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This study examines the role of normative values and stakeholder commitment in the evalua-tion and implementation process of social and organizational innovations in highly regulated systems, using the example of the four-day work week in German healthcare. Based on 26 expert interviews across micro, meso, and macro levels, the study reveals how actor-specific values and institutional contexts shape judgment about ecological, economic, social, and or-ganizational performance sustainability. The findings show that commitment to innovation is not determined solely by functional considerations but emerges in a field of tension between normative aspirations. Stakeholders align themselves differently along axes such as employee vs. patient orientation or short- vs. long-term thinking, resulting in competing innovation scenarios. The study proposes a transferable framework enabling organizations to map stakeholder values, locate areas of tension, and assess the depth and direction of commitment.
While scholarship on feminist foreign policy continues to proliferate, the impact of anti-feminist objectives on foreign policy requires attention. In this article, I critically examine the intersection of abortion politics and U.S. foreign policy, arguing that American foreign policy has long been shaped by an anti-feminist practice. The U.S. has systematically restricted access to abortion abroad for over 50 years through legislation and executive actions. Applying quantitative and qualitative research methods, I trace the history of abortion-related foreign policy from 1973 to 2022, analyze all congressional foreign policy bills referencing abortion, and draw on interviews with legislative staff and issue advocates from the 115th Congress (2017-18) to highlight how anti-abortion advocacy shapes U.S. foreign policy decisions. These findings suggest that while feminist mobilization has constrained anti-abortion efforts domestically in the US, foreign policy remained a key battleground where anti-feminist actors have historically been more successful. This case underscores the importance of analyzing domestic policy dynamics to understand the broader implications of feminist and anti-feminist agendas in international relations.
We consider the Cauchy problem to the 3D fractional Schrödinger equation with quadratic interaction of $u\bar u$ type. We prove the global existence of solutions and scattering properties for small initial data. For the proof, one novelty is that we combine the normal form methods and the space-time resonance methods. Using the normal form transform enables us to have more flexibility in designing the resolution spaces so that we can control various interactions. It is also convenient for the final data problem.
Professionals engaged in community work within their own communities frequently encounter challenges associated with dual relationships. The psychological impacts of dual roles are often overlooked.
Aims
This study explores the experiences of Muslim professionals in Christchurch, New Zealand, following the 15 March 2019 mosque terrorist attacks. It examines how they balance their community roles with their professional responsibilities while also safeguarding their personal well-being.
Method
Semi-structured interviews were conducted with 20 Muslim professionals engaged in dual relationships within their community. Participants were selected through purposive sampling from diverse sectors, including government agencies, research positions and community support services. Reflexive thematic analysis was utilised to identify key themes.
Results
Participants reported significant emotional strain, including vicarious trauma and burnout, driven by their dual roles. Faith emerged as a key motivator, with altruism framed as a spiritual duty. Identity struggles were common, shaped by societal scrutiny and a desire for validation. While formal support systems were sometimes inadequate, peer support and culturally attuned leadership provided relief. The findings highlight the complex interplay of psychological, spiritual and structural factors in sustaining professionals following a disaster.
Conclusions
This research highlights the emotional toll on Muslim professionals supporting their community following a terrorist attack, with broader implications for minority groups responding to similar incidents. The findings highlight the need for culturally competent, trauma-informed support systems within community care organisations. Recommendations include strengthening of peer support, training supervisors in cultural responsiveness and ensuring tailored mental health resources to support well-being and professional effectiveness in high-impact roles.
Measure of uncertainty in past lifetime distribution plays an important role in the context of information theory, forensic science and other related fields. In the present work, we propose non-parametric kernel type estimator for generalized past entropy function, which was introduced by Gupta and Nanda [9], under $\alpha$-mixing sample. The resulting estimator is shown to be weak and strong consistent and asymptotically normally distributed under certain regularity conditions. The performance of the estimator is validated through simulation study and a real data set.
This paper describes a health-system’s experience incorporating Standardized Antimicrobial Administration Ratio (SAAR) data to optimize the existing antimicrobial use module within the electronic health record. We describe the design and implementation via a standard operating procedure (SOP), which incorporates SAAR and the optimized dashboards into the health-system’s antimicrobial stewardship program.
Design:
This is a descriptive study outlining our process of optimizing the electronic health records default antimicrobial use dashboard into a dual-purpose dashboard, SAAR and Antimicrobial Use (AU) dashboard, to be used across a health-system.
Setting:
10-hospital health-system
Intervention:
For adult and pediatric populations, a pre-populated dashboard was created for each SAAR antimicrobial category using the existing EHR application. For adult, pediatric, and neonatal populations, improvements were made to visualize AU data in the dashboards. We created the framework for a standardized metric for our health-system’s antimicrobial stewardship program (ASP). An SOP was developed to establish an expectation for SAAR data analysis at the site level of our health-system’s ASP. The dashboards and SOP were created to evolve with the AUR protocol and health-system.
