This study develops a multi-level model to examine how industry-level environmental turbulence - including market, technological and pandemic disruptions - drives institutional change and shapes hospitals' strategic decisions to form health-care alliances (HCAs) in Taiwan. Adopting a theory-driven qualitative multiple-case study design, the research investigates 10 dyadic HCAs through in-depth interviews with 25 key informants from hospitals, government agencies and academic institutions. The data were analyzed using an abductive, multi-level coding strategy that integrates Transaction Cost Theory (TCT), the Resource-Based View (RBV) and Institutional Theory to explain how turbulence influences alliance formation across different phases of development. The results show that market turbulence motivates cost-efficiency alliances, technological turbulence fosters resource-based collaborations and pandemic turbulence triggers government-led institutional reforms that enhance hospitals' pursuit of legitimacy. These findings collectively reveal a multi-level progression from environmental turbulence to institutional change and organizational determinants, ultimately leading to the formation of hospital-led or government-led alliances. Understanding these distinct drivers enables managers and policymakers to design adaptive alliance strategies that balance efficiency, resource acquisition and legitimacy, thereby enhancing resilience and care quality in turbulent health-care environments. This study contributes a novel integrative framework linking environmental turbulence with organizational responses in the health-care sector. By combining TCT, RBV and Institutional Theory with Das and Teng's Alliance Development Process model, it advances theoretical and practical insights into the dynamics of HCA formation under conditions of uncertainty.

HIV Stigma Among Health Care Providers in Türkiye: A Cross-Sectional Analysis of Knowledge, Attitudes, and Discriminatory Behaviors.

In light of global movements targeting contested monuments, this study explores the management of colonial-era statues in Flanders, Belgium, through the lens of Evolutionary Governance Theory (EGT). While international ‘urban fallism’ has catalyzed public debate and policy shifts, Flemish municipalities display a notably restrained approach towards contested statues. This paper investigates whether societal discussions on colonial heritage and urban fallism translate into institutional change in heritage management at the municipal level. Based on a qualitative case analysis of Flemish municipalities and interviews with local policy actors, the research reveals a largely reactive, ad-hoc governance approach. Most local governments exhibit reluctance to address colonial statues unless provoked by external pressure or public unrest, with only a few urban municipalities showing signs of adaptive and participatory heritage policies. A co-evolutionary perspective uncovers the complex interdependencies between societal discourse, political steering and institutional inertia, offering insights into the challenges of effectuating heritage policy change. While debates may serve as catalysts, they seldom result in structural policy transformation. Based on our data set collected up to 2022, the paper concludes by arguing for more adaptive, participatory governance frameworks that acknowledge both local contingencies and broader sociopolitical dynamics, thereby shifting the conversation beyond the binary of whether statues should simply ‘stay or go’.

This study explored the experiences, perspectives and confidence of teaching and research staff of discussing race and ethnicity, and associated equalities matters, at a post-1992 university in North West England, UK. In particular, it studied whether colleagues, who were largely white, had the understanding and personal skills to deliver on race equity in teaching and learning in a Higher Education Institution (HEI). Further, it examined whether there was a disconnect between the intention of an HEI working towards the Race Equality Charter (REC) mark and the detrimental effects this may have on its minoritised ethnic staff. The study was based on focus groups and interviews of 43 academic staff as participants using Critical Race Theory (CRT) and Intersectionality as the theoretical lens. These address discrepancies between institutional declarations and realities within higher education, which is important, as HEIs are increasingly positioning themselves as committed to diversity and equity, while the practical implementation often remains inconsistent. The findings demonstrate that the white participants were not confident, competent or pro-active enough to effect any meaningful change in race equity. At the same time, the minoritised ethnic participants often felt the burden of having to relive the trauma and pain of racism and take the lead in any race equity initiatives. In sum, the study demonstrates that HEI initiatives that purport to tackle systemic racism through decolonisation and the REC mark have little chance of effecting institutional change if the staff do not have the confidence, competence and necessary skills to make it happen.

Background: Postpartum complications requiring surgical intervention are challenging due to physiologic and anatomic changes. While laparotomy remains standard, laparoscopy is increasingly used. We compared outcomes of laparoscopic management of postpartum complications versus open management of postpartum complications. Methods: This retrospective cohort study included patients undergoing surgical intervention within three weeks postpartum at a single tertiary center between 2010 and 2023. Approach selection was primarily time-dependent, following an institutional practice change in 2020. Demographic, operative, and postoperative outcomes were compared. Results: Sixty-two participants with postpartum complications necessitating surgical intervention were included: 54 in the laparotomy group and 8 who underwent laparoscopy. Demographic characteristics were similar between groups. The main indication for laparoscopy was suspected uterine scar defects (p = 0.006), while laparotomy was obtained mainly in cases of suspected bleeding (p = 0.001). Both groups had comparable operative time, though the laparoscopy group had a shorter postoperative admission (p = 0.043). Conclusions: Laparoscopy is feasible for various postpartum complications. It offers comparable operative times to laparotomy with shorter postoperative admissions. Therefore, it is a promising alternative in selected cases when surgical expertise is available.

