Search Results (1,830)

Water is the source of life and also the lifeline of cities. The reconstruction of secondary water supply systems is a key component of urban renewal reforms, and the collaborative governance of such projects has become a focal topic through academic research. In this article, we try to discover the path to successful “bottom-up” collaborative water governance with Collins’s theory of interaction ritual chains (IRC) through a case study of a secondary water supply reconstruction program in J Estate, Jinshan District, Shanghai. The case study involved a total of 104 households, and we employed convenience sampling for all households through door-to-door inquiries, which included semi-structured interviews and non-participant observations. A total of 15 households participated in our interview. This study demonstrates that repeated social interactive rituals, such as bodily co-presence, rhythmic synchronization, and shared signs, can stimulate the accumulation of residents’ emotional energy, which becomes the initial power to promote community water governance and, in return, becomes the driving force for sustained collective action and mutual trust. Drawing on Collins’s theory of IRC, this article fills a gap by explaining the symbolic mechanism driven by emotions and personal relationships that macro-level governance ignores. We also demonstrate the spillover effects of such social rituals and propose policy recommendations that governments should apply, using these rituals to mobilize and consolidate residents’ emotions to create a virtuous circle of collaborative governance. Full article

Background: Midwifery leadership is central to delivering safe, high-quality maternity care. Yet despite sustained investment in leadership development and governance frameworks, UK national reviews consistently identify leadership as a weakness. Understanding why this persists is vital to achieving meaningful improvement. Objective: This paper offers a reflective commentary on the challenges of midwifery leadership in the UK, drawing on national evidence, leadership theory, and professional experience. Methods: A reflective commentary approach was adopted, informed by over 30 years of practice across clinical, academic, and national improvement roles. The discussion integrates insights from national maternity inquiries, academic literature, international comparisons, and leadership theories including compassionate, courageous, and adaptive leadership. Findings: Structural and cultural barriers—including workforce shortages, rising clinical complexity, tensions between midwifery- and medically led models of care, and punitive governance systems—limit the effectiveness of midwifery leadership. These conditions erode psychological safety, fuel attrition, and constrain succession planning. Reflection on professional experience highlights the impact of these dynamics on leaders’ ability to act with confidence and influence. Evidence also points to the value of relational, values-based behaviours—compassion, courage, adaptability, and systems thinking—in enhancing resilience and outcomes. International examples show that supportive policy environments and greater autonomy enable midwifery leadership to thrive. Conclusions: Midwifery leadership requires both individual capability and structural support. Practical priorities include dismantling punitive cultures, embedding Safety-II approaches, investing in leadership development, and enabling professional autonomy. Without such systemic reform, the ambitions of the NHS Long Term Plan will remain at risk, regardless of individual leaders’ skills. Full article

Background: Healthcare systems globally face complex challenges including rising costs, increasing chronic disease burden, and fragmentation of care. Systems-based models represent promising approaches to healthcare transformation, yet their implementation remains incompletely understood. Objective: To critically analyze the Saudi model of Care (MoC) as a case study of systems-based healthcare transformation, examining its conceptual framework, implementation strategies, and projected health outcomes. Methods: We conducted a narrative review synthesizing publicly available official documents on the Saudi MoC, primarily the 2017 overview and 2025 revision, identified through targeted searches of Ministry of Health websites and grey literature portals (no date restrictions); formal quality appraisal was not applied as sources were official policy documents, with bias mitigated through cross-verification and critical analysis. Results: The Saudi MoC exemplifies systems-based transformation through its multi-layered framework organized around six patient-centered systems of care spanning the lifecycle. Key innovations include: (1) an architectural approach integrating activated individuals, healthy communities, virtual care, and traditional clinical settings; (2) a comprehensive intervention taxonomy with 42 specific initiatives; (3) explicit contextual adaptations for diverse settings; and (4) a phased implementation approach with detailed performance metrics. National indicators improved during the reform period, including life expectancy and maternal and child health. These are national trends observed during the period of health reforms. Causal attribution to the Model of Care requires a counterfactual evaluation. Conclusions: This analysis of the Saudi MoC contributes to the literature on systems-based healthcare transformation by illuminating how theoretical principles can be operationalized at national scale. The model’s patient-centered design, comprehensive intervention taxonomy, and attention to implementation factors offer valuable insights for other healthcare systems pursuing transformation. Further research should examine actual implementation outcomes as the model matures. Full article

