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This chapter provides a snapshot of Rwanda’s evolving political settlement and economic development trajectory. The chapter begins by highlighting significant structural vulnerabilities that shaped Rwanda’s domestic politics historically, including ethnicity-based inequalities and political contestation, historical divisions associated with the royal family and aristocracy, refugee issues, inadequate employment opportunities and regional inequalities. It then highlights the rapid growth that took place in Rwanda over the last three decades, which has also been accompanied by significant export diversification. It then provides a brief political settlement analysis of present-day Rwanda, highlighting how development is being contested transnationally, pointing to the key vulnerabilities characterising its hub-based strategy. In particular, it describes how increased elite vulnerability has meant that the government has been reluctant to support domestic capital. As a result, the Rwandan government has failed to develop effective state–business relations aimed at achieving structural transformation.
The book is motivated by the question of analysing how Rwanda’s development trajectory can contribute to our understanding of why structural transformation remains so elusive. This chapter introduces the central contributions of the book. First, the book employs structuralist political settlements analysis to highlight how contemporary late development is contested transnationally, prompting the need for analysis across different scales. Second, the book describes how African growth has been largely driven by the services sector and Rwanda is emblematic of contemporary African growth experiences, especially since, like elsewhere on the continent, structural transformation has remained elusive. Third, the book contributes to existing literature on Rwanda by highlighting that the Rwandan Patriotic Front prioritised services-based strategies partly to reduce its reliance on domestic businesspeople because of the elite vulnerability that has characterised its rule. This strategy has yielded growth and export diversification without achieving structural transformation because elite vulnerability has inhibited effective state–business relations. The introduction also includes a discussion of the methodology employed in the book and the structure of the chapters that follow.
While early postwar musical modernist explorations seemed progressive during the 1950s, Yugoslav composers faced European and American avant-garde trends at the inaugural Music Biennale Zagreb in 1961. Founded by Croatian composer Milko Kelemen, who refused to conform to the demands of socialist realism, the Zagreb Biennale was the most significant cultural event in Yugoslavia in the early 1960s and continued to play a pivotal role in the country’s cultural diplomacy over the next three decades. Taking advantage of the Cold War political divisions, Yugoslavia’s unique position as a “liberal” communist state that did not belong to either bloc, and an economic model that adopted elements of socialism and capitalism, Kelemen devised a plan that reads like a Cold War spy novel. Pitting the Soviets against the Americans and Western Europeans with fabricated stories, Kelemen managed to secure the participation of the most recognizable figures in contemporary music in the US and Europe. Consequently, his festival became one of the most relevant international festivals of contemporary music and a forum for Yugoslavia’s engagement with Western avant-gardism.
This article examines the evolution of COVID-19 vaccination efforts during 2021 and 2022 in six Central American countries, each with distinct social policy legacies and political regimes. Drawing on official data sources, the article differentiates two phases: the initial rollout of vaccines and the subsequent expansion of second-dose coverage to secure immunity. We advance three main arguments. First, differences in performance can be partly explained by the state capacities needed to implement vaccination campaigns. Second, regime type does not explain success; Nicaragua matched the performance of the most effective democratic countries. Third, presidential will accounts for the divergent trajectories of autocratic regimes. These findings underscore that in times of crisis, effective social intervention is possible without democratic pressures and accountability and highlight the need to further examine variation within nondemocratic regimes.
Longtermists such as William MacAskill maintain that if we are concerned about human well-being and the longterm future, we should embrace continued technological advancement and development, and that, indeed, one of the most significant threats to longterm human well-being and the well-being of other sentient creatures is technological stagnation – remaining at roughly the present technological level. This paper argues that we should be much more skeptical regarding claims that link continued technological development with positive contributions to well-being. We should take seriously that even if technological development has contributed significantly to improvements in well-being in the past, that we may reach or have already reached a point at which future technological development no longer does so, and that, in that event, thinking about longterm ethical concerns actually recommends developing the capability to slow down, stop, or even roll back (some) technological development.