ABSTRACT This Epilogue is a call to action for implementing justice praxis through practical application of justice-oriented ideologies. In this paper, I advance a justice praxis framework grounded in advocacy, agency, and strategic action to support faculty and academic leaders committed to equity-oriented institutional change. This requires us to (a) advocate for, (b) utilize our agency, and (c) act strategically in the promotion of justice.

During moments of institutional change, advocates and critics of reform are forced to publicly and privately articulate why their city should consider or avoid a proposed change. These arguments for and against reform rely on assumptions about the character and purpose of municipal politics—the relevant cleavages, the proper purposes to which municipal politics is directed, and the character of municipal political representation. Moments of reform thus reveal the “implicit theories” of urban politics held by the individuals involved—an opportunity to peer behind quotidian policy debates and explore how local political elites think about the character and purposes of municipal politics. To this end, this article explores implicit theories of urban politics in Calgary, Alberta, during the early post-war period in which the city abandoned its proportional representation, partisan, and at-large electoral system and adopted single-member majoritarian ward-based politics. Combining quantitative electoral data with qualitative archival and newspaper material, the author describes how long-term shifts in electoral competition combined with changing conceptions about the purposes of local politics—especially among the labour movement and urban left in Calgary—to produce a period of major reform. The author shows how these changes reflect changing theories of urban politics, originating in particular configurations of local institutions, in Canadian cities in the early post-war era.

In May 2023, the Province of Ontario introduced legislation to dissolve the Region of Peel, an upper-tier government serving the communities of Mississauga, Brampton and Caledon—one of the most populated and fastest-growing communities in Canada. While this planned change was eventually reversed, the decision was made without public consultation or input from local lawmakers, catching many by surprise. One in 10 people in Ontario live in the Peel Region, and the province opted to eliminate a tier of government without ever meaningfully seeking approval of those elected to represent the community or members of the community themselves. While the province’s decision in the Peel Region (and the subsequent review of regional government in the province through the Legislative Assembly’s Standing Committee on Heritage, Infrastructure and Cultural Policy) is the latest iteration of municipal reform in the province, unilateral decision-making has been a consistent trend throughout Ontario’s municipal history. This article traces the development of democratic control in Ontario’s municipal institutions, beginning with the early democratic impulses of settlers in the creation of the district and county system through the creation of regional government and the era of amalgamation, which saw close to 400 municipal governments in the province consolidated. How have these changes altered the state of municipal democracy over time? How has democracy been centred during these periods of transition? What do these experiences tell us about the tension between provincial authority and local democracy? The article answers these questions, with the goal of exploring the degree of democratic engagement in Ontario’s local government reforms and considering the implications of these past and current institutional changes for Ontario’s municipal system and local government, more broadly.

Cultural Competency and Implicit Bias: Decreasing Barriers to Native American and First Nation Mental Health Care.

ABSTRACT Fostering positive team relationships and fair learning environments is severely hampered by structural violence in educational institutions. The purpose of this study is to investigate how structural violence affects the cohesiveness of educational teams and to provide peace pedagogically based solutions to these issues. In total, 200 students, 50 teachers, and 50 administrators from secondary schools in urban and rural areas participated in surveys, semi-structured interviews, focus groups, and classroom observations as part of a mixed-methods approach to data collection. Significant differences were found by quantitative analysis using ANOVA and t-tests: p-values < 0.01 for rural students who reported lower levels of team cohesiveness (mean = 3.2) and access to instructional resources (mean = 2.9) than urban students (team cohesion mean = 4.1, resources mean = 4.3). These conclusions were supported by observations made in classrooms, which showed tense teacher-student relationships and interrupted group activities in underfunded schools. These findings highlight how systemic injustices negatively impact teamwork, morale, and academic performance. The study comes to the conclusion that institutional changes, fair resource allocation, and supportive legislation are necessary to combat structural violence. To improve team relationships and lessen the negative effects of structural violence, practical implications include implementing the ideas of peace pedagogy to establish inclusive and cooperative learning settings.

