The role of paradiplomacy for cultural heritage preservation: The cosmological axis of yogyakarta

This autoethnographic study examines the epistemic, institutional, and interpersonal dynamics shaping an interdisciplinary clinical research project in clinical sociology. The project involved a randomized controlled trial combining adapted physical activity and art therapy for oncology patients, assessed through validated questionnaires, participant observation, semi-structured interviews, and arts-based techniques. While methodologically robust, the collaboration unfolded within a clinical setting marked by entrenched biomedical dominance and hierarchical institutional culture. Findings reveal how epistemic hierarchies privileged quantitative and biomedical approaches over qualitative and sociological contributions, generating delegitimization, symbolic control, and exclusionary practices. These tensions, embedded within broader institutional structures, translated into daily micro-interactions that produced emotional distress, frustration, and marginalization, while also eliciting acts of resistance and mutual care. Adopting an embedded, reflexive analysis, the study situates these dynamics within literature on epistemic injustice, interdisciplinary collaboration, and the affective dimensions of research work. Implications highlight the need for institutional recognition of methodological pluralism, reflexivity training, and relational practices of care to foster more equitable partnerships. The discussion also addresses methodological limitations - including the partial anonymization and narrative simplification of events - and outlines future directions for advancing interdisciplinary research through long-term institutional partnerships grounded in openness to diverse epistemologies. • Epistemic hierarchies shape everyday interactions in interdisciplinary clinical research. • Qualitative and arts-based methods are marginalized within biomedical research settings. • Emotional reflexivity reveals how power operates through relational and affective dynamics. • Care persists in fragile, informal ways amid institutional and epistemic pressure. • Friendship and loyalty complicate authority and silence in clinical research collaborations.

Human and ethical values are foundational to nursing education and practice. However, limited empirical evidence exists on how ethical formation is enacted and sustained in Certified Nursing Assistant (CNA) education, particularly in vocational and non-university settings, despite CNAs'central role in patient care.To explore perceived strengths and challenges in the human and ethical formation of CNA students across different stages of training and early professional practice.Qualitative descriptive study using thematic analysis. The study was conducted within a five-semester CNA education program. Data were generated through 29 semi-structured interviews and two focus groups involving 44 participants, including students, graduates, teachers, teaching managers, clinical preceptors, and employers. Perspectives were explored across four stages: prior to program entry, during the curriculum, the internship period, and early employment.Ethical approval was granted by the institutional Scientific Ethics Committee (ID 211014002). Participation was voluntary, written informed consent was obtained, and confidentiality and anonymity were ensured.Participants identified a distinctive institutional hallmark characterized by humanized care and ethical commitment. Ethical formation was supported by students'value-based motivations, educator engagement, and reinforcement during clinical learning. However, participants also described tensions, including reliance on hidden curricula, insufficient educator preparation, misalignment between ethical instruction and clinical realities, limited support during internship, and lack of structured opportunities for continuing ethical development after graduation. Ethical formation in CNA education was shaped not only by formal curriculum, but also by institutional culture, clinical environments, and transition into practice. Although the program promotes strong humanistic and ethical values, the findings highlight the need for a more explicit and sustained institutional approach to ethics education. Strengthening ethical formation through curriculum, clinical accompaniment, interprofessional collaboration, and continuing support is essential to foster moral agency and person-centered care.

ABSTRACT Spatial planning in new democracies offers an opportunity to discuss processes for territorial and local development. This paper reflects on the elaboration of the first municipal spatial plans in Timor-Leste, where process moved beyond technocratic and legalistic-based approaches to engage directly with multi-layered governance structures, power institutions, and local actors. It argues that in countries where spatial planning and democracy are in their early days, planning processes, embedded in local engagement and co-production, can contribute to strengthening local institutions, empower local actors, and serve as an important bridge between conflicting rationales, while promoting societal and institutional planning cultures.

