Institutional Design Research Articles

The apprenticeship of Chilean congressional leaders (1834-1924) from the perspective of the theory of legislative institutionalization

This article analyzes the historical development of Chilean congressional leadership offices (1834-1924), while testing a proposition of the theory of legislati ve institutionalization that says that legislatures gradually move to-ward greater boundedness over time. The indicator of boundedness is the length of the apprenticeship of congressional leaders. Lateral entry, short office tenure, and returning leaders became distinctive features in the case at hand. Institutional design and exchanges between the legislat ure and the environment determine legislative institutionaliz ation, so a legislature insti-tutionalizes by acquiring stability, permanence, distinctiveness, and sustain-ability in a polity.

How do Australian female consumers exercise their decision-making power when making financial product decisions? The triad of financial market manipulation, rationality and emotions

PurposeThis study explores the decision-making powers of Australian female consumers in the financial product market. More precisely, it examines how the integrative effects of rationality, emotions and personality traits influence the decision-making powers of Australian female consumers when making financial product purchase decisions.Design/methodology/approachThe study employs a quantitative research approach, utilising a survey strategy. The proposed conceptual model was tested using structural equation modelling (AMOS) on a valid 357 responses from Australian female consumers.FindingsThe findings revealed that rationality, self-efficacy and impulsivity have a positive impact on the decision-making powers of Australian female consumers. Besides this, self-efficacy and anxiety had significant moderating effects on the decision-making power of Australian female consumers when buying financial products, whereas anger and impulsivity were found to have no moderating effects.Research limitations/implicationsThe study offers understanding on the role of emotions and personality traits in financial decision-making, which can help financial institutions design sound products and services that can also ensure consumers' overall well-being.Originality/valueInformed by the theoretical notions of the appraisal-tendency framework (ATF) and emotion-imbued choice model (EIC), the study makes a unique contribution by investigating the impact of rationality, emotions and personality traits on the decision-making powers of female consumers in the Australian financial product market.

Building robustness for rural revitalization: A social-ecological system perspective

Collaborative governance has the potential to foster co-creative solutions to rural issues. Many rural areas have deteriorated due to rapid and encroaching urbanization and globalization. By building institutions to support and convey collaborative governance processes, rural areas can be revitalized and equipped with the ability to cope and evolve in the face of unexpected shocks and disturbances, they can be made robust. Concepts and arguments developed in a social-ecological systems framework are drawn on to flesh out a theoretical logic to aid understandings of how institutional design can enhance the robustness of a rural social-ecological system through fostering collaboration. A critical instance case study of a rural revitalization project undertaken at a traditional village in Hong Kong, Lai Chi Wo, allows for in-depth analysis of the relationship between intuitional design, collaborative governance and robustness. Through this case study, we show how institutions can be designed and built to foster collaborative processes and, hence, enhance the system's robustness. The demonstration of this logic extends theoretical understandings regarding the identification of mechanisms through which institutional variables can impact and condition collaborative processes and so outcomes. While demonstrated here in the case of rural revitalization, these findings contribute to wider understandings of how collaborative endeavors can be fostered and enhanced and how robustness in social-ecological systems can be better supported.

State Theory and Public Administration in Latin America: Research Traditions and a Test Case

Research and teaching about the state in Latin America have been under the strong influence of constitutional law and political philosophy since the nineteenth century. To this day, a formal constitutional understanding of the state dominates not only professional training and scholarly research in the fields of government and public administration but also, perhaps more significantly, public controversies about the design of state institutions. Such controversies do not happen often, but they have significant consequences when they do. We will illustrate the last point with a test case, the public controversy about the configuration of state institutions that took place during the past ten years in Mexico. The controversy had ample coverage in national media, and it contributed to a series of institutional conflicts—still ongoing—at the highest levels of the federal government in the country. Our analysis of this national debate, in section 2 of the article, shows that certain preconceived ideas about public life and the constitutional order are much more than just “technical” legal principles; they form a practical expectation of political and institutional life. Certain of these ideas, however, have been employed to support political positions that are hostile toward the consolidation of professional state bureaucracies. Only relatively recently, an alternative line of research on the state has begun to develop in Latin America, including contributions from political sociology and history, which systematically examines issues related to professional bureaucracies and political legitimacy.