Results:
Pre-populated dashboards for adult and pediatric SAAR antimicrobial categories are configurable within existing electronic health-records, requiring minimal manipulation from the user to view which antimicrobials are driving a location’s SAAR.
Conclusion:
In anticipation of required AUR reporting, other health-systems using the same EHR can utilize this approach to integrate the SAAR into their health-system’s antimicrobial stewardship programs. Collaboration between antimicrobial stewardship clinicians, pharmacist information technology (IT) analysts and infection preventionists are essential to accomplish this endeavor.
In this paper, we showcase how flow obstruction by a deformable object can lead to symmetry breaking in curved domains subject to angular acceleration. Our analysis is motivated by the deflection of the cupula, a soft tissue located in the inner ear that is used to perceive rotational motion as part of the vestibular system. The cupula is understood to block the rotation-induced flow in a toroidal region with the flow-induced deformation of the cupula used by the brain to infer motion. By asymptotically solving the governing equations for this flow, we characterise regimes for which the sensory system is sensitive to either angular velocity or angular acceleration. Moreover, we show the fluid flow is not symmetric in the latter case. Finally, we extend our analysis of symmetry breaking to understand the formation of vortical flow in cavernous regions within channels. We discuss the implications of our results for the sensing of rotation by mammals.
Social reproduction offers a critical lens through which to analyse how labour law creates and constructs labour/ers. Socially reproductive work, traditionally ignored in waged labour markets, has been omitted from legal categories that protect workers. Yet these same legal categories that create and construct labour/ers are themselves socially reproduced. In Sicilian agricultural work, social reproduction happens in the extra care that is needed in labour carried out by migrantised workers, as well as the silence that is reproduced by markets that overlook the exploitation buttressing a local economy. The lens of social reproduction connects the work behind the scenes that depends on the complicity, whether wilful or ignorant, of consumers who do not ‘care’ that the labour producing Sicilian Denominazione di Origine Protetta (Protected Designation of Origin, DOP) and Indicazione Geografica Protetta (Protected Geographical Denomination, IGP) products is legally irregular. Contributing to discussions of labour law’s limits, this article addresses how labour exploitation is socially reproduced through the invisibilisation of labour involved in cultivating and harvesting Sicilian DOP olives and IGP tomatoes.
Allogeneic hematopoietic stem cell transplantation (HSCT) is essential for the long-term survival of acute leukemia (AL) patients. Peripheral blood stem cell transplantation has become the preferred method due to its lower invasiveness and convenience. The blood cell separator is key for hematopoietic progenitor cell collection, with CD34+ cell collection efficiency (CE) influencing transplant outcomes and healthcare costs. This study compares the cost-effectiveness of two devices, Spectra Optia and COM.TEC apheresis system, to assess their impact on CD34+ cell CE in HSCT.
Methods
A decision tree–Markov model was constructed from the perspective of the healthcare system to simulate the 5-year outcomes of 10,000 acute leukemia patients experiencing allogeneic stem cell transplantation. Resource cost differences between two devices were analyzed under two scenarios: minimizing resource consumption (scenario 1) and maximizing CD34+ cell volume (scenario 2). Cost-effectiveness analysis was undertaken combining quality-adjusted life years (QALYs) and total medical costs, with incremental net monetary benefit calculated at predefined willingness-to-pay thresholds.
Results
Compared to COM.TEC, Spectra Optia reduced apheresis times by 1–6 percent and improved the rate of engraftment success by 0.23 percent to 1.82 percent. In scenario 1, the net benefit per patient ranged from $634.85 to $1,260.43, and in scenario 2, the net benefit per patient ranged from $169.62 to $256.65.
Conclusion
Higher CE of the apheresis system optimizes both healthcare resource consumption and clinical outcomes. In the analysis considering the device price, Spectra Optia achieved cost-effectiveness dominance over COM.TEC at a surgical volume exceeding 121 cases per device.
This article explores a continuum of environmental participation, from formalized participation in decision-making processes, protected by law, at one end, to protest on the streets, criminalized by law, at the other. Participation across this continuum is partially constituted, but also constrained, by law. We share and extend Brian Wynne’s evocative language of ‘uninvited’ participation to describe the contributions that fall outside institutionalized participation, so that our continuum is composed of ‘invited participation’, ‘uninvited participation’, and ‘forbidden participation’. Focusing especially on those states where liberal democracy is thought to be most secure, this article looks across the interconnections between different categories of environmental participation, highlighting the breadth and intensity of the shrinking of civic space in Europe, and the role of law in that.
