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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
This chapter analyses how industry analysts identify, evaluate, and promote disruptive ventures through designations such as ‘Cool Vendor’, ‘Innovator’, or ‘Market Disruptor’. These endorsements act as powerful funnelling devices, amplifying some narratives while marginalising others. The chapter interrogates the paradox of analysts as both critical evaluators and active promoters of the innovations they assess. Drawing on valuation studies, it distinguishes between evaluation (assessing worth) and valorisation (creating worth), showing how analysts simultaneously constrain speculative excess while conferring legitimacy. Through empirical cases, the chapter reveals the dual role analysts play as gatekeepers and amplifiers in the digital economy. By legitimising select start-ups, they transform localised narratives into widely recognised signals of market potential. This valorisation process illustrates how hype is not merely curtailed but actively channelled into market-making dynamics, underscoring the analysts’ central role in the institutionalisation of hype.
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 3.8 highlights the importance of funding as a tool for preparing for and responding to pandemics. A pandemic can wreak health, societal and economic havoc. Prioritizing common and global public goods for health and specifically for pandemic planning is complex and requires financing mechanisms at national, regional and supranational levels. Key learning, including from COVID-19, is that
– Pandemic preparedness is subject to inherent market and collective action failures and is often underfunded.
– Governments need clear strategies for funding preparedness.
– Preparedness depends on strong health system foundations and contingency funding mechanisms that go beyond simply setting funds aside. It is crucial that funds can be mobilized quickly and in a coordinated fashion.
– Key steps for planning responses include
Assessing existing activities and mapping value for money
Agreeing the need for public financing for population-based functions (i.e. common goods)
Identifying appropriate types of financing that reflect the complexity of determining resource needs and allow for nuanced cost estimation
Developing context-specific financing tools that include flexible funds and address accountability
Holding transparent discussions about trade-offs
Improving budget transfer mechanisms
Integrating domestic finance into multiyear budgets, and
Managing and strengthening international collaboration
International guidance and learning from COVID-19 can help inform preparations. Organizations including the WHO and World Bank offer tools to help decision-makers. It is crucial that these are assessed for suitability to context and customized to the national and local setting.
This chapter asks how two subjects defined in the terms of ‘religion’ – the ‘Muslim’ and the ‘Jewish’ subject – became recognizable as such in the decades prior to the independence of the ‘Islamic Republic’ of Pakistan and the ‘Jewish National Home’ of Israel, which aligned the recognition and formation of the religious minority, the nation, and the state. It addresses the recognition of Israel and Pakistan in the contexts of their colonial pasts and analyses the role of demography, the claim for political representation, and the work of two international commissions that shaped the borders of their statehood. It shows how emerging modes of cultural recognition built on and cemented very particular understandings of ‘religion’ and funnelled certain aspects of social, political, and cultural life into coherent, representable, and recognizable forms of religious difference. By looking in detail at the epistemological politics of religious difference, the chapter illustrates the costs that come with the recognition of ‘religion’ and ‘religious difference’ in the transition from empire to state. The double face of the imperial recognition of the ‘Indian Muslims’ and the ‘Palestinian Jews’, in other words, worked both as a condition for legitimate government and power and as a resource for the future challenge against them.
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 3.4 explores how pharmaceutical care is financed. Paying for medicines includes how the end-purchase of existing medicines is managed but also the way investment in research and development (R&D) is handled. Key learning includes that
Pharmaceutical innovation draws on substantial public and private resources.
– The public sector primarily supports early-stage research, regulates the industry and incentivizes development.
– The private sector is typically central to development, commercialization, manufacture and marketing. It seeks high profit margins and is not always transparent or responsive to policy priorities.
Novel and specialized therapeutics as well as population ageing are likely to accelerate medicines expenditures. This requires careful management of pricing and reimbursement.
Policy-makers can leverage a mix of push and pull strategies to align industry efforts with societal need including through
– Clear communication of health system priorities
– Transparent incentive and pricing systems and measures to enhance R&D efficiency
– Payment mechanisms that foster equity and sustainability
– Cross-country collaboration including on preparedness, procurement and pricing transparency.
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 3.10 evaluates innovative financing for neglected diseases. Neglected diseases (NDs) account for about a fifth of the global burden of disease and affect over a billion people. They are neglected because the pharmaceutical sector does not consider it profitable to develop treatments for them. This reflects that fact that NDs are most prevalent in low- and middle-income countries with relatively low purchasing potential. Key learning includes that
Global pharmaceutical research and development (R&D) invests a disproportionate share of innovation, activity and resources in low burden diseases and fosters significant inequities.