ABSTRACT Indigenous Australians bring significant expertise, leadership, and cultural knowledge to the higher education sector, offering contributions that are deeply valuable and transformative. Since 2009, there has been a notable emergence of executive-level Indigenous leadership roles across Australian universities, yet while these developments mark important progress, substantial discrepancies remain across the sector. Some of these are tied to the leadership cultures of individual institutions, while others reflect broader systemic issues that have yet to be addressed through coherent national policy. Using an Indigenist methodological approach and insights from semi-structured interviews with 23 Senior Indigenous Leaders, the study uncovers key challenges faced by these leaders and identifies the structural reforms needed to achieve genuine institutional transformation. The findings underscore the need for sector-wide reform, including transparent remuneration frameworks, clear role delineations, and governance structures that recognise Indigenous sovereignty and knowledge traditions as essential to genuine institutional transformation.

Prenatal counselling at the threshold of viability raises profound ethical challenges for healthcare professionals. Decisions occur under conditions of prognostic uncertainty, high emotional intensity, and variable institutional norms. This scoping review aimed to map the ethical implications and moral conflicts perceived by healthcare professionals involved in periviability counselling, including how counselling is conducted, which contextual factors shape decision-making, and the perceived role and value of Clinical Ethics Consultation (CEC). The review followed the PRISMA-ScR guidelines and the Joanna Briggs Institute framework (JBI), using a PCC structure. A comprehensive search was conducted in PubMed, CINAHL, APA PsycInfo, Psychology and Behavioral Sciences Collection and Web of Science. Eligible studies included qualitative, quantitative, or mixed-methods research published in English and reporting on ethical issues, moral dilemmas, or decision-making among healthcare professionals involved in prenatal or periviability counselling. Editorials, commentaries, conference abstracts, theoretical papers, and studies focused solely on parental perspectives were excluded. Two reviewers independently screened all records using CADIMA, with disagreements resolved by consensus with a third reviewer. Data were charted and synthesized through descriptive numerical analysis and inductive thematic synthesis. Twenty-five studies met inclusion criteria: 14 surveys, 9 qualitative studies, 1 mixed-methods study, and 1 randomized controlled trial (RCT). Healthcare professionals represented included neonatologists, obstetric and maternal-fetal medicine clinicians, nurses, trainees and ethicists. Six major themes emerged across study types: (1) variability in resuscitation thresholds and counselling practices; (2) pervasive prognostic uncertainty; (3) value pluralism and interprofessional divergence; (4) communication challenges in high-stakes encounters; (5) institutional culture and system-level influences; (6) moral distress and emotional burden among professionals. CEC was rarely integrated into practice: 17 studies did not mention it, 7 discussed it only conceptually, and only 1 described its operational use. Periviability counselling is ethically complex and inconsistently implemented across settings. Professionals navigate uncertainty, divergent values, and institutional pressures with limited structured support, while appropriate shared decision-making remains inconsistently achieved. Although CEC holds considerable potential value, it is still rarely used. Strengthening counselling practice will require clearer frameworks, improved communication strategies, interprofessional collaboration and the meaningful integration of ethical support systems.

