Diagnosing heart failure (HF) in dialysis patients is challenging due to overlapping symptoms of volume overload. The Kansas City Cardiomyopathy Questionnaire (KCCQ) is a health status questionnaire measuring HF symptoms and functional limitations, with lower scores indicating greater burden. We studied 625 Chronic Renal Insufficiency Cohort study (CRIC) participants who developed end-stage kidney disease (ESKD) and had KCCQ scores post-ESKD diagnosis treated with hemodialysis (HD) or peritoneal dialysis (PD). The primary outcomes were rates of HF hospitalization, 30-day HF readmission and all-cause mortality. KCCQ was modeled dichotomously (<75 vs ≥75) and continuously (per 5-point decrement). Poisson regression with robust standard errors was used to test the association of KCCQ score with each outcome. Among 625 participants (mean age 59 years; 60% male; 87% on HD), median follow-up from KCCQ evaluation was 6.8 (IQR 3.2-12.0) years. Those with KCCQ <75 had nearly twice the rate of HF hospitalizations (15.4 vs 8.4/100 person-years) compared to KCCQ ≥75. Each 5-point decrement in KCCQ was associated with 9% higher adjusted relative risk (aRR) of HF hospitalization (p=0.0003), 7% higher aRR of 30-day HF readmission (p=0.03), and 6% higher aRR of all-cause mortality (p<0.001). Stratified by HF subtype, patients with HFrEF and KCCQ <75 had 81% higher aRR of HF hospitalization vs those with KCCQ ≥75 (p=0.02). Decline in KCCQ by ≥ 5 from pre-ESKD to post-ESKD was associated with >40% increase in aRR of all-cause mortality (p=0.02). Higher HF symptom burden and functional limitations at dialysis initiation are independently associated with increased risk of HF hospitalization and all-cause mortality, suggesting that the KCCQ score may help predict outcomes early in the course of treatment.

This study analyzes the influence of Intellectual Capital, operational efficiency, and the Islamicity Performance Index (IPI) on the profitability of Islamic Commercial Banks in Indonesia during 2021–2024. Using a quantitative approach, this study examined 52 research samples derived from 13 Islamic banks based on annual report data. Intellectual Capital was measured using the iBVAIC model; operational efficiency was proxied by BOPO; Islamicity Performance Index was represented by PSR, ZPR, EDR, and IIR; and profitability was measured using ROA. Panel data regression with a Random Effects model and robust standard errors was employed for data analysis. The findings show that Human Capital and Structural Capital positively affect ROA, while Physical Capital is insignificant. Both operational efficiency and the Islamicity Performance Index have a significant negative effect on profitability. Overall, the findings indicate that the examined variables collectively provide a strong explanatory power for variations in ROA, underscoring the importance of strengthening human resource quality, improving cost efficiency, and optimizing sharia compliance to enhance the sustainable performance of Islamic banking. This study provides both theoretical reinforcement and practical guidance by highlighting the strategic roles of intellectual capital, operational efficiency, and the Islamic Performance Index in supporting the sustainable profitability of Islamic banks.

