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People with disabilities represent a large, underutilized labor force, and while disability employment is increasingly recognized as a strategic human resource opportunity, reports on its value are fragmented. Existing research often emphasizes benefits for firms or employees with disabilities, overlooking other stakeholders and potential accompanying costs. This systematic review synthesizes 45 empirical studies published between 2000 and 2025, examining both benefits and costs across multiple stakeholders, value dimensions, and organizational positions. Findings reveal that most reported values were gain-related and firm-centered. Meanwhile, patterns of intra-stakeholder clustering and inter-stakeholder linkages highlighted the complex dynamics of shared outcomes. Four benefit–cost dynamics were identified, alongside evidence of occupational segregation in low-value job roles. By applying a multi-stakeholder framework, this review advances the human resource management literature, showing how disability employment can be leveraged strategically to create interconnected values, foster inclusion, and support sustainable workforce practices.
In this work we investigate the landscape of quasi-isodynamic (QI) stellarators using the near-axis expansion of the magnetic field. Building on recent theoretical developments, we construct a database of more than 800 000 stable, approximately QI vacuum magnetic configurations. These configurations span a range of field period numbers and other geometric control parameters, including the magnetic axis shape and plasma elongation. To evaluate each configuration, we use a broad set of measures, including effective ripple, sensitivity of the Shafranov shift to changes in plasma $\beta$, the prevalence of maximum-$\mathcal{J}$ trapped particles and the Rosenbluth–Hinton residual, among others. This enables an exhaustive, thorough and quantitative characterisation of the database. Statistical analysis and modern machine learning techniques are then employed to find correlations and identify key descriptors and heuristics to help understand tendencies that govern the behaviour of numerical optimisation. The database provides baseline configurations for further studies and to serve as tailored initial conditions for optimisation. With this work we initiate a long-term program to complete a systematic exploration of QI stellarator design space.
Edited by
Jonathan Cylus, European Observatory on Health Systems and Policies,Rebecca Forman, European Observatory on Health Systems and Policies,Nathan Shuftan, Technische Universität Berlin,Elias Mossialos, London School of Economics and Political Science,Peter C. Smith, Imperial College of Science, Technology and Medicine, London
Patients with hypoplastic left heart syndrome who develop a restrictive atrial septum prenatally have higher rates of postnatal mortality compared to those without atrial restriction. It is not understood whether the gestational age at which restriction becomes apparent echocardiographically impacts clinical outcomes.
Methods:
A single-centre, retrospective cohort study was performed, including 196 patients with hypoplastic left heart syndrome from 2008 to 2022. A restrictive atrial septum was diagnosed based on fetal echocardiographic findings of an intact atrial septum, antegrade:retrograde pulmonary vein Doppler velocity time integral ratio <3, and/or the presence of a decompressing vein. Patients were grouped as follows: 1. Without Restriction, 2. Early Restriction (<30 weeks’ gestation), and 3. Late Restriction (≥30 weeks’ gestation), based on the gestational age at which diagnostic criteria for restriction were met. Comparative postnatal overall survival and transplant-free survival analyses were performed using the Kaplan–Meier method.
Results:
Overall mortality rates were higher in the Early group (62%, n = 13) compared to the Late group (29%, n = 7) and the group without atrial restriction (40%). Similarly, transplant rates were higher in the Early group (23%) compared to the Late group (14%) and those without restriction (14%). Overall survival and transplant-free survival were not statistically different among the groups.
Conclusions:
While not statistically significant in this cohort with a small number of patients with atrial restriction, our data suggest that patients with hypoplastic left heart syndrome who meet diagnostic criteria for atrial restriction later in gestation may have outcomes more similar to those without atrial restriction.