Total intravenous anesthesia (TIVA) in children has gained popularity due to potential advantages, including decreased respiratory adverse events, postoperative nausea and vomiting, and emergence agitation. British Columbia Children's Hospital (BCCH) has a reputation for TIVA use, training, and advocacy, including intravenous induction. To inform practice change and education by exploring how institutional culture impacts TIVA adoption, particularly regarding intravenous cannulation in awake children. Current and former BCCH anesthesiologists and trainees were surveyed and interviewed about TIVA practices at BCCH and at their current institutions. The survey covered demographics, practice settings, past and current methods for induction and maintenance of anesthesia, factors contributing to technique selection, TIVA barriers and facilitators, and implementation factors. Semi-structured interviews conducted with a subset of participants were analyzed using deductive and inductive thematic analysis. Twenty-six participants completed the survey: 21 attending physicians, 2 fellows, and 3 residents; 58% with < 10 years' and 23% with > 20 years' anesthesia practice. Most participants (92%) practised in an academic setting, caring for a median [interquartile range] 400 [200-500] children annually. Most (96%) indicated their BCCH experience had changed their practice, with a greater effect on using intravenous anesthesia for maintenance than induction. Changes were influenced by a positive experience (77%), supportive environment (42%), and scientific evidence (42%). Choice of anesthetic technique depended on patient factors (89%), institutional expectations (46%), pharmacology (42%), and patient preference (39%), but not parental preference (15%). Interviews with 11 participants focused on intervention bundles to enable success, expectation-setting, family education, equipment and staff availability, and supportive workflows. Training in a TIVA institution can have a profound effect on using TIVA in children and drive changes in anesthetic practice elsewhere. Introducing TIVA requires a supportive culture, appropriate equipment, and the personalization of approaches, and may benefit from understanding factors in change management.

ABSTRACT The early history of tourism in Bali is often narrated through the activities of colonial administrators, foreign artists, and cultural institutions that promoted the island as an exotic destination. Such narratives rarely consider the role of indigenous intermediaries who facilitated the circulation of Balinese cultural objects within emerging tourism markets. This article examines the activities of a Balinese woman known as Mak Patimah of Singaraja, whose presence in colonial newspapers, travel accounts, and exhibition reports between 1921 and 1937 reveals how local actors participated in the formation of Bali's early tourism economy. Mak Patimah occupied a strategic position linking local craft production, colonial exhibition networks, and international travellers. Drawing on the concepts of cultural brokerage and the commodification of cultural objects, this article argues that Mak Patimah functioned as an indigenous intermediary who mediated the early circulation of Balinese art and craft within emerging international tourism networks, highlighting the role of gendered entrepreneurship in Bali's early tourism economy.

This study addresses the challenges of measuring technical efficiency and productivity in the performing arts sector during the post-pandemic recovery period (2022–2023). Utilizing a non-radial Data Envelopment Analysis and the Global Malmquist Index, the research evaluates how human resource allocation influences performance, using 21 Polish philharmonic institutions as an empirical context. The results reveal significant performance variations and relatively low sector-wide efficiency. Notably, philharmonics supervised by regional authorities demonstrated higher efficiency and productivity compared to those under municipal governance. Furthermore, productivity growth was driven primarily by sector-wide technological progress rather than improvements in individual unit efficiency. The study identifies employment as a crucial factor, though its impact is mediated by operational scale. These findings provide broader methodological and practical insights for cultural economics and public policy, particularly regarding staffing optimization in post-crisis contexts, while filling a significant gap in the performing arts efficiency literature.

Across Canadian postsecondary educational institutions, sexual violence persists as a serious yet largely undisclosed harm with profound impacts on students' mental, physical and academic well-being. Canadian scholarship has not been systemically synthesised to clarify how sexual violence disclosure processes are framed or experienced within postsecondary contexts despite disclosure often being the primary way students seek support. The aim of this scoping review was to: (1) characterise existing perceptions of disclosure within Canadian postsecondary sexual violence evidence; (2) identify key sources and perspectives informing the Canadian postsecondary sexual violence evidence; (3) synthesise reported impacts of disclosure for students pertaining to Canadian postsecondary sexual violence and (4) highlight gaps and research priorities for Canadian postsecondary sexual violence. A scoping review conducted using Arksey and O'Malley framework, with incorporated enhancements from Levac and colleagues. Documents published between 1 January 2014 and 7 March 2025 were reviewed. These were located through searches in PsycINFO, ERIC, Sociological Abstracts, Criminal Justice Abstracts and SCOPUS, along with targeted searches of organisational and government websites. Peer-reviewed and grey evidence in English, published from 2014 onward that addressed sexual violence in Canadian postsecondary settings were included. Eligible evidence included empirical studies, theoretical papers, reviews, dissertations, commentaries, books, book chapters and organisational reports. Letters to the editor, book reviews and conference abstracts were excluded. Extraction and synthesis examined how disclosure is defined, its purpose, associated barriers and outcomes; the role of intersectionality and power relations; and recommendations to improve sexual violence responses. A total of 224 documents (164 peer-reviewed articles and 60 grey literature documents) were included in the review. Results indicate disclosure is a complex, iterative process, shaped by systems of power that differentially affect students across intersecting identities. Barriers to disclosure were most often linked to both institutional and structural inequities that influence students' experiences and outcomes. Findings clarify that advancing the safety of sexual violence response and research depends on centring student perspectives and expertise. This scoping review provides an overview of the power dynamics and risk involved in sexual violence disclosures among students in Canadian postsecondary institutions. Meaningful and transparent application of intersectional and trauma-informed approaches is critical to supporting epistemic safety and cultivating institutional cultures of care rather than perpetuating further harm for Canadian students.