A range of push and pull incentive mechanisms have been developed to delink the cost of research from market profitability and promote innovation in areas of need.
These include measures to
– Reduce the upfront costs by subsidizing R&D pre-discovery (push incentives) and
– Offer a reward post-discovery (pull incentives)
The evidence on the effectiveness and reach of incentive schemes is scant and more needs to be done to understand the relative cost-effectiveness of the different incentive mechanisms and the extent to which they mitigate inequalities in innovation and access to new medicines.
A global, unified governance framework for needs assessment and resource allocation could usefully
– Carry out systematic comparison of the relative needs associated with NDs globally
– Assess the costs and benefits of addressing these
– Set priorities for the coordinated global allocation of funding and targeted incentive mechanisms, and
– Consider payment mechanisms that will translate research into market launches.
We investigate Taylor–Couette flow with realistic no-slip boundary conditions at all surfaces through direct numerical simulation (DNS) and theoretical analysis. Imposing physically consistent end-wall conditions at the top and bottom lids significantly alters the flow dynamics compared with that for periodic boundary conditions. We extend the classical angular-momentum-flux framework to account for axial transport, thereby extending the Eckhardt–Grossmann–Lohse model (Eckhardt et al. J. Fluid Mech. vol. 581, 2007, pp. 221–250) to no-slip boundary conditions. A systematic exploration of the parameter space $(\textit{Re}, n)$ uncovers multiple long-lived states with different roll number $n$ configurations at identical Reynolds numbers $\textit{Re}$, giving rise to pronounced hysteresis loops occurring under realistic boundary conditions. Our DNS for no-slip axial endcaps reveals a sequence of structural transitions: as the inner-cylinder Reynolds number increases, the flow evolves from Taylor vortex flow through chaotic wavy vortex flow and turbulent wavy vortex flow to an axisymmetric turbulent Taylor vortex flow. Using modal energy budgets, we identify transition mechanisms and quantify how the accessible phase-space volume and associated roll-specific angular momentum flux depend on control parameters and the specific flow state. Our findings demonstrate the impact of realistic boundary conditions on the dynamics in Taylor–Couette flow and how they change the stability landscape of multiple states. The coexistence of distinct flow patterns and their stability analysis offers promising insights into transition dynamics between laminar and turbulent regimes in closed sheared flows.
Since the 1950s, US officials have sought to reduce cancer incidence by regulating chemical exposures. However, rodent carcinogenicity tests are lengthy and expensive, making it impractical to identify carcinogens among the tens of thousands of chemicals on the market through animal testing. Introduced in 1973, the quick and inexpensive ‘Ames test’ indicated whether a chemical caused mutations in bacteria, and putatively cancer in humans. In the 1970s and 1980s, scientific societies, international bodies and government agencies launched efforts to validate the Ames test for carcinogenicity. While the Ames test became the most commonly used mutagenicity (or genotoxicity) test, technical determinations of its validity could not resolve policy issues concerning how much predictiveness was required for regulatory action. The availability of new animal carcinogenicity data through the 1980s affected calculations of the predictiveness of the Ames test for carcinogenicity, and criticisms of the rodent bioassay also complicated the interpretation of mutagenicity data. This article documents the challenges of validating even a very successful chemical safety test, while paying attention to how academic scientists, government agencies and international bodies participated (and sometimes competed) in setting regulatory standards.
When the German occupation of the British Channel Islands began in 1940, many members of the Wehrmacht believed they were stationed in a Schlaraffenland, a paradisical ‘Promised Land’. At the Islands’ liberation five years later, German soldiers, having experienced an occupation characterised by monotony, loneliness, starvation and resultant distrust of leadership, had become so worn down by the geographic conditions of the Islands that they believed such a Schlaraffenland could be almost anywhere else. This radical shift in perspective demonstrates troops’ descent into disillusionment. Exploring the geographic causes of this disillusionment and how geography shaped soldiers’ responses to it, this article highlights how soldiers in rural and isolated postings had profoundly different experiences of occupation from those of their counterparts in more densely populated areas. In studying these occupation experiences, historians can understand more clearly the complex ideological landscape of troops and the ways the physical landscape shaped their behaviours.
Anxiety disorders are associated with disrupted amygdala connectivity; however, resting-state functional MRI studies have reported heterogeneous findings. To clarify these inconsistencies, we conducted a meta-analysis of amygdala-based connectivity studies.