BackgroundHIV infection with low CD4 count is a known risk factor for severe clinical outcomes in patients with mpox in the current global mpox outbreak. However, it is unclear how a low CD4 in addition to other clinical factors, such as viremia or co-infection with other sexually transmitted infections (STIs), serve as predictors of mpox severity. We sought to assess the risk of mpox-related hospitalization in patients with HIV, examining CD4, viral load (VL), antiretroviral treatment (ART) prescription as a proxy of adherence, and STI co-infection in people diagnosed with mpox in New York City (NYC).Table 1.Demographics and Clinical Characteristics of Patients with HIV and Mpox Receiving Tecovirimat in NYC by Hospitalization Status (N=395)Table 2.Relative Risk of Hospitalization in People with HIV and Mpox Receiving Tecovirimat in NYCMethodsWe analyzed retrospective deidentified data from 8 NYC healthcare systems for patients with mpox and HIV initiating tecovirimat, an antiviral used for severe mpox, from May–December 2022. We used descriptive statistics to assess demographic and clinical characteristics of patients who were hospitalized. We used multivariable Poisson regression with robust standard errors to examine factors associated with hospitalization, adjusting for potential confounders.ResultsOf 395 patients with HIV and mpox who initiated tecovirimat, 17.72% (N=70) were hospitalized. Demographics, CD4, VL and ART prescription data are summarized in Table 1. Hospitalized patients were more likely to be non-Hispanic Black, have concurrent herpes or syphilis diagnoses, HIV viremia (HIV RNA >=200copies/mL) or CD4 < 200 cells/mm3. Multivariable models (Table 2) show patients who were non-Hispanic Black (aRR=2.14), who newly initiated or restarted ART at the time of mpox diagnosis (aRR=2.81), who had CD4 50-200 cells/mm3 (aRR=1.97), or had syphilis (aRR=1.71) were at higher risk of hospitalization after adjusting for confounding variables.ConclusionIn this diverse NYC cohort across multiple health systems, our findings highlight the importance of addressing structural racism as well as co-management of HIV and other STIs alongside acute mpox infection. Limitations of our analysis include lack of data on mpox vaccination status, few patients with CD4 < 50, and use of ART prescription as an imperfect proxy for ART adherence.DisclosuresOfole Mgbako, MD, MS, Gilead Sciences: Advisor/Consultant Robert Pitts, MD MPH, Gilead Inc: Advisor/Consultant|ViiV: Advisor/Consultant

Drug policy and culture: A cross-national comparative study using Hofstede's index.

In Ethiopia, while undernutrition among adult patients with tuberculosis (PWTB) is well-documented, evidence on anemia and its coexistence with undernutrition remains limited. This study was aimed at assessing nutritional status and associated factors among adult PWTB attending public hospitals of Sidama Region. A facility-based cross-sectional study was conducted from 4 February to 27 March 2024 among 418 systematically sampled PWTB from public hospitals. Data were collected using pretested structured questionnaires and analyzed in STATA 14. Modified Poisson regression with robust standard errors identified factors associated with nutritional status, presented as adjusted prevalence ratios (APR) with 95% confidence intervals (CI). The magnitudes of undernutrition and anemia were 37.1% (95% CI: 32.4–41.7) and 48.6% (95% CI: 43.7–53.4) respectively. Intestinal parasites were detected in 25.1% (95% CI: 20.9–29.3) of adult PWTB. Anemia prevalence was significantly higher in undernourished PWTB (87.1%) compared to those with normal nutrition (25.8%; p < 0.001). Undernutrition was associated with food-insecurity (APR = 1.89; 95% CI: 1.47–2.45), low dietary diversity (APR = 1.56; 95% CI: 1.21–2.01), TB-HIV coinfection (APR = 1.65; 95% CI: 1.23–2.21), and parasite infection (APR = 1.78; 95% CI: 1.41–2.25). The identified predictors of anemia among PWTB were food insecurity (APR = 1.41; 95% CI: 1.16–1.73), parasitic infection (APR = 1.23; 95% CI: 1.01–1.51), and TB-HIV coinfected (APR = 1.36; 95% CI: 1.04–1.77). The study revealed a prevalence of undernutrition and anemia among PWTB, with key predictors including poor dietary diversity, food insecurity, TB-HIV coinfection, and parasitic infection. Given the public health significance of anemia, especially among undernourished patients, we recommend integrating routine nutritional screening and targeted interventions—such as food support, parasite control, and HIV care—into TB treatment programs.