The Mahatma Gandhi National Rural Employment Guarantee Scheme (MGNREGS) is one of the largest right-s based public employment initiatives worldwide, conceptualized to improve the livelihood security of rural India by providing wage employment guarantees. For almost two decades, MGNREGS has been extensively studied for its implications on women’s employment, wage equality and empowerment. This paper presents a thematic narrative review to compile diverse scholarship on the gendered effects of MGNREGS in rural India. By referencing the literature on development economics, gender studies, political economy and governance, this review will critically assess the evidence on employment generation, wage trends and women’s empowerment. The results indicate that MGNREGS has contributed substantially to women’s participation in the labour force and has led to reduce the gender gap in wages because of the provision of equal wages. Empirical research points to better income security, financial inclusion and access to local governance institutions. However, the potential of the scheme in bringing about a structural change is not uniform. Structural factors such as delayed wages, unpaid career work, caste, governance and disparities are some of the factors that hinder the potential of the scheme in bringing about the outcome sin terms of empowerment. The review points out the gaps in research which include a lack of longitudinal studies, a lack of integration of unpaid care work in impact assessments and a lack of exploration of intersectional vulnerabilities. The review concludes that although MGNREGS has empowered women economically, its potential for bringing about structural gender transformation is dependent on institutional changes and sensitivity to context.

Abstract This paper investigates the extent of political rent seeking in Hungary in the 2010s. Political capitalism —where powerful private interests influence public policy for private gain—creates opportunities for rent seeking that vary across sectors. The analysis is based on a theoretical model assuming rent seeking occurs in a three-stage process: changes in economic institutions granting regulatory privileges, which are enhanced by political-business networks; this leads to scarcities, and increased market power in certain markets; which then generates rents. To quantify this, the study evaluates Hungarian political capitalism by examining the impact of political decisions on firms’ rents, analysing the profit trends of the 1,000 largest Hungarian firms (selected annually by net sales) and comparing their mean profit share (earnings before tax) across two periods: 2008–2012 and 2019–2023. A significant increase in a sector’s mean profit share was assumed to indicate increased rent seeking. Using Welch’s two-sample t-tests, three sectors were identified as potentially experiencing increased rent seeking: agriculture, construction, and financial and insurance activities. Quantitative findings include a 320% increase in mean agricultural profit share (70% in mean ROA), a more than fivefold increase in construction mean profit share (mean ROA from 3.3% to 10.1%), and a more than 6.5 times increase in financial sector mean profit share. Furthermore, a similar Czech analysis showed no significant increases in any sector’s profit share, suggesting that the detected rises in Hungarian sectors are linked to domestic activities rather than external factors, which strengthens the findings.

This issue offers a composite and analytically rich snapshot of how governance scholarship is currently reconfiguring its core questions in response to a world marked by persistent uncertainty, uneven development trajectories, and accelerated institutional change. Taken together, the articles collected here treat governance not as a static set of rules or formal structures, but as a multi-level capacity to design, coordinate, implement, and legitimate decisions under conditions where social expectations, economic constraints, and policy pressures frequently collide.

This article examines the prominence of infographics within the contemporary visual culture of global maternal health advocacy, exploring their aesthetic, narrative and semiotic power. Infographics are a ubiquitous sensory and aesthetic feature of the global health space, filling the pages of annual reports and websites of United Nations (UN), Non-Governmental organization (NGO) and government agencies and on display in the exhibition halls and power point presentations at international conferences. I focus on the social and political work that infographics do, observing the ways in which they go beyond their remit of conveying information and rendering complex numerical data in a neutral and accessible way. I begin by describing two key historical precedents in data visualization, highlighting the pioneering work of Florence Nightingale and W.E.B. Du Bois who used data visualizations as tools in their advocacy projects of social and institutional change. Infographics in the global maternal health advocacy space, I argue, are likewise calculated appeals, combining numbers with color and compelling imagery to move the viewer to awareness and action. Further, they tend to follow a contemporary neoliberal script that frames maternal survival in terms of investment, empowerment, and economic potential. In this way they shape how we understand the problem of maternal mortality and they legitimize solutions that can be taken up by policy makers and funders. This analysis contributes to broader anthropological conversations about visuality, biopolitics, and the humanitarian logic and procedural aesthetics of the contemporary global health enterprise.

This article examines the evolution of U.S. Arctic policy over the past decade, focusing on the period from the Obama administration to the beginning of Trump’s second presidency in 2025. Drawing on the analysis of strategic documents, public discourse, and institutional behavior, it identifies how shifting priorities have shaped the Arctic as a foreign policy domain—ranging from multilateral climate cooperation to sovereignty-driven strategic competition. The study discusses how patterns of continuity and rupture manifest across administrations, and how competing visions of national interest have redefined the Arctic as a foreign policy domain. While the Biden administration reintroduced elements of multilateralism, environmental stewardship and climate diplomacy, it operated under the structural constraints of renewed great power competition following the outbreak of Ukraine War in 2022. Early indications from Trump’s second presidency suggest a reinforced emphasis on sovereignty, economic exploitation, and strategic rivalry, undermining environmental priorities and cooperative governance. The study contributes to the literature by tracing patterns of continuity and rupture across administrations and by situating U.S. Arctic policy within the broader dynamics of global strategic competition and institutional change.