This report examines gender differences in trust-based social networks in contemporary China. Using data collected from a uniquely designed survey, respondents rate the trustworthiness of 24 prototypical social roles, enabling our construction of gender-specific networks. Community detection analysis reveals a tripartite structure in men’s networks – older-generation kin, same-generation kin and non-kin – versus a simpler kin/non-kin split among women. Two explanatory pathways are tested: cultural dispositions and life chance access. Matching analyses suggest cultural orientation as the primary driver: when men and women both embrace traditional ideas to the same degree, their network partitioning differences cease to exist. Further analyses suggest that the gender difference in social network partitioning lies in the fact that men are more traditionally oriented than women. This study highlights a gendered cultural configuration in which men appear relatively more “traditional” and women more “modern” as played out through gendered forms of social networking.
To describe the evidence on antimicrobial stewardship programs (ASPs) and strategies implemented in outpatient settings.
Design:
We conducted a scoping review to describe the evidence published since 2013 on the effects and implementation of outpatient ASP strategies and programs.
Methods:
We searched Ovid MEDLINE, Embase, and Scopus from January 1, 2013 through September 3, 2024. Data were summarized in figures and tables. We categorized studies by types of ASP strategies and settings. We also summarize the reported outcomes using the RE-AIM framework.
Results:
Of 29,544 unique citations/abstracts, 285 primary studies and 37 systematic reviews were eligible. Most included primary studies were observational (k = 226) and only 59 (21%) were randomized controlled trials (RCT). Most studies were conducted in primary care (k = 135) or emergency room/urgent care (k = 79). The most commonly evaluated individual strategies were patient and/or clinician education only (k = 55), audit and feedback (k = 48), and laboratory testing (k = 45). Overall antimicrobial and inappropriate prescribing rates were the most frequently assessed outcomes; patient treatment outcomes and health care utilization were also commonly reported.
Conclusions:
There has been substantial growth in the evidence base, but this is largely from observational studies. Evidence gaps include a need for more controlled studies, and evaluation of additional outcomes. Few studies evaluated implementation costs or barriers, reach, and sustainability. Many of these additional outcomes would provide valuable insights to aid policy makers in the most feasible and appropriate strategies for implementation.
Anxiety disorders show striking sex differences in prevalence, symptoms, and clinical characteristics, shaping how they manifest and are experienced.
Methods
Here, we report the first sex-specific meta-analysis of genome-wide association studies (GWAS) of anxiety, leveraging two of the largest biobank datasets, UK Biobank and All of Us, comprising 85,042 female cases with 196,789 controls and 36,732 male cases with 136,924 controls. Functional annotation, sex-specific polygenic scores (PGS), and genetic correlations were performed to assess genetic differences and functional implications.
Results
In females, 21 lead SNPs were significantly associated with anxiety, compared to five in males. Although the genetic correlation between sexes was high, it was significantly different from one, indicating partially distinct genetic architectures. In addition, both the SNP-based observed and liability-scale heritabilities (assuming a 2:1 female-to-male prevalence ratio) were significantly higher in females. Gene-based tests and functional prioritization identified different genes associated with anxiety in females and males. Moreover, genetic correlation analyses revealed stronger associations of female anxiety with attention-deficit/hyperactivity disorder (ADHD) and body mass index (BMI), whereas male anxiety showed stronger correlations with waist-hip-ratio-adjusted BMI.
Conclusions
While the overall genetic architecture of anxiety is largely shared, our findings reveal distinct sex-specific genetic associations and correlations, highlighting the value of analyzing the sexes separately to uncover genetic signals that may be masked in sex-combined samples.
The press publishers’ right (granted under Art. 15 of the EU’s 2019 Directive on Copyright in the Digital Single Market) equips publishers with a legal basis for negotiations with digital intermediaries. However, the process of bargaining has not been specified by the EU legislator, which left it to the discretion of EU Member States and the market. This chapter examines the four main approaches to the operationalisation of the press publishers’ right in the EU, in contrast with the bargaining framework that has evolved in Australia without the underpinning of a new intellectual property right. It analyses these frameworks from the perspective of ‘bargaining in the shadow of the law’ to understand the relationship between statutory law and private bargaining as mediated by institutional frameworks. By defining and coding key parameters concerning the bargaining parties, their endowments (bargaining chips), measures to mitigate dependencies and the role played by the authority (such as a regulator), the chapter shows that bargaining frameworks sit as complex institutional constraints between pure private ordering and the law. It is the shape of the bargaining framework that matters for the range and frequency of agreements between press publishers and digital platforms.