COVID-19 in newborns presents a multifaceted clinical spectrum, with the potential for severe outcomes. This study aimed to evaluate the clinical evolution and hospital outcomes of neonates with a molecular diagnosis of COVID-19. A case-control study was conducted in a public referral maternity hospital for high-risk pregnancies. Two controls were selected for each case, matched by sex and gestational age. Variables related to birth data, symptoms, and clinical progression were collected from medical records and analyzed statistically, with crude and adjusted relative risks calculated using Poisson regression with robust standard errors. A total of 25 neonates with confirmed SARS-CoV-2 infection were identified among 875 newborns. Compared with controls, infected neonates had a longer hospital stay (median of 19 days vs. 8 days; p &lt; 0.001) and higher readmission rates (16% vs. 0%; p = 0.03). After adjusting for potential confounders, COVID-19 infection was associated with a 2.41-fold higher risk of neonatal death (95% CI: 1.24–4.67; p = 0.009). No evidence of vertical transmission was found. These findings suggest that neonates with COVID-19 may experience longer hospitalizations and an adjusted higher risk of mortality, emphasizing the need for vigilant surveillance and supportive care. However, given the observational design of the study, these results indicate associations rather than causal relationships. Understanding the clinical behavior of COVID-19 in this population—characterized by inherently low immunity—and recognizing its interaction with other neonatal conditions are essential for improving hospital management and outcomes.

Emotional problems represents a prevalent clinical manifestation in pediatric populations with attention-deficit/hyperactivity disorder (ADHD), exacerbating functional impairments and complicating treatment outcomes. While pharmacological and behavioral interventions target core ADHD symptoms, structured approaches addressing emotional dysregulation through executive function training remain underexplored. Ecological executive skills training (EEST) has emerged as a promising intervention. This study systematically evaluates the multidimensional impact of EEST by integrating behavioral, cognitive, and emotional metrics to establish an evidence-based framework. A total of 65 primary school children diagnosed with ADHD for the first time were recruited for this study. Children with ADHD were evaluated by Achenbach Child Behavior Checklist (CBCL), Strengths and Difficulties Questionnaire(SDQ), Conner's Parent Symptom Questionnaire (PSQ), Vanderbilt ADHD Diagnostic Parent Rating Scale (VADPRS), Behavior Rating Inventory of Executive Function(BRIEF) and Weiss Functional Impairment Rating Scales-Parent Report (WFIRSP). Statistical analysis was conducted using SPSS software (version 19.0). Categorical variables were presented as counts (n) and percentages (%). Improvements in Inattention were analyzed using Generalized Estimating Equations (GEE) with robust standard error estimators. 1.Efficacy of Mood Regulation: After three months of treatment, the experimental group exhibited significantly greater improvement than the control group in anxiety and depression subscales of the CBCL, SDQ teacher emotional symptom ratings, PSQ (Anxiety), VADPRS and VADTRS anxiety/depression items, and the BRIEF Emotion Regulation Index. 2. Core Symptom Severity: The experimental group demonstrated significantly greater reductions in inattention and hyperactivity/impulsivity symptoms compared to controls, as measured by the VADPRS and VADTRS. 3.Executive Functioning Improvements: The experimental group showed significantly greater enhancements (P < 0.05) across all BRIEF executive function domains, with particularly significant improvements observed in working memory. 4. EEST can improve Social Functioning Outcomes. EEST significantly alleviates emotional probloms in children with ADHD, including symptoms of anxiety, depression, and impaired emotional control. Furthermore, this intervention demonstrates measurable improvements in core ADHD symptoms, executive functioning, and social competency. The Chinese Clinical Trial Registry (ChiCTR). 2,200,062,513​.

Exposure to green, blue, and biodiverse spaces and their associations with loneliness in urban adults: Findings from the EPIPorto cohort.