A growing number of Medicaid programs have expanded to employ family members to provide long-term home care to individuals with disabilities, challenging the traditional wisdom that the law systematically denies the economic value of family caregiving. This article qualitatively studies a novel dataset of fair hearing records arising out of one of these programs—New York State’s Consumer-Directed Personal Assistance Program (CDPAP)—and makes two contributions to the literature on care, disability, and the welfare state. First, this article explores the new public/private boundary of care when the state limitedly expands its public care responsibility by compensating some family caregiving, providing a more nuanced picture of how the legal system both values and undervalues care. Second, it contributes to disability law scholars’ debate about medicalization by studying how medicalization works as a state legibility project in the context of state-supported disability care. Especially for traditionally undervalued social goods such as care, medicalization provides some metrics, albeit highly constrained, to make its value visible. Meanwhile, through capturing care recipients and their families’ more expansive understandings of care’s value, this study reveals the constraints of these metrics and supports making the relational dimension of care legible to the state.
Early life, or the neonatal period, is perhaps the most challenging time for ruminant livestock, as they adapt to the extra-uterine environment, undergo important physiological maturation, and navigate harsh ambient conditions. Maternal influences during gestation, especially energy and protein nutrition in late pregnancy, can alter many processes that affect the neonatal period. These processes include fetal growth and development, gestation length, difficulty of parturition, and maternal behavior, which interact to affect offspring vigor at birth. Moreover, colostrum and early milk production and composition are affected by gestational nutrition, and these along with the previous factors affect the neonate’s ability to obtain transfer of passive immunity, thermoregulate, perform basal metabolism, and ultimately survive to weaning. Often, the long-term effects of maternal nutrition during gestation on offspring are attributed solely to the prenatal environment, but it is critical to also consider influences of early life on later productivity and health. More research is needed to integrate these neonatal outcomes with prenatal and postnatal mechanisms as well as later ruminant livestock performance. Better understanding of the maternal environment’s effects on the neonatal period provides opportunity for improved management of ruminant livestock dams and offspring.
Vertical thermal convection exhibits weak turbulence and spatio-temporally chaotic behaviour. For this configuration, we report seven new equilibria and 26 new periodic orbits. These orbits, together with four previously studied in Zheng et al. (J. Fluid Mech., 2024b, vol. 1000, p. A29) bring the number of periodic-orbit branches computed so far to 30, all solutions to the fully nonlinear three-dimensional Navier–Stokes equations. These new and unstable invariant solutions capture intricate spatio-temporal flow patterns including straight, oblique, wavy, skewed and distorted convection rolls, as well as bursts and defects. These interesting and important fluid mechanical processes in a small flow unit are shown to also appear locally and instantaneously in a chaotic simulation in a large domain. Most of the solution branches show rich spatial and/or spatio-temporal symmetries. The bifurcation-theoretic organisation of these solutions is discussed; the bifurcation scenarios include Hopf, pitchfork, saddle-node, period-doubling, period-halving, global homoclinic and heteroclinic bifurcations, as well as isolas. Furthermore, these orbits are shown to be able to reconstruct statistically the core part of the attractor, so that these results may contribute to a quantitative description of transitional fluid turbulence using periodic orbit theory.
This article critically examines the mediating role of teacher and student reflexivity in relation to promotional interest agents within the Global Action Programme on climate change. Regarding reflexivity, Margaret Archer’s basic idea seeks to mediate between agency and structure. Although social structures are considered limiting, it is believed that individuals can still practice personal reflexivity, leading to efforts to think and act critically in responding to climate change. Knowing the role and variations of environmental agent reflexivity in addressing climate change in Indonesian school is important. This study uses critical ethnography, which is intended to describe hidden realities. In a micro-sociological context, teacher’s interactions with students can be empowering and limiting. Both can interact dynamically, sometimes dominating, interdependent, connected and disconnected until connected again. This condition is influenced by the extent to which there is an opportunity for reflective monitoring through dialogue, discussion and deliberation. Referring to Archer’s typology of reflexivity, each environmental agent reflects four modes of internal conversation: communicative reflexivity, autonomous reflexivity, meta-reflexivity and fractured reflexivity. While Archer centres internal conversation in reflexive agency, this study foregrounds silent conversation in digital spaces as a critical bridge between reflection and environmental action in schools.
Choice of law clauses are a central instrument for safeguarding party autonomy. At the same time, it must be ensured that consumers are protected and sufficiently informed, particularly with regard to the applicable law. The CJEU has established important principles in this regard in the Amazon decision. Based on the principles of choice of law in private international law, the article takes a closer look at the protection of the weaker party. The Amazon decision is placed in the system of private international law and justified by taking into account the various functions of information duties.