Edited by
Jonathan Cylus, European Observatory on Health Systems and Policies,Rebecca Forman, European Observatory on Health Systems and Policies,Nathan Shuftan, Technische Universität Berlin,Elias Mossialos, London School of Economics and Political Science,Peter C. Smith, Imperial College of Science, Technology and Medicine, London
Chapter 3.1 draws out insights into the way primary care is paid. Primary care delivers first-contact access to health services and seeks to coordinate care. It is paid for in different ways in different settings: through salary, capitation (a fixed payment per enlisted patient), fee for service, pay for performance or blended payments that combine two or more of these methods. Key learning includes that
The way health systems pay for primary care can incentivize treatment that supports wider health systems’ goals, most particularly by
– Reducing avoidable referrals to secondary care, improving efficiency and reducing waste and
– Encouraging adherence to evidence-based clinical guidelines, enhancing quality.
Pay for performance is often used to improve quality but the evidence on how effective it is, is mixed. If performance measures are not carefully designed to be context-specific and adjust for risk appropriately, they can create unintended barriers to and inequalities in access.
The design of primary care payment models needs to be ‘holistic’, to consider the goals of the health system and to underpin quality, access and efficiency.
One of the ways in which healthcare’s climate impact can be reduced is by taking greenhouse gas emissions into account when deciding which treatments are reimbursed and/or included in clinical guidelines. In a report for the Minister of Health, Welfare, and Sports in the Netherlands, we explored how this idea could be put into practice. We developed a set of two criteria: greenhouse gas emissions per patient (which can be compared to, for example, QALYs gained), and total amount of greenhouse gas emissions for all patients undergoing the intervention (which can be compared to, e.g., healthcare’s remaining carbon budget). In the coming three years, the National Health Care Institute will use these criteria in an experimental setting, to gain practical experience and to assess whether there is sufficient support among policy makers, practitioners, and patients for taking into account climate impact regularly.
Chapter 4 examines the analyst briefing as a critical arena where hype is tested, negotiated, and reshaped. Entrepreneurs, accustomed to investor storytelling, often struggle to recalibrate their narratives for analysts, who probe, challenge, and demand coherence with market frameworks. Drawing on unique fieldwork access, the chapter documents how narratives undergo iterative repair as entrepreneurs work with analyst relations (AR) experts to align claims with evaluative expectations. Analysts are portrayed not as passive recipients but as active co-producers of credible narratives, engaging in what Knorr Cetina terms ‘proxy-ethnographies’ to assess deliverability. This process extends entrepreneurial storytelling beyond investor contexts into broader market-shaping activities. Analyst briefings emerge as pivotal sites of ‘taming hype’, where exaggerated claims are moderated, restructured, and, in some cases, elevated into credible categories.
Edited by
Jonathan Cylus, European Observatory on Health Systems and Policies,Rebecca Forman, European Observatory on Health Systems and Policies,Nathan Shuftan, Technische Universität Berlin,Elias Mossialos, London School of Economics and Political Science,Peter C. Smith, Imperial College of Science, Technology and Medicine, London
Chapter 3.3 examines informal payments. Informal payments are unsanctioned, unregulated payments made out-of-pocket by patients directly to their health care provider for services that are covered by third party purchasers. They are not recorded in routine administrative databases but can be captured in surveys, although they are usually underreported. Key learning includes that
Informal payments (IPs) reduce access to health care and financial protection. They can undermine population health and reduce trust in providers and governments in the long run.
IPs often stem from unmet desire for safe, timely or high-quality care and imply a mismatch between supply, demand and pricing in the formal health care payment system. When formal system payments are felt to be inadequate, IPs may also be used to express gratitude to providers.
Settings with low physician density and / or where the share of GDP spent on health care is low, tend to have higher levels of IPs.
IPs are also associated with settings with high reliance on formal out-of-pocket payments (user charges).
Reducing or ending IPs is difficult and requires a combination of specific, targeted measures and broad health systems reforms that address underlying causes.
The policy measures that may reduce IPs include
– Formalizing out-of-pocket payments, with exemptions to protect vulnerable populations
– Making clear and explicit what the health care benefits package covers
– Better monitoring and enforcement of rules and penalties
– Maintaining and expanding publicly-financed statutory coverage.