To quantify the association between time-varying HbA1c and long-term risks of implant failure and peri-implantitis, and to test for non-linear dose-response and thresholds. Adults receiving endosseous implants (2015-2024) in a multi-provider practice network with ≥ 1 year potential follow-up were included. HbA1c was modeled as a time-updated exposure with a 30-day lag and 90-day carry-forward. Implant-level cause-specific Cox models with robust standard errors (patient clustering) and surgeon frailty estimated adjusted hazard ratios (aHRs). HbA1c was modeled continuously (restricted cubic splines) and categorically (<7.0%, 7.0-<8.0%, ≥8.0%). Competing risks were assessed using Fine-Gray models. Absolute risks were estimated using Kaplan-Meier (failure) and Aalen-Johansen (peri-implantitis). Among 782 adults (1,312 implants), median follow-up was 5.6 years. A total of 68 failures and 171 peri-implantitis events were recorded. Each 1% higher HbA1c was associated with increased hazards of failure and peri-implantitis. Compared with HbA1c <7.0%, HbA1c ≥8.0% was associated with approximately double the risk of failure and peri-implantitis. Spline models indicated non-linearity, with a steeper gradient beyond ~8.0%. Five-year absolute risks of failure were 3.2%, 4.8%, and 8.1%, and of peri-implantitis 12.1%, 17.2%, and 26.0% across HbA1c bands <7.0%, 7.0-<8.0%, and ≥8.0%, respectively. Findings were consistent in competing-risk and sensitivity analyses. Higher time-varying HbA1c levels were associated with a dose-dependent increase in implant failure and peri-implantitis risk, with a steeper rise above ~8.0%. Reporting absolute risks by glycemic category and emphasizing supportive periodontal therapy may improve shared decision-making.

Lipoprotein(a) testing trends in young ischemic stroke patients from 2015-2024: An analysis of 188,000 individuals.

In Ethiopia, while undernutrition among adult patients with tuberculosis (PWTB) is well-documented, evidence on anemia and its coexistence with undernutrition remains limited. This study was aimed at assessing nutritional status and associated factors among adult PWTB attending public hospitals of Sidama Region. A facility-based cross-sectional study was conducted from 4 February to 27 March 2024 among 418 systematically sampled PWTB from public hospitals. Data were collected using pretested structured questionnaires and analyzed in STATA 14. Modified Poisson regression with robust standard errors identified factors associated with nutritional status, presented as adjusted prevalence ratios (APR) with 95% confidence intervals (CI). The magnitudes of undernutrition and anemia were 37.1% (95% CI: 32.4-41.7) and 48.6% (95% CI: 43.7-53.4) respectively. Intestinal parasites were detected in 25.1% (95% CI: 20.9-29.3) of adult PWTB. Anemia prevalence was significantly higher in undernourished PWTB (87.1%) compared to those with normal nutrition (25.8%; p < 0.001). Undernutrition was associated with food-insecurity (APR = 1.89; 95% CI: 1.47-2.45), low dietary diversity (APR = 1.56; 95% CI: 1.21-2.01), TB-HIV coinfection (APR = 1.65; 95% CI: 1.23-2.21), and parasite infection (APR = 1.78; 95% CI: 1.41-2.25). The identified predictors of anemia among PWTB were food insecurity (APR = 1.41; 95% CI: 1.16-1.73), parasitic infection (APR = 1.23; 95% CI: 1.01-1.51), and TB-HIV coinfected (APR = 1.36; 95% CI: 1.04-1.77). The study revealed a prevalence of undernutrition and anemia among PWTB, with key predictors including poor dietary diversity, food insecurity, TB-HIV coinfection, and parasitic infection. Given the public health significance of anemia, especially among undernourished patients, we recommend integrating routine nutritional screening and targeted interventions-such as food support, parasite control, and HIV care-into TB treatment programs.