Methods
A systematic search of Embase, PubMed, and Web of Science was performed through December 26, 2025. Studies comparing amygdala-based whole-brain resting-state functional connectivity in patients with anxiety disorders versus healthy controls were included. Meta-analysis was conducted with the latest software – Seed-based d Mapping with Permutation of Subject Images (SDM-PSI), which employs voxel-wise tests and multiple corrections to minimize false positives. Subgroup analyses were performed to examine differences by age and hemisphere.
Results
Fifteen datasets (378 patients, 405 controls) were included. Compared to healthy controls, patients with anxiety disorders had decreased amygdala-anterior cingulate cortex (ACC, g = −0.54, 95% confidence interval [CI]: −0.73 to −0.35) connectivity and increased connectivity with the left superior temporal gyrus (g = 0.46, 95% CI: 0.27–0.65), middle temporal gyrus (g = 0.38, 95% CI: 0.19–0.57), and cuneus (g = 0.35, 95% CI: 0.17–0.53). After threshold-free cluster enhancement correction, only reduced amygdala-ACC connectivity remained significant (g = −0.54, 95% CI: −0.73 to −0.35). Subgroup analyses confirmed this effect was driven mainly by adult patients and the left amygdala.
Conclusions
Reduced connectivity between the left amygdala and the ipsilateral ACC was the most robust neuroimaging marker of anxiety disorders, which suggests a lateralized vulnerability. By applying updated analytic methods, this study refines our understanding of the neuropathology of anxiety disorders and provides a potential primary target for biomarker development and novel interventions.
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
We evaluated an Epic-based outpatient parenteral antimicrobial therapy (OPAT) order set to assess its impact on clinical workflows and analytics. Free text, missing structured fields, and lack of microbiology linkage made it difficult to track care, monitor safety, and analyze outcomes, highlighting essential design requirements for OPAT system rebuilds.
This chapter is about the concept of religion in International Relations (IR) scholarship, the pitfalls of multiculturalist approaches, and the potential of alternative approaches centring genealogical care. It illustrates this through close conceptual readings of central figures such as Daniel Philpott, Jürgen Habermas, William Connolly, and Iza Hussin. It argues that such conceptual analysis is necessary in order to understand the endemic ideological and cognitive bias built into the dominant multiculturalist framework on religion in IR, as well as the importance for alternatives to it. This is significant because these biases continue to structure both scholarship and political practice of religious freedom, the regulation and governance of religious minorities, the identification and evaluation of ‘religious’ conflict and conflict parties, as well as the initiatives for reworking the relationship between religion and politics within international practices and theory.
The ketogenic diet (KD) is a well-established therapeutic option for children with non-surgical drug-resistant epilepsy (DRE). The purpose of this study was to determine whether specific anti-seizure medications (ASM) are associated with positive seizure outcomes when used concurrently with KD.
Methods:
This was a retrospective chart review of children with DRE treated with KD at the Hospital for Sick Children from Jan 2011 to Feb 2022. Data included demographics, epilepsy etiology, seizure type, and ASM used. Children with seizure data available for at least 3 months without dose modification were enrolled. Children with ≥50% reduction in seizures from baseline were classified as responders. The effect of ASM on the efficacy of the KD was analyzed using logistic regression with two models: ASM with clinical parameters such as age, etiology, seizure types, and diet type; and the second model with ASM alone.
Results:
A total of 127 children (55 boys) were enrolled. In both models, 5 ASMs were found to have a statistically significant positive association with the efficacy of the ketogenic diet – lacosamide (OR 10.261 [95% CI: 1.533–68.671]), vigabatrin (5.582 [1.141–27.312]), lamotrigine (5.004 [1.423–17.601]), topiramate (3.194 [1.064–9.589]), and levetiracetam (2.895 [1.085–7.722]). No ASMs were negatively associated with seizure responder rate in either model.
Conclusion:
Several ASMs were positively associated with KD efficacy for seizure reduction. Given the observational design and potential confounding, these findings should be interpreted cautiously and support selecting concomitant ASM based on electro-clinical phenotype and tolerability rather than anticipated effects on KD efficacy.
With the outbreak of the Haitian Revolution, thousands of people sought refuge in neighbouring British Jamaica, or ended up there as prisoners of war. This contribution examines how colonial authorities responded to a mass influx of people in a time characterised by political uncertainty. It sheds light on a system of registration employed in 1790s Jamaica to manage refugees and to gauge who would be entitled to assistance. This system was built on surveillance, categorisations of people, and a language of deservingness, made use of both by colonial administrators, on whose deliberations access to support effectively depended, and refugees in their own narratives. The article shows how refugee registration was not a top-down process but rather one that was actively influenced from below, as refugees themselves made use of the unclearness of categorisations and hijacked the system in order to gain access to specific sets of relief funds.