Patients with inflammatory bowel disease (IBD) may be at increased risk of complications following lumbar spine surgery due to systemic inflammation, immunosuppressive therapy and nutritional deficiencies. This systematic review and meta-analysis evaluated the comparative outcomes of lumbar spinal surgery in patients with and without IBD.
Methods:
We searched five databases through June 2025 for randomized and observational studies comparing postoperative outcomes of lumbar spine surgery of any type between adult patients with and without IBD. A random-effects meta-analysis was performed using the DerSimonian and Laird method.
Results:
Four retrospective cohort studies encompassing 878,116 patients (15,763 with IBD and 564,733 controls) were included. IBD patients had significantly higher odds of multiple adverse outcomes, including any complication (OR = 1.63, 95% CI: 1.08–2.47), serious adverse events (OR = 1.68, 95% CI: 1.39–2.02), minor adverse events (OR = 2.04, 95% CI: 1.63–2.55), wound infections (OR = 1.21, 95% CI: 1.08–1.35), venous thromboembolic events (OR = 1.86, 95% CI: 1.49–2.32), pneumonia (OR = 2.31, 95% CI: 1.93–2.77), urinary tract infections (OR = 2.29, 95% CI: 1.35–3.87), acute kidney injury (OR = 1.91, 95% CI: 1.68–2.17) and blood transfusions (OR = 1.64, 95% CI: 1.29–2.08). Myocardial infarction (OR = 1.76, 95% CI: 1.40–2.23) was also more common in IBD patients. No significant difference was observed in 90-day hospital readmissions.
Conclusion:
Patients with IBD may experience significantly increased risks of postoperative complications after lumbar spine surgery. However, substantial heterogeneity among retrospective studies limits the strength of causal inferences. These findings highlight the importance of tailored perioperative management and risk counseling in this population.
In 2019, the EU legislature introduced a right in favour of press publishers over their press publications. The rationale supporting EU intervention in relation to Article 15 of Directive 2019/790 on Copyright in the Digital Single Market (CDSMD) is multi-fold, ranging from support for press publishers when licensing the use of press publications to ensuring a fair marketplace and the protection of a free and pluralist press in performing its societal functions. Article 15 CDSMD has now been transposed at the national level. Despite the harmonizing objective of EU legislature, the resulting legal landscape across the EU appears fragmented. Focusing on the exclusion of ‘very short extracts’ of press publications and considering selected divergent national transpositions, this chapter investigates whether such divergences will thwart the harmonization objective of 15 CDSMD, whether they are incompatible with EU law, and, if so, what the solutions could be. The chapter’s title question is answered: harmonization is necessary, but where the instrument chosen is a directive, national legislatures must correctly interpret and act within the freedom afforded to them under EU law. In many national transpositions of Article 15 CDSMD, this has not occurred.
To inform how we think about EU media law in the future, this chapter traces the understandings of harm evident in EU media laws, their proposal documents, and explanatory notes since the 1989 Television Without Frontiers Directive. It identifies a shift from concern with individual harm from exposure to content, to addressing a variety of sources of harm to individual consumers, collectives, and societal systems. It demonstrates that a link between assumptions about control over risk and responsibility remains persistent and shows how responsibility for preventing harm has been increasingly distributed among various actors as changes in the technology and design of services and in the harms being addressed have affected control over the risk. This chapter argues that future thinking in EU media law needs to focus on how the institutional architecture can support effective cooperative responsibility, including addressing imbalances of power and information asymmetries.
El crédito fue una realidad de múltiples caras en la Europa del Antiguo Régimen. Entre sus formas destacó la hipoteca de bienes y rentas a cambio de dinero, una fuente de ingresos seguros para los prestamistas. Este artículo analiza una realidad poco conocida, aunque suficientemente relevante como para motivar la intervención reguladora del Consejo de Castilla durante toda la Edad Moderna: los censos perpetuos. La compra de censos constituyó un sistema crediticio especialmente extendido en las áreas rurales del noroeste de la península ibérica. Su modalidad más gravosa adoptó la forma de contratos perpetuos, eludiendo una normativa que no contemplaba esta variante. Esta situación generó numerosos pleitos ante tribunales locales y regios, así como intensos debates entre los juristas de la época. A través del caso del vino del Ribeiro, se examina la expansión de estas hipotecas perpetuas como instrumento de crédito rural y las contradicciones que acabaron debilitando sus ventajas para los acreedores.