This study examines the monthly returns of thirteen companies with renewable energy investments on the Borsa Istanbul at the firm level between 2015 and 2024. The aim is to measure how stock returns are explained by market sentiment within a multi-factor structure. The scope encompasses the entire population and allows comparison of two sub-periods: 2020 to 2022 and 2022 to 2024. The method is based on the single-factor CAPM and multi-factor APT frameworks, with estimates made using the least squares method and Newey West robust standard errors. Diagnostic tests included F-statistics, adjusted R-squared, and Durbin Watson-Breusch-Pagan and Jarque Bera. Outliers were weighted between the first and ninety-ninth percentiles. The CAPM used the market proxy as the equal-weighted monthly sector return. The APT extracted principal components from the panel returns, and firm-based factorial regressions were run. Our findings indicate that the CAPM's overall explanatory power is limited, but some stocks exhibit significant sensitivity to market volatility. Our firm-based analysis reveals that Zorlu, SAY, and Pamukova exhibit high beta values, Odaş exhibits significant co-movement in the mid-high range, Aksa, Enerjisa, and Orge remain marginal, and market sentiment is weak for Alarko Doğan Global Koç and Ak Enerji. The APT increases its explanatory power and reveals that the common sector component dominates both subperiods. Our periodic analysis found that AKSA, IŞIKLAR, ODAŞ, PAMUKOVA, SAY, and ZORLU exhibited strong bonds between 2020 and 2022, while the bond strengthened further between 2022 and 2024 for AKSA, ENERJİSA, ODAŞ, ORGE, SAY, and ZORLU. Conversely, ALARKO, AK ENERJİ, and GLOBAL's returns were better explained by the company's news feed, project schedule, and balance sheet dynamics. When a two-tiered pricing system is established for energy stocks, the first tier sees common sector volatility become the primary driver during certain periods, while the second tier, driven by company-specific sentiment, drives differentiation. It has been concluded that these two risks should be managed together in portfolio decisions.

Purpose: This study investigates whether ESG disclosure and profitability affect the value relevance of accounting information proxied by Tobin’s Q in coal firms, analyse the Green Investment Policy (GIP) moderation role. It aims to show the ESG efforts and “green” capital allocation uncertainty into higher market valuation in an emission-intensive sector. Method: Archival coal companies analysis listed on the Indonesia Stock Exchange (IDX) for 2019–2024. Data collected from annual and sustainability reports. The empirical with panel data regression and moderated regression analysis (MRA) using interaction terms (ESG × GIP; Profitability × GIP), also robust standard errors in ensuring the inference in heteroskedasticity. Findings: ESG disclosure not statistically significant in influencing firm value, either directly or through interaction with Green Investment Policy (GIP). Meanwhile, the interaction between Profitability and GIP is positive and significant, indicating that profits connected to credible green investments are more favourable valued by the market. This suggest that investors prioritize the quality of profit deployment within a sustainable and verifiable framework, rather than merely the total amount of profits. In accounting terms, integrating profitability with credible green investment produces stronger value signals, reflected in higher Tobin’s Q. Novelty/Value: The study redefines value relevance by emphasizing the profits distribution for verifiable green investment than ESG disclosure alone. The study underlining mixed evidence on ESG with the financial performance grows to be value-relevant in relation with credible GIP. The results provide managers, investors, and policymakers to align financial and sustainability objectives in emission-intensive industries.

This study investigates the socio-economic determinants of malnutrition in low-income countries, with a specific focus on the role of macroeconomic and structural indicators. Drawing upon panel data from 2014 to 2020, the empirical model incorporates four independent variables: out-of-pocket health expenditures, gross domestic product per capita, urbanisation, and unemployment. Malnutrition serves as the dependent variable, reflecting both direct and indirect outcomes of socio-economic vulnerability. A panel data framework was employed, and the model was estimated using a random-effects specification with robust standard errors, selected on the basis of the Hausman test result (p &gt; 0.05). The findings show that GDP exerts a negative and statistically significant effect on malnutrition, whereas urbanisation has a positive and statistically significant effect. In other words, improvements in national income are associated with reductions in malnutrition prevalence, while higher levels of urbanisation—under conditions of rapid and unplanned growth—are associated with higher malnutrition levels. Out-of-pocket health expenditures and unemployment do not display statistically significant independent effects. These results reinforce the importance of inclusive economic growth and socially planned urban development as critical levers in addressing undernutrition. At the same time, the analysis is framed within a critical political economy perspective that links contemporary patterns of undernutrition to long-standing histories of colonial extraction, unequal trade relations and constrained policy space in the global economy. For health policy-makers and development practitioners, the study underscores the necessity of integrating socio-economic and urban planning into nutrition strategies to ensure sustainable improvements in health outcomes across low-income settings.