This study examines occupational accident rates in the construction sector through a case study conducted in the Balearic Islands (Spain) between 2009 and 2018. The analysis is structured around three key dimensions: macroeconomic trends, changes in occupational accident reporting systems, and legislative reforms enacted during the study period. The research evaluates the influence of business, economic, and regulatory factors on two distinct construction typologies: private residential buildings (single-family and multi-family dwellings) and public-use residential buildings (hotels, aparthotels, and tourist apartments). The objective is to determine how business characteristics and construction environments influence occupational accident prevalence, establishing a causal framework informed by economic indicators and regulatory shifts. Using local data, the study analyzes variations in accident rates by construction type, accident form, and company size. The results indicate that accident rates are structurally shaped by economic and regulatory factors, with notable differences across construction typologies and company sizes. These findings highlight the need for evidence-based, targeted prevention strategies. This study enhances understanding of how structural conditions influence occupational risk in construction and offers a foundation for developing more effective safety policies. Full article

Pastoralist socio-ecological systems across Africa, Asia, and Latin America are transforming under climate stress, with adaptation patterns shaped by gendered power. I systematically reviewed 35 empirical studies (2013–2025) using PRISMA 2020 and the SWiM protocol. Searches in Web of Science and Scopus applied pre-registered inclusion criteria (empirical, pastoralist/agro-pastoralist focus, gender analysis); screening used a single reviewer with a 25% independent audit. The objective of the research was to examine power as an organising principle across four interconnected domains: labour redistribution, resource control, decision-making authority, and knowledge recognition. Most studies (≈70–80%), report increased women’s workloads alongside male control of land, water, and high-value stock, decision-making that is mitigated by committee presence without agenda/budget authority, and women’s knowledge being recorded as informal rather than actionable. Exceptions arise where inheritance or titling and decision procedures change. The paper’s innovation is a relational agency framework that links roles, rights, and records to specify tractable, auditable levers that convert participation into consequential authority. The goal is to guide context-sensitive reforms that redistribute power and improve adaptation in pastoralist systems. Full article

Remote First Nations communities in Australia experience ongoing energy insecurity due to geographic isolation, reliance on diesel, and uneven consumer protections relative to grid-connected households. This paper analyses evidence on electricity access, infrastructure and practical experience along with initiatives for improving existing infrastructure; highlights government policies, funding frameworks and regulation; demonstrates the benefits of community-led projects; provides geographic and demographic insights; and relevels key challenges along with pathways for effective solutions. Drawing on existing program experience, case studies and recent reforms (including First Nations–focused strategies and off-grid consumer-protection initiatives), this paper demonstrates that community energy systems featuring solar-battery systems can significantly improve reliability and affordability by reducing reliance on diesel generators and delivering tangible household benefits. The analyses reveal that there is an ongoing gap in protecting off-grid consumers. Hence, this work proposes a practical agenda to improve electricity supply systems for First Nations community energy systems through advanced community microgrids (including long-duration storage), intelligent energy management and monitoring systems, rights-aligned consumer mechanisms for customers with prepaid metering systems, fit-for-purpose regulation, innovative blended finance (e.g., Energy-as-a-Service and impact investment) and on-country workforce development. Overall, this paper contributes to a perspective for an integrated framework that couples technical performance with equity, cultural authority and energy sovereignty, offering a replicable pathway for reliable, affordable and clean electricity for remote First Nations communities. Full article