Edited by
Jonathan Cylus, European Observatory on Health Systems and Policies,Rebecca Forman, European Observatory on Health Systems and Policies,Nathan Shuftan, Technische Universität Berlin,Elias Mossialos, London School of Economics and Political Science,Peter C. Smith, Imperial College of Science, Technology and Medicine, London
Research on German modal particles (MPs) has long noted their tendency to occur in combination with one another. Prior studies have investigated this phenomenon relying mostly on qualitative and introspective methods. The present article demonstrates the benefits of employing quantitative methods to investigate MP combinations. In a corpus-linguistic study of spoken German, we address the question of ordering tendencies within these sequences, as well as the question of co-occurrence, that is, which MPs exhibit a tendency to combine with which others. Based on the results obtained we point out how longstanding questions on MP combinations may profit from the quantitative methods employed.*
Older refugees often navigate complex health care needs while aging in resettlement contexts. For Syrian refugees in the Greater Toronto Area and surrounding regions, barriers within the Canadian health care system may shape how care is accessed, coordinated, and supplemented through transnational practices.
Objective
This study examines how older Syrian refugees aging in the Greater Toronto Area and surrounding regions navigate health care and construct hybrid health care pathways across local and transnational contexts.
Methods
A qualitative interpretive descriptive design was used. In-depth interviews were conducted with 20 Syrian refugees aged 55–63. Data were analyzed using reflexive thematic analysis to identify patterns in participants’ experiences of accessing, coordinating, and supplementing health care.
Findings
Participants described persistent linguistic barriers, long wait times, and limited access to culturally aligned services within the Canadian health care system. In response, they developed hybrid health care pathways that combined Canadian health care with transnational practices, including consultations with clinicians abroad, cross-border medication use, family support, traditional remedies, and digital technologies. Digital tools played a central role in bridging language and geographic gaps and supporting care coordination. While these hybrid pathways enhanced autonomy, continuity of care, and perceived control, they also introduced risks related to medication safety, fragmented care, informal decision-making, and digital inequities.
Discussion
The findings show that older Syrian refugees’ health care navigation extends beyond formal Canadian health services and is shaped by transnational relationships, cultural knowledge, digital access, and prior health system experiences. Hybrid health care pathways can support continuity and culturally meaningful care, but they also require careful attention to safety, communication, and equity. Health systems should develop culturally responsive and digitally inclusive models that recognize transnational care practices while supporting safer integration with local care.
The overarching principle of humanity in international humanitarian law (IHL), which entails the prohibition of unnecessary suffering, the right to humane treatment and respect for human dignity during armed conflicts, constitutes a key guiding principle for the conduct of hostilities. As military decision-making becomes increasingly determined by artificial intelligence (AI), and the growing use of AI-enabled systems in modern warfare raises ethical and legal concerns over the erosion of human oversight and increasing civilian harm, the principle of humanity offers a critical perspective for assessing whether these technologies preserve or undermine the human-centred foundations of IHL.
This article interrogates whether the use of AI decision support systems (AI-DSS) in armed conflict poses a threat to or reinforces the principle of humanity in IHL. It analyzes the principle of humanity within the framework of IHL, focusing on its legal relevance and broad scope of application in its purpose of protecting life and health and ensuring respect for the human person. From there, the article delves into the challenges and opportunities that the use of AI-DSS presents in the conduct of hostilities for the fulfilment of the principle of humanity in compliance with IHL. The article concludes that it is necessary to adopt a normative framework for the responsible use of AI under IHL and proposes a set of guiding principles and standards grounded in the principle of humanity to ensure that AI is developed and deployed in a more ethical and responsible manner during warfare.
Previous research shows that speakers use prosody to disambiguate between string-identical canonical information questions and noncanonical questions conveying surprise. In this study, we investigated whether the prosodic cues produced by speakers are enough for naïve listeners to distinguish between the two readings of two distinct question structures in French that can express either a request for information or an emotive reaction of surprise: ‘qu’est-ce que’ and ‘c’est quoi ce NP’ questions. This article provides experimental evidence that listeners can in fact disambiguate between the two interpretations based on prosodic cues alone, in particular the contour and the duration of the question word.