Traditional compatibilists respond to the Consequence Argument by denying either the fixity of the past or by denying the fixity of the laws, neither of which is without theoretical cost. Recently, however, several authors—Christian List (2019b), Scott Sehon (2016), and Ned Markosian (2012)—have introduced novel approaches to free will that, they claim, imply that determinism is no threat to free will and, thus, that free will and determinism turn out to be compatible. The strategies employed by these authors differ considerably, with one influenced by psychology and decision theory, another by traditional philosophy of action, and the other by the metaphysics of causation. Nevertheless, this article aims to show, first, that these approaches share a common thread and, second, that each implicitly requires us to give up either the fixity of the past or the fixity of the laws (but without making this explicit or explaining how their views are preferable to traditional compatibilist views with respect to giving up the fixity of the past/laws). The article concludes with an important lesson that may be learned from our survey of these novel and interesting, even if ultimately unsuccessful, approaches to compatibilism.
This article analyzes the medicalisation strategies deployed by Peruvian alienists in the daily life of the Lima Asylum during the last third of the 19th century. Special attention is given to the process of hospitalisation of the insane in the psychiatric hospital, since this administrative procedure reveals the dialogue, confrontation, and negotiation between the asylum staff and the state and social bodies in the public management of insanity. Through the support of the civil authorities in charge of the psychiatric hospital administration, we argued that the local alienists sought to impose medical knowledge in the asylum space as the legitimate criterion for the confinement of the insane in Peru. This process was not without tensions, setbacks, and disputes, especially with the families and the state agencies of control and social defence seeking to preserve their former prerogatives over the fate of their insane. However, we propose that these medicalisation strategies promoted by the alienists in the daily space of the Lima Asylum managed to situate psychiatric care as a state problem and these actors as experts in the public management of insanity.
Children with coeliac disease (CD) on a gluten-free diet (GFD) often have poor dietary quality (DQ). A Gluten-Free Food Guide (GFFG) was developed to address this. This pilot randomised controlled trial evaluated the impact of GFFG dietary counselling on DQ and ultra-processed food (UPF) intake in newly diagnosed CD children. Child–parent pairs were randomised to the standard of care only (CON: n 20) or the intervention (INT: standard of care + GFFG; n 20). Primary outcomes included DQ (Healthy Eating Index-Canadian) and UPF intake (NOVA classification), assessed at baseline (BL), 3 and 6 months. In INT, dietary variety scores, a subcomponent of DQ, increased between BL and 3 months (BL: 6·7 (3·3–6·7) v. 3 months: 10 (10–10); P = 0·01) and in higher variety scores than CON at 3 months (P < 0·01). Total DQ and UPF intake remained unchanged. Increased dietary variety in INT was associated with increases in dairy products (BL: 7·5 (sd 3·6) % v. 3 months: 12·4 (sd 6·7) %; P = 0·01) and unsweetened milk (BL: 2·5 (sd 2·2) % v. 3 months: 4·7 (sd 3·0) %; P = 0·01) servings, consumed as a percentage of the total food group servings. These improvements were not observed at 6 months. A greater number of INT children met the GFFG protein recommendation at 3 months (BL: 0/19 v. 3 months: 5/19; P = 0·01), with no change in CON. A single GFFG session improved short-term dietary variety and unsweetened milk intake. Ongoing work addressing the GF food environment, dietitian access and policies to improve DQ are needed.
The entity responsible for preparing and distributing the restatements of U.S. law has commissioned a new Restatement of Conflict of Laws. This effort includes a reworking of the provisions relating to contractual choice of law clauses. In this Article, I describe the draft contractual choice of law provisions. As a governing theme, I highlight the balance between party autonomy and economic efficiency on one hand and respect for democratic sovereign governance on the other hand: a balance that can traced through each of the new draft provisions. I explain how the current draft resembles and differs from the provision on contractual choice of law clauses in the prior restatement on conflict of laws.
‘Democratic innovations’, which enhance citizen participation in decision-making processes, have been proposed to address challenges faced by many democracies. Only recently has research studied these innovations’ legitimacy among the public, which is of importance if innovations are to be viable remedies for democracy’s problems. This paper advances this literature with survey experiments conducted in Ghana. Ghanaians ascribe higher legitimacy to citizen deliberative bodies (mini-publics), open participatory processes, and citizen-elite deliberation processes relative to the status quo. These processes generate more legitimacy among those who do not favor the process outcome. Ghanaians were most favorable towards citizen-elite deliberation, viewing it as more fair, democratic, and likely to ameliorate partisan tensions. I suggest that this is because citizen-elite deliberation is most consistent with Ghanaian understandings of democratic accountability. This highlights the importance of context in shaping democratic reforms’ legitimacy, with implications for theory and reform design.