Background: Although most amputations caused by diabetes and peripheral artery disease (PAD) are preventable, current limb preservation efforts in the United States remain poorly understood. This study aims to identify key barriers and facilitators to limb preservation from the primary care provider (PCP) perspective. We plan to use the insights from this work to promote targeted intervention strategies. Methods: Using a mixed-methods design, an online 5–10 min survey was distributed to Oklahoma primary care providers who could elect to participate further in a semi-structured, audio-recorded interview. Descriptive analysis was used to summarize survey results. Interviews were transcribed and qualitatively analyzed using grounded theory. Donabedian’s structure, process, and outcome framework was used to categorize how each identified barrier and facilitator increases or reduces the risk of limb loss for at-risk patients at the practice level. Finally, we compared and contrasted survey and interview findings. Results: Thirty surveys were completed (approximately 14% response rate), and seven interviews were conducted with PCPs geographically dispersed across Oklahoma. Most clinicians reported in the survey that they see at-risk limbs at least once every 1–2 months (n = 29, 96.7%). Half of clinicians were satisfied or very satisfied with access to vascular surgery (n = 15, 50.0%), interventional specialists (n = 13, 43.3%), and endocrinologists (n = 12, 40.0%). Finally, survey respondents reported that social needs most often affecting their patients with a limb at risk of amputation include income, health education, transportation, and health insurance. Interviews confirmed PCPs frequently see at-risk limbs. We identified thematic barriers to limb preservation that included limited access to specialty care, limited PCP and patient amputation prevention education, and patient social struggles surrounding transportation, finances, and insurance. Patient advocates (community, clinical, or personal), affordable medications, and more time with patients were reported as facilitators in amputation prevention. Conclusions: Oklahoma PCPs frequently see at-risk feet, realize poor access to care, and desire structural change to support excellent preventive care in diabetes and PAD. Limb preservation in Oklahoma is contingent upon shifting from disempowerment to engagement that requires systemic reform, clinical innovation, and community engagement. We identified several intervention strategies, including increasing education for PCPs to empower them to initiate early prevention, improving early identification and preventive therapy for patients at risk for limb loss, and cultivating specialty care access via networking and policy change. Full article

The persistence of a binary biomedical framework in healthcare has become increasingly inadequate to address the realities of human diversity. Recent literature highlights how this dichotomous model reinforces inequities for transgender and intersex populations, sustaining barriers to access, stigmatisation, and poorer health outcomes. In this Perspective, I critically reflect on the limitations of the binary paradigm and draw on developments in science, clinical practice, education, and policy to propose a future-oriented approach to health equity. Emerging evidence underscores the complexity of sexual development as a spectrum and the urgent need to move from pathological frameworks toward affirming care based on rights. Key advances include the adoption of affirmative care models, reforms in medical curriculum, and the rise of inclusive research methodologies that capture gender diversity beyond binaries. However, structural barriers—such as rigid clinical protocols, outdated educational content, and insufficient policy alignment—continue to hinder meaningful change. This article advocates for systemic transformation in healthcare education, practice, and research. I outline strategic priorities for the field are the implementation of gender diversity in medical training, the implementation of rights-based clinical guidelines, and the design of inclusive methodologies that remove structural discrimination. These actions are essential to build a more precise, ethical and universally inclusive health system. Ultimately, ensuring sustainable and equitable outcomes requires bridging scientific innovation with human rights principles and focussing on the lived experiences of transgender and intersex individuals. Full article

The interest in analyzing alternative fuels and new propulsion technologies for shipping decarbonization is growing rapidly. This paper aims to evaluate the performance of high-temperature polymeric exchange membrane fuel cells (HT-PEMFCs) fed by reformed methanol and their potential application as a propulsion system for vessels. The proposed system is intended to be installed on board a 10 m long ship, designed for commercial use in the marine area of Capri Island. Numerical and experimental analyses were performed to estimate the system’s performance, and a feasibility assessment was carried out to verify its real applicability on board the reference case study. From the numerical perspective, a CFD model of the ship hull, as well as a thermochemical model of the propulsion system, was developed. From the experimental point of view, the system behavior was tested by means of a dedicated test bench. The results of the numerical models allowed for the sizing of the propulsion system and the calculation of the fuel consumption. In particular, to satisfy the ship’s power demand, two 5 kW HT-PEMFCs were needed, with a total fuel consumption of 12.7 kg over a typical daily cruise, with a methanol consumption of 1.88 kg/h during cruising at 7 knots. The feasibility analysis highlighted that the propulsion system fits the vessel’s requirements, both in terms of volume and weight. Full article