Healthcare accounts for 4%-5% of global CO2 equivalent (CO2e) emissions, of which hospitals form a considerable component. Identifying evidence-based targets for carbon reduction in pediatric anesthesia can help guide meaningful reductions in healthcare-related environmental harm. A narrative review was conducted integrating published data on carbon emissions associated with anesthetic agents, perioperative workflows, waste generation, and hospital energy systems. Quantitative CO2e estimates were incorporated when available. Preoperative strategies with measurable carbon savings include early anesthesia assessment, telehealth consultations, and standardization of diagnostic testing. Intraoperatively, avoidance of nitrous oxide and desflurane yield the largest individual reductions. Propofol waste can be reduced through dose calculators and optimized vial selection. Switching to reusable equipment further limits environmental harm. Institutional actions, including decommissioning nitrous oxide pipeline systems, enhancing sustainability training, and optimizing heating, ventilation, and air conditioning systems, offer the largest measurable carbon reductions. Pediatric anesthetists can reduce environmental harm while optimizing patient care. While individual clinician choices -in particular avoiding desflurane and nitrous oxide use-are impactful, the largest and most sustainable emissions reductions derive from coordinated institutional and systems level changes.

This study examines how STEM programs can be intentionally designed to serve as mechanisms for organizational transformation. Grounded in organizational change theory and findings from a multi-site qualitative case study of the Meyerhoff Adaptation Project, the study presents four design principles that illustrate how intentional choices can reconfigure structures, cultures, and power dynamics, which enable inequity within higher education. The principles offer guidance for developing sustainable, equity-centered STEM initiatives that advance institutional change.

This article examines the evolving role of symphony orchestras in Australia's cultural landscape, tracing their shifting status from civic emblems of national prestige to publicly funded institutions negotiating relevance in a pluralistic and policy-driven environment. Using a historically informed institutional and discursive analysis, it explores how orchestras have reflected, and at times resisted, broader transformations in Australia's cultural imaginary, including the rise of public broadcasting, the emergence of cultural policy frameworks, and the growing emphasis on diversity, inclusion and public value. Rather than treating orchestras as static heritage bodies, the article positions them as dynamic institutions whose legitimacy has been continually renegotiated across different cultural policy regimes. From their origins in mid-century nation-building projects to their current positioning within public value discourses, orchestras serve as a revealing case study of how cultural relevance is constructed, challenged and redefined over time. In doing so, the article contributes to wider discussions of institutional change, settler cultural legacies and the evolving role of cultural organisations in shaping and negotiating national identity.

ABSTRACT This paper compares the evolution of housing policy in Portugal and Italy over the past century through a process-tracing analysis informed by historical institutionalism. While numerous studies have examined social housing across Europe, systematic comparisons of how social mechanisms and actor interactions shape institutional change remain rare for Southern Europe. Drawing on an analytical framework that combines institutional analysis with policy process perspectives, the paper reconstructs long-term sequences of policy formation and reform to explain both continuity and change. The analysis shows that, despite differences in timing and governance, both countries have followed homeownership-oriented trajectories, with limited social rental expansion and reliance on family provision – key traits of the Southern European model. Yet their institutional paths diverged: Italy’s early regionalization contrasts with Portugal’s enduring centralization and later Europeanization. The study demonstrates how international pressures and domestic politics generate path-dependent yet distinct housing policy regimes.

The paper develops a conceptual model of macroeconomic forecasting designed to support strategic planning and the formation of national economic policy in the context of post-crisis recovery. The relevance of the topic arises from the increasing complexity and unpredictability of economic processes, which require forecasting tools capable of integrating multidimensional information and responding quickly to structural shifts. The purpose of the paper is to substantiate methodological principles for building an adaptive and analytically robust forecasting system that can offer reliable projections under conditions of uncertainty. The research methodology is based on the combination of econometric modelling, scenario analysis, system-structural assessment and data-driven analytical techniques. This approach allows the model to incorporate heterogeneous datasets, reflect the dynamics of sectoral and institutional changes, and capture behavioural responses of economic agents. The integration of traditional macroeconomic indicators with high-frequency and alternative data sources enhances the sensitivity of forecasts and ensures the capacity to detect early signals of economic fluctuations. The obtained results demonstrate that an effective conceptual model of forecasting should be multi-layered, adaptive and institutionally oriented. It must include interconnected analytical blocks that account for macroeconomic, structural, technological and behavioural determinants of development. Such a model makes it possible to simulate alternative recovery trajectories, evaluate the effects of policy decisions and identify risks that may alter the expected path of economic growth. The findings confirm the importance of flexible forecasting tools for supporting government decision-making at both operational and strategic levels. The practical value of the paper lies in providing a scientifically grounded framework that can be directly used by policymakers to improve the quality of economic planning, design evidence-based public interventions, optimise resource allocation and strengthen the resilience of the national economy during recovery and long-term development.