This article examines how European-level heritage instruments translate the passage from Cold War division to free movement into repeatable practices of rights education. It compares three governance carriers that operate through different technologies of authority: the European Heritage Label, the Council of Europe’s Cultural Routes programme, and the House of European History. Treating policy and curatorial documentation as discourse that organises practice rather than merely describing it, the analysis follows the critical insight that institutional texts create problems, allocate agency, and stabilise normative assumptions through recurring vocabularies and evaluative criteria. Across the three instruments, mobility becomes teachable through three mechanisms: enforceable obligations and monitoring, spatial sequencing and renewal rules, and modular pedagogy with multilingual accessibility. The comparison also identifies failure conditions that are legible within institutional evaluation cultures themselves: European dimension language may substitute for curricular depth, multilingual provision may be treated as symbolic compliance rather than access justice, and network governance may concentrate recognition in emblematic hubs while peripheral nodes remain thinly resourced.

The objective of this study is to examine the impact of smart governance on institutional sustainability in Saudi higher education. The study employs a quantitative cross-sectional survey design and a stratified random sample of 611 faculty members. In particular, the study estimates a linear model of institutional sustainability where smart governance in conjunction with the contextual variables of ICT and institutional culture are exogenous, and that the impact of smart governance on institutional sustainability is mediated through institutional performance. The results show that smart governance has a significant positive impact on institutional sustainability in Saudi higher education institutions. This supports the growing body of literature suggesting that digital transformation and participatory governance enhance organizational effectiveness and long-term sustainability. The study also finds that institutional performance mediates this relationship, indicating that smart governance tends to augment sustainability indirectly by enhancing efficiency, innovation, and responsiveness. Furthermore, the results of the study are consistent with the claim that Institutions with strong technological capabilities and supportive cultures are better positioned to leverage smart governance for sustainability. Toward this end, the study contributes to the extant literature on the subject by stretching smart governance literature into the Saudi higher education context, integrating governance, performance, and sustainability into a single framework, and documenting empirical evidence supporting the mediation mechanism of institutional performance and contextual effects of information technology integration and institutional culture.

Background Students with disabilities in South African higher education continue to encounter persistent institutional, structural and attitudinal barriers, despite a progressive policy landscape. These challenges are particularly visible within Comprehensive, Open, Distance and e-Learning (CODeL) institutions, where accessibility and retention intersect with the demands of remote learning environments. Objectives This article examines the systemic barriers and enabling practices that shape the accessibility and retention of students with disabilities in a South African CODeL institution. It further analyses how institutional cultures, academic support systems and the availability of assistive technologies mediate student experiences. Method A mixed methods design was employed, drawing on data from students with disabilities and support staff. The analysis is theoretically framed through Critical Disability Theory and Tinto's Theory of Student Integration to provide an integrated understanding of the structural and relational conditions influencing student success. Results Findings reveal a set of enablers, including targeted support initiatives and pockets of effective institutional responsiveness. However, substantial challenges persist, such as limited access to appropriate assistive technologies, inconsistent provision of academic accommodations and fragmented institutional coordination. A notable gap remains between policy commitments to inclusion and everyday practices within the institution. Conclusion The study demonstrates that while existing support mechanisms offer important enablers, they remain insufficient within a system that continues to rely on reactive models of accommodation. A shift toward proactive, systemic transformation is required to advance inclusive practices and improve student retention in distance education contexts. Context-specific recommendations for strengthening institutional responsiveness and supporting the sustained participation of students with disabilities are offered.