The Indonesian banking sector faces a paradox of maintaining high capital buffers for stability while pursuing profitability amid digital disruption. This study examines the profitability determinants of conventional commercial banks, with a novel focus on testing the moderating role of the Capital Adequacy Ratio (CAR) in the loan-to-deposit ratio (LDR) and return on assets (ROA) relationship a mechanism hypothesized to explain previous empirical inconsistencies. Using quarterly panel data from 43 banks from Q1 2020 to Q3 2025 (989 observations) and a Fixed Effects model corrected with robust standard errors, the results reveal three key findings. First, the moderation hypothesis is rejected; high capital buffers do not significantly alter the impact of LDR on ROA. Second, operational efficiency (BOPO) proves to be the most consistent and dominant determinant of profitability. Most importantly, the key contribution lies in the discovery of sharp heterogeneity: traditional determinant models exhibit very strong explanatory power (R² = 66%) for small banks (CAR ≤ 25.1%) but fail to explain profitability for large, over capitalized banks (R² = 26.1%), where no traditional variables are significant. This demonstrates that profitability drivers evolve with bank scale, rendering one size fits all policy and strategic approaches ineffective. Consequently, regulators must implement differentiated macroprudential policies, while bank management should tailor core strategies based on their specific segment.

This study empirically examines the impact of internet penetration and digital infrastructure on the structural transformation of the banking sectors in Turkey and 24 European Union member states from 2004 to 2024. Utilizing a comprehensive panel dataset, we analyze how internet usage, mobile cellular subscriptions, and fixed broadband subscriptions affect key banking indicators: employment, branch networks, ATMs, and POS terminals. Controlling for GDP per capita and population, we employ second-generation econometric techniques, including the Pesaran CD test and CADF unit root test, to address cross-sectional dependence, and use fixed and random effects models with Driscoll-Kraay robust standard errors. The findings reveal a dual and contrasting impact of digitalization. We identify a substitution effect, where increased internet and fixed broadband access are significantly linked to a decline in traditional physical infrastructure (bank branches and ATMs) and a slight decrease in banking sector employment, aligning with automation. Concurrently, a complementarity effect, particularly from mobile cellular expansion, shows a positive relationship with employment, indicating new digital roles. ATMs also continue to complement branch networks, reflecting a coordinated physical service strategy. This study's main contribution is providing robust, cross-country empirical evidence that disentangles these substitution and complementarity effects within a single framework. It challenges the one-dimensional view of digitalization's impact, showing that the overall effect on banking structure depends on the specific channel (internet, mobile, broadband), with important implications for policymakers and financial institutions.

This research aims to investigate how sales type, product type, and price influence net profit in an F&amp;B outlet using a Data Warehouse system. A quantitative method was applied by integrating daily transaction data into a Data Warehouse architecture built through an Extract, Transform, and Load (ETL) process, allowing the data to be more organized and easier to analyze. To address heteroskedasticity and obtain more reliable coefficient estimates, multiple linear regression with HC3 robust standard errors was used. The results show that price and sales type have a significant and positive effect on net profit, while product type shows mixed effects depending on the category. The regression model, with an R² value of 0.994, indicates that these three variables explain most of the variation in net profit. Overall, the findings highlight how structured data processing through a Data Warehouse can support profitability analysis and improve decision-making in F&amp;B operations.

