality and fraud prevention. The study reveals three key findings. First, all direct effects prove significant: internal control systems emerge as the strongest predictor of internal audit quality (β=0.431, p<0.001), while auditor competence most powerfully influences fraud prevention (β=0.408, p=0.001). Second, auditor integrity exhibits complex and counterintuitive moderation patterns: it negatively moderates the competence-audit quality relationship (β=-0.264, p=0.034) and independence-audit quality relationship (β=-0.095, p=0.029), indicating compensatory mechanisms or contextual pressures in corrupt environments. Third, integrity does not moderate any relationships with fraud prevention nor internal control system relationships with either outcome, revealing that fraud prevention is more heavily determined by structural factors than individual ethical characteristics.

ABSTRACT Recent research has examined various aspects of the government's use of artificial intelligence (AI), including its implications for accountability as well as the policy and management recommendations proposed to address some related concerns. However, two important gaps remain and need further empirical exploration. First, it is unclear why accountability in AI‐based system use is viewed as such a critical issue. Second, it is uncertain to what extent existing policy and management recommendations from academia are reflected in government policies. This study aims to bridge these gaps by empirically investigating how the public sector addresses accountability in the use of AI‐based systems. Based on an analysis of policy documents related to AI‐based systems from 32 U.S. states, our findings show why accountability matters, who is being held accountable to whom, by what standards, and with what consequences from a practical perspective. Furthermore, we identify several research‐practice gaps that merit further exploration.

Purpose: The purpose of this study is to assess the impact of corrupt practices on public sector accounting performance in Kano State, with a focus on how corruption affects transparency, accountability, and efficiency in financial reporting and resource management. Methodology: The study adopted a descriptive research design. Primary data were collected through a structured questionnaire using a 5-point Likert scale. The population comprised 75 personnel from the Kano State Ministry of Finance, including accountants, auditors, cashiers, and other financial officers. Due to the manageable population size, a census sampling technique was employed. Out of 75 questionnaires administered, 66 were completed and returned, yielding an 88% response rate. Data were analyzed using mean and standard deviation in SPSS. Results and conclusion: The results indicate that corruption persists in Kano State's public sector, substantially undermining transparency, accountability, and overall accounting performance. It was concluded that corrupt practices significantly distort financial information, weaken internal controls, and reduce the efficiency of public sector accounting functions. Implication of findings: The findings reveal that corruption severely undermines public sector accounting performance, erodes trust in institutions, and hampers effective resource management in Kano State, necessitating urgent reforms for transparency and accountability.

Background: Generalized myasthenia gravis (gMG) severely impacts activities of daily living. Productivity losses and the need for care can impact household finances and consequently government public accounts. This study adopts a governmental perspective framework to assess the fiscal consequences of treating gMG that is inadequately controlled by standard therapy, beyond healthcare costs. Savings in tax revenue loss and benefit payments are considered. Objectives: To value the fiscal consequences of treating adults with acetylcholine receptor–antibody positive (AChR-Ab+) gMG with efgartigimod vs current treatments. The lifetime impact on people living with gMG and their caregivers is considered from the perspective of Canada’s public accounts. Methods: A lifetime Markov cohort simulation following adults with gMG according to their Activities of Daily Living (MG-ADL) score was linked to labor and fiscal stages of both patients and care- givers. Based on the MyRealWorld MG study, MG-ADL scores defined the labor market characteristics of both individuals with gMG and their caregivers. National statistics data on sex- and age-specific labor outcomes were used to model patients with minimal symptoms. Benefit payments and tax revenue losses attributable to gMG were estimated and valued according to national official sources. Public healthcare costs were included. The difference between efgartigimod and current treatments was assessed by discounted lifetime incremental fiscal consequences. Sensitivity analyses were applied to the fiscal parameters. Results: Without active treatments, the lifetime fiscal burden associated with individuals with gMG and their caregivers was estimated at CAD$1.24 million in government expenditures. Compared with the current weighted bundle of treatments in Canada, efgartigimod was estimated to save CAD$458 754 per treated adult. Results were sensitive to the distribution of the bundle of treatments. Discussion: Beyond healthcare costs, gMG severely impacts productivity and governmental accounts. Decision-makers should be provided evidence of fiscal consequences when assessing healthcare technologies. The public sector in Canada was estimated to have a return of CAD$1.58 per every CAD$1 spent on efgartigimod for people with gMG compared with the current bundle of treatments. Conclusions: Improving health outcomes and reducing the need for informal caregivers benefits those affected by gMG and governmental accounts.