What's a policy without trust? How the legacy of policing shapes experiences of drug decriminalization in British Columbia.

Research on occupational trauma of journalists has mainly concentrated on Western countries and war or conflict news reporting. It has stayed within the psychological framework of individual stress, without sufficiently examining the institutional and cultural roots of the issue. This study investigates the characteristics of vicarious trauma (VT) expression and its formation mechanisms among Chinese journalists in their daily news reporting, through the lens of institutional culture. By analyzing 25 published journalist notes and related texts, this research finds that VT experienced by Chinese journalists stems from the interaction of three institutional-cultural forces: dual professional norms create a basic tension where empathy is permitted and encouraged but negative expression is limited; regulatory rigidity hinders the institutional avenues available for trauma resolution; and a reflective culture offers attribution scripts that turn sources of trauma from institutional dilemmas into personal moral faults. Consequently, even when journalists recognize the institutional causes of their VT, the prevailing reflective culture often channels such negative emotions inward, resulting in internal trauma marked by a loss of meaning, exhaustion of self-efficacy, and intertwined feelings of moral guilt. This study not only broadens the context of research on journalistic trauma but also highlights the high dependency on situational and institutional factors in the development of VT as an occupational issue. Meanwhile, by combining institutional-cultural analysis with individual psychology, this study expands the cultural boundaries of VT theory and offers a new perspective for understanding the occupational risks and news production practices of Chinese journalists.

The Maram Naga tribe, indigenous to the Senapati district of Manipur, possesses a rich socio-cultural heritage heavily defined by agrarian traditions and deep-rooted customary laws. Despite women serving as the indispensable backbone of the community’s economic and domestic sustenance, they face systemic political disenfranchisement, most notably through their explicit exclusion from traditional village councils and the critical half-yearly and annual community discussions. This research paper explores the dichotomy between the high economic participation and low political agency of Maram women. Utilizing a qualitative, exploratory approach that synthesizes primary focus group discussions with secondary literature, such as The Place of Women in Naga Society. This study examines the traditional justifications for this exclusion, which are deeply rooted in patriarchal hegemony, patrilineal land ownership, and customary taboos. The findings reveal that the exclusion of women from formal decision-making severely impacts community welfare, manifesting in unaddressed socio-economic crises such as the rampant rise in alcoholism, gender-based violence, and stark disparities in health and educational investments. Furthermore, the psychological toll of this political exclusion stifles female agency and creates bottlenecks in sustainable community development. To rectify this imbalance, the paper proposes actionable pathways to inclusive governance. By leveraging the rising influence of women’s collectives like the Maram Women Union, celebrating female-centric cultural institutions such as the Mangkang festival, and capitalizing on the economic independence fostered by Self-Help Groups (SHGs), women are increasingly challenging the status quo. The study concludes by recommending a hybrid governance model that respects indigenous customary laws while integrating modern, democratic mandates for female representation, ensuring that the "silent half" becomes an active, institutionalized voice in the sustainable development of the tribe.