&lt;table width="593" border="1" cellspacing="0" cellpadding="0"&gt;&lt;tbody&gt;&lt;tr&gt;&lt;td valign="top" width="387"&gt;&lt;p&gt;Dengue Hemorrhagic Fever (DHF) exhibits substantial variation across districts and over time in Aceh Province, making it suitable for analysis within a panel data framework. This study models district-level DHF incidence using applied econometric techniques based on non-spatial panel data regression, employing a balanced panel dataset of 23 districts/cities observed from 2020 to 2022. The Common Effect Model (CEM), Fixed Effect Model (FEM), and Random Effect Model (REM) are estimated and formally compared using the Chow test, Hausman test, and Lagrange Multiplier test, with results consistently indicating that the Fixed Effect Model is the most appropriate specification due to the presence of unobserved, time-invariant district-specific effects. Diagnostic testing identifies heteroskedasticity in the error structure; therefore, the selected FEM is re-estimated using White cross-section robust standard errors to ensure reliable statistical inference. Empirical results show that population density is positively and statistically significantly associated with DHF cases, while the number of health workers is negatively and significantly associated, whereas rainfall, number of hospitals, sanitation coverage, and poverty level do not exhibit statistically significant effects in the final robust specification. The selected model explains approximately 86% of the within-district variation in DHF incidence, demonstrating the importance of appropriate model specification and robust variance estimation in panel data regression applied to epidemiological outcomes, while emphasizing that the estimated relationships represent statistical associations rather than causal effects.&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;/tbody&gt;&lt;/table&gt;

Purpose This study aims to investigate the moderating effect of financial development on the relationship between remittances and entrepreneurial activity in Africa between 2006 and 2022 while accounting for the influence of the entrepreneurship ecosystem. Design/methodology/approach To ensure the robustness of the findings, the authors use both the mean-based and moment-based estimation techniques using the Driscoll and Kraay (1998) robust standard error and method of moment quantile regression approaches, respectively. These estimation approaches are robust to cross-sectional dependence and the distributional and heterogeneous effects of remittance inflows on entrepreneurial activity. Findings The results of this study show that remittance inflows have a positive effect on new business entry in Africa. This suggests that remittance inflows to the continent improve the development of entrepreneurial activities. Furthermore, the magnitude of the effects of financial development and remittance inflow on entrepreneurial development is negative. This finding indicates that remittance inflows and financial development play a substitutable role in influencing entrepreneurial activities. The results also reveal that the entrepreneurship ecosystem, a proxy for institutional quality, supports entrepreneurship development in Africa. Practical implications This study highlights several policy implications for achieving a virile financial sector that can strengthen the beneficial effects of remittance inflows on entrepreneurship start-ups on the African continent. Originality/value This study complements existing studies by investigating the moderating role of financial development in the remittance inflow–entrepreneurship nexus in Africa.

In an era where economies increasingly rely on knowledge and innovation, sustaining long-term growth depends on understanding how education drives productivity beyond conventional measures. Yet, existing studies on the education–growth nexus remain fragmented, often focusing narrowly on schooling attainment while overlooking the complementary roles of lifelong learning and public investment in human capital. Addressing this critical gap, the present study adopts a multidimensional approach to evaluate how educational attainment, adult learning participation, and government expenditure on education collectively shape economic performance across the 27 European Union (EU) member states. Drawing on an unbalanced Eurostat panel dataset (2013–2022), the study employs a fixed-effects regression model with White cross-section robust standard errors to account for heteroskedasticity and serial correlation. The empirical results reveal that all three educational dimensions exert positive and statistically significant effects on GDP, with government educational expenditure emerging as the most influential driver, followed by adult learning participation, underscoring the transformative role of continuous skill renewal in dynamic labor markets. These findings advance Human Capital Theory by framing education not merely as an individual asset but as an interactive, systemic driver of national productivity and resilience. The study offers actionable insights for policymakers, calling for integrated strategies that align formal education, lifelong learning systems, and sustained public investment to foster inclusive, knowledge-driven, and sustainable economic growth across the EU.