Background: Human immunodeficiency virus and hypertension increasingly co-occur in South Africa. Despite publicly funded care, patients with multimorbidity face high out-of-pocket costs, yet limited evidence exists from the patient perspective. Purpose: To quantify the economic burden of comorbid HIV and hypertension, assess predictors of monthly out-of-pocket costs, and explore coping mechanisms. Methods: We conducted a cross-sectional analysis using patient-level data from the Mobile Phone Text Messages to Improve Hypertension Medication Adherence in Adults with HIV (MOPHADHIV trial) [Trial number: PACTR201811878799717], a randomized controlled trial evaluating short messages services adherence support for hypertension care in people with HIV. We calculated the monthly direct non-medical, indirect, and coping costs from a patient perspective, valuing indirect costs using both actual income and minimum wage assumptions. Generalized linear models with a gamma distribution and log link were used to identify cost determinants. Catastrophic expenditure thresholds (10–40% of monthly income) were assessed. Results: Among 683 participants, mean monthly total costs were ZAR 105.81 (USD 5.72) using actual income and ZAR 182.3 (USD 9.9) when valuing indirect costs by minimum wage. These time-related productivity losses constituted the largest share of overall expenses. Regression models revealed a strong income gradient: participants in the richest quintile incurred ZAR 131.9 (95% CI: 63.6–200.1) more per month than the poorest. However, this gradient diminished or reversed under standardized wage assumptions, suggesting a heavier proportional burden on middle-income groups. Other socio-demographic factors (gender, employment, education) not significantly associated with total costs, likely reflecting the broad reach of South Africa’s primary health system. Nearly half of the participants also reported resorting to coping mechanisms such as borrowing or asset sales. Conclusions: Comorbid HIV and hypertension impose substantial patient costs, predominantly indirect. Income disparities drive variation, raising equity concerns. Strengthening integrated human immunodeficiency virus—non-communicable diseases care and targeting financial support are key to advancing South Africa’s Universal Health Coverage reforms. Full article

This study investigates the impact of working capital management (WCM) on profitability in the Indian cement industry, an energy-intensive sector central to the country’s infrastructure growth. Using a balanced panel of listed firms over 2010–2024, we employ pooled OLS, two-way fixed effects, quantile regressions, and dynamic system GMM to address heterogeneity and endogeneity concerns. The results demonstrate that reductions in the cash conversion cycle (CCC), accelerated receivables collection, leaner inventories, and prudent use of payables significantly improve profitability. Quantile regressions reveal that highly profitable firms capture larger absolute gains from CCC reductions, while size-split analysis indicates that smaller and liquidity-constrained firms achieve proportionally greater marginal relief. These findings represent complementary perspectives rather than unified statistical relationship, a limitation we acknowledge. Dynamic estimates confirm the robustness of results after accounting for persistence and reverse causality. Beyond firm-level outcomes, the study contributes conceptually by linking WCM efficiency to sustainability financing: liquidity released from shorter operating cycles can be redeployed into green and energy-efficient investments, offering a potential channel for ESG alignment in carbon-intensive industries. Policy implications highlight the role of digital reforms such as TReDS and e-invoicing in strengthening liquidity efficiency, particularly for mid-sized firms. The findings extend the international WCM profitability literature, provide sector-specific evidence for India, and suggest new avenues for integrating financial and sustainability strategies. Full article

Objectives: This study aims to examine the impact of Diagnosis-Related Group (DRG) payment on medical costs, efficiency, and quality of healthcare services in public hospitals, providing policy recommendations for further health insurance payment reforms in China. Methods: Utilizing inpatient medical insurance settlement data from 2020 to 2023 in the selected city, we constructed a regression discontinuity design (RDD) and an interrupted time series (ITS) model to evaluate the causal effects of the DRG reform. The analysis includes 66,533 inpatient settlement records. Results: Following the reform, the average length of stay (LOS) decreased by 2 days (95% CI: −3.43 to −0.70, p < 0.01), total hospitalization expenditures dropped by 13% (95% CI: −0.26 to −0.00, p < 0.05), and expenditures from the medical insurance fund declined by 25% (95% CI: −0.39 to −0.12, p < 0.01). Additionally, examination and consultation fees were reduced by 23% (95% CI: −0.41 to −0.05, p < 0.05), although patients’ out-of-pocket burden increased by 8% (95% CI: 0.05 to 0.10, p < 0.01). In terms of healthcare quality, the 30-day readmission rate decreased by 1% (95% CI: −0.01 to −0.00, p < 0.01), and the mortality rate among low-risk patients declined by 4% (95% CI: −0.04 to −0.03, p < 0.01). We found no evidence of patient selection or denial of admission. Heterogeneity analysis revealed that the reduction in hospital stay was concentrated among enrollees under the Urban and Rural Resident Basic Medical Insurance and those treated in secondary hospitals. The policy’s effects peaked shortly after implementation but gradually attenuated over time. Conclusions: Our study offers hospital-level evidence indicating that the initial stage of DRG implementation achieved its preliminary goals of optimizing medical resource allocation and improving the efficiency of medical insurance fund utilization. However, the reform still faces several challenges. These findings may offer valuable references for developing countries pursuing reforms in primary healthcare and health insurance payment systems. Full article