Professionalism is a core competency in graduate medical education, yet research examining specialty-specific professionalism perceptions between trainees and faculty remains limited, particularly regarding the influence of role and institutional culture on these perceptions. This study examined how anesthesiology trainees and attendings perceive unprofessional behavior and whether these perceptions differ based on participant characteristics. A multisite cross-sectional survey was conducted at five anesthesiology residency programs from February to March 2024. Participants rated degree of unprofessionalism on 19 workplace vignettes depicting potentially unprofessional behaviors using a 7-point Likert scale. Vignettes were categorized into five themes: verbal, supervision, quality, time, and engagement. Proportional odds models examined differences in ratings based on role (trainee vs . attending), adjusting for gender, race, underrepresented status, and institution. Among 369 respondents (153 trainees, 216 attendings; 35.9% response rate), perceptions varied by scenario and participant characteristics. Six vignettes were more consistently rated as unprofessional (more than 80% unprofessional ratings), while four showed higher variability (less than 50% unprofessional ratings). Significant institutional differences were observed in five vignettes (odds ratios [ORs] less than 0.14 or greater than 3.7; P < 0.0001 to 0.027). Age influenced ratings of five vignettes (ORs, 0.75, 1.68, 1.63, 1.35, and 1.31, respectively; P < 0.0001 to 0.027), while gender, race, and underrepresented status showed no significant differences. After adjustment for demographics, trainees and attendings differed significantly in their ratings of 10 vignettes ( P < 0.0001 to 0.033). Attendings rated nine scenarios as more unprofessional than trainees (ORs ranging from 0.26 to 0.50), while trainees rated only one scenario as more unprofessional than attendings (OR, 2.01). Perceptions of unprofessional behavior among anesthesiology professionals vary significantly by role and institution. These findings underscore the importance of context-sensitive approaches to professionalism education that acknowledge diverse perspectives and institutional cultures while maintaining core professional standards.

China's current body donation landscape remains challenging, with traditional cultural factors such as values and religious beliefs widely regarded as significant influencers. However, the specific cultural factors at play remain unclear. This systematic review aims to comprehensively synthesize the factors within traditional Chinese culture that affect willingness to donate. Following the PRISMA guideline, two researchers systematically searched ten databases based on the predefined search strategy from the establishment to August 2025, including PubMed, Embase, Web of Science, Scopus, Medline, ScienceDirect, China Biology Medicine (CBM/Sinomed), VIP Full-text Database, Wanfang Data Knowledge Service Platform, and China National Knowledge Infrastructure (CNKI). Sixteen relevant articles were retained for analysis after evaluating 2106 articles. The included studies encompassed 14,556 participants. Using content analysis based on the theory of cultural stratification, the study summarized 12 culturally related factors: spiritual culture (body perspective, death perspective, life perspective, values perspective, filial piety, social opinion); institutional culture (funeral rites, commemorative ceremonies, donation procedures, legal); and material culture (monuments and memorials, reception institutions). Overall, Chinese body donation was impeded by numerous obstacles that are not mutually independent. Measures should be taken including systematically integrating death education into the national curriculum, establishing a comprehensive donation system, advancing the development of material culture, and leveraging media and digital technologies to promote the sustainable and healthy development of modern medicine.

Trends in Bunnell and Huber Abductorplasty are Driven by Differences in Patient Age, Geographical Region, and Surgical Training.

Since the COVID-19 pandemic, flexible work arrangements, including working from home and remote roles, have become a sustained feature of academic life. While these models offer ongoing benefits such as flexibility, accessibility, and accommodation of diverse personal circumstances, there remains limited discussion of how they are reshaping academic work culture and affecting campus-based colleagues. The shift away from shared physical workspaces has altered key dimensions of professional life, diminishing informal collegial interactions. Although existing literature has explored the pedagogical and logistical challenges associated with the rapid shift to online teaching, less attention has been paid to the longer-term impacts of sustained remote work on academic identity, institutional culture, and the everyday practices of academic citizenship. In this paper, we consider how flexible work arrangements are reshaping the social fabric of academic nursing and blurring the boundaries between home and work. We argue that while flexible work patterns are likely to remain embedded in academic structures, they can carry unintended consequences, that require careful consideration. Sustaining a vibrant and inclusive academic culture will require intentional strategies to foster connection, visibility, and equity among both remote and campus-based colleagues.