The genus Canoparmelia Elix & Hale contains c. 40 species, predominantly occurring in tropical and subtropical regions. The genus is characterized by having relatively narrow, subirregular lobes with rotund or subrotund eciliate margins, a pored epicortex, the presence of isolichenan in the cell walls, bifusiform conidia, and simple rhizines (Elix 1993; Crespo et al. 2010b). Phylogenetically, it belongs to the Parmotrema clade of parmelioid lichens (Crespo et al. 2010b). Since its original circumscription (Elix et al. 1986), species have been transferred to other genera, including Austroparmelina A. Crespo et al. (Crespo et al. 2010a), Crespoa (D. Hawksw.) Lendemer & B. P. Hodk. and Parmotrema A. Massal. (Crespo et al. 2010b; Hawksworth 2011; Lendemer & Hodkinson 2012; Kirika et al. 2016). In addition, some species of the genus Crespoa are morphologically similar to certain Canoparmelia species, which leaves uncertainty regarding the identification of the samples.
Edited by
Jonathan Cylus, European Observatory on Health Systems and Policies,Rebecca Forman, European Observatory on Health Systems and Policies,Nathan Shuftan, Technische Universität Berlin,Elias Mossialos, London School of Economics and Political Science,Peter C. Smith, Imperial College of Science, Technology and Medicine, London
Chapter 1.1 discusses the use of taxes and social health insurance contributions. A key objective of health financing is to redistribute financial resources from the healthy to the sick and from the well-off to the poor. This can be best achieved through compulsory prepayment mechanisms like taxes and social contributions. Key learning includes that
A high reliance on public revenue raising instruments (taxes and/or social health insurance) is essential to progress towards universal health coverage.
Large informal economies and poor governance can make collecting public revenues difficult.
Health financing systems have to be able to adapt to
– Offset challenges to the revenue base such as economic decline, low levels of economic development or a preponderance of informal employment or economic activity and
– Meet increasing health care demands which grow with rising expectations and population.
The traditional distinction between health systems that rely on general taxation (Beveridge or NHS systems) and social insurance contributions (Bismarck or SHI systems) has blurred with time.
Health systems increasingly rely on a diverse mix of revenue raising instruments to finance health care.
There is a growing focus on de-linking employment from entitlement to services in historically SHI-based systems and on emphasizing general taxation as a preferred source of revenues.
To evaluate knowledge and attitude toward antibiotic use and self-medication with antibiotics.
Design:
Cross-sectional study.
Setting:
A Thai public university.
Participants:
Medical students.
Methods:
An anonymous online survey was conducted among pre-clinical- and clinical-year medical students between January 2023 to February 2024.
Results:
Of the 538 students included, 391 (65%) and 147 (35%) were in pre-clinical and clinical years, respectively, and 59% were female. Most of the students (>90%) were knowledgeable about the names of antibiotics and importance of adhering to prescribed antibiotic regimen. Less than 50% were knowledgeable about antibiotic resistance in gonorrhea and resistance transmission among humans or animals to humans. Clinical-year students had significantly higher knowledge score about antibiotic use than pre-clinical-year students (10 vs. 8 of 15; P < .001). Most students agreed that antibiotic resistance is mostly caused by human actions and antibiotic use and resistance should be taught early in a high school. Pre-clinical-year students were more-likely than clinical-year students to agree that alternative treatments are always available when antibiotics are ineffective. In multivariable logistic regression analysis, factors associated with higher antibiotic knowledge score were higher academic years (P < .001). While being pre-clinical-year students was independently associated with using antibiotics without appropriate indications (any diarrheal illnesses, upper respiratory tract infections and abrasions) and stopping antibiotic prematurely (P < .001).
Conclusions:
Interventions to improve knowledge and practices regarding antibiotic use should be tailored to students’ academic years and be guided by the study’s findings.