In this paper, we propose a novel method to reduce non-Gaussian errors in measurements using sampling-based distribution estimation. Although non-Gaussian errors are often treated as statistical deviations, they can frequently arise in practical unmanned aerial systems that depend on global navigation satellite systems (GNSS), where position measurements are degraded by multipath effects. However, nonlinear or robust filters have shown limited effectiveness in correcting such errors, particularly when they appear as persistent biases in measurements over time. In such cases, adaptive techniques have often demonstrated greater effectiveness. The proposed method estimates the distribution of observed measurements using a sampling-based approach and derives a reformed measurement from this distribution. By incorporating this reformed measurement into the filter update, the proposed approach achieves lower error levels than traditional adaptive filters. To validate the effectiveness of the method, Kalman filter simulations are conducted for drone GNSS/INS navigation. The results show that the proposed method outperforms conventional non-Gaussian filters in handling measurement bias caused by non-Gaussian errors. Furthermore, it achieves nearly twice the estimation accuracy compared to adaptive approaches. These findings confirm the robustness of the proposed technique in scenarios where measurement accuracy temporarily deteriorates before recovering. Full article

Leptospirosis remains a pressing yet under-recognized public health burden in the Philippines with an alarming 43.45% rise in cases in early 2025. Outbreaks closely follow flooding, disproportionately affecting impoverished communities in informal, flood-prone settlements where poor sanitation, unsafe housing, and limited healthcare access compound vulnerability. Current responses remain largely hospital-based and reactive, straining resources during seasonal surges while leaving structural drivers unaddressed. This article calls for a shift to multisectoral, preventive strategies that reduce socioeconomic vulnerabilities through stronger intersectoral collaboration, investments in flood control and basic services, and enhanced digital surveillance. Without systemic reforms that integrate health, environment, and social policy, leptospirosis will continue to impose a recurring and inequitable burden on marginalized populations. Full article

Jurors play a critical role in the administration of justice, yet their compulsory exposure to graphic and distressing evidence during criminal trials is often overlooked in discussions of mental health and legal reform. This paper investigates the psychological impact of jury service in trials involving murder, domestic violence, sexual assault, and child abuse, where laypeople are required to view autopsy photographs, listen to emergency calls, and assess disturbing testimonies without any formal training or mandatory psychological support. While vicarious trauma, secondary traumatic stress, and moral injury are recognised in research on law enforcement, social work, and healthcare, there is limited acknowledgement that no professional group consistently receives adequate trauma prevention or recovery support. This gap is particularly concerning for jurors, who are laypeople compelled to participate in the justice process. Drawing on legal case studies, psychiatric research, and international precedent, this paper argues that the justice system imposes an invisible emotional burden on jurors while offering limited, inconsistent, and mostly reactive support. Although applicable to many countries, particular attention is given to Australian jurisdictions, where counselling services are sparse and optional, and where juror confidentiality laws restrict therapeutic disclosures. This research also considers the legal and ethical implications of exposing untrained civilians to traumatic material and explores whether the state could, or should, bear legal liability for post-trial psychological harm. Ultimately, this paper calls for the introduction of clearly defined trauma-informed jury procedures, including pre-trial psychological briefings, structured debriefings, and systemic reform, to acknowledge juror well-being as a necessary component of fair and ethical justice. Full article