METHODS OF ECOLOGICAL DESIGN OF SCHOOLS AND KINDERGARTENS

The article deals with the problems of environmental degradation in the Kursk region as a result of anthropo-genic activity. The attention is focused on the administrative center of this region, its climatic and ecological state. Analyzed the situation of the environment and its impact on children of school and preschool age. Life in the city forces citizens to face daily imbalances that occur with human intervention in the natural ecosystem. The creation of architectural spaces that correspond to the age and characteristics of the socialization of children, providing a har-monious natural environment, is aimed primarily at the development of mental and physical health. The comfortable object-spatial environment of educational centers seeks to develop the abilities of preschool and school-age children to the maximum. To this end, the article considers foreign experience in the environmental design of educational insti-tutions - schools and kindergartens. Kursk, located in the west of Russia, is characterized by a temperate continental climate with no priority wind directions. Its general ecological characteristics are quite high in comparison with other subjects. Based on the anal-ysis of data on air pollution, precipitation, harmful substances in building materials, proposals are made on ways to level adverse factors in the design of children's school and preschool institutions. A design solution is proposed for the educational complex (secondary school and kindergarten), from innovative structures of special rigidity and strength, made by industrial methods, which ensures quick and high-quality assembly of the object at the construction site. The compositional and planning solution of the complex takes into account the favorable orientation of class-rooms and group rooms; the adopted form of the building is due to wind protection and functional zoning, and is generally aimed at creating an optimal and safe space.

Introduction

This special issue features articles based on contributions to the international workshop “The Circulation of State Models and Institutional Designs between Europe and Latin America—Transatlantic Perspectives on Political and Legal History in the Twentieth Century,” which was held virtually on 26 May 2022. The event was co-organized by the research group Modernity and Society 1800–2000 at the History Department, KU Leuven, and the School of Law and the School of Modern Languages and Cultures, University of Warwick. The initiative was also sponsored by the Instituto de Investigaciones de Historia del Derecho (INHIDE), a prestigious legal history research center based in Buenos Aires. We acknowledge the important assistance of Martin Kohlrausch and Magaly Rodriguez Garcia (KU Leuven), Ingrid de Smet (University of Warwick), and Ezequiel Abásolo and Viviana Kluger (INHIDE) in the final settlement of that event. The event was attended by prestigious legal scholars: Carlos Herrera (CY Cergy Paris Université), Peter Heyrman (KU Leuven), Elisa Speckman (Universidad Nacional Autónoma de México), Eduardo Zimmermann (Universidad San Andrés), and Werner Thomas (KU Leuven). Several exponents from diverse institutions in Europe and Latin America also participated as contributors in a rich interdisciplinary dialogue between legal history and political history: Zakia Mestari (University of Toulouse), Luciano Aronne de Abreu (Pontifícia Universidade Católica do Rio Grande do Sul), María Angélica Corva (Universidad Católica Argentina), Ana Brisa Oropeza Chávez (Universidad de Anahuac-Veracruz), Janne Schreurs (KU Leuven), Agustín Parise (Maastricht University), María Rosario Polotto (Universidad Católica Argentina), Pamela Cacciavillani (Universidad de Monterrey), and Horacio García Bossio (Universidad Católica Argentina) attended the meeting.

К оценке траекторий трансформаций постсоветских политических систем

Introduction. The article examines the formation and development of political systems in the former eleven republics of the USSR from the standpoint of the institutional transformations taking place there. The struggle for power between various elite groups and citizens’ identities and the dynamics of citizens’ identities were also the basis for comparison. The authors consider the parameters mentioned to make the comparison and typology of the modern post-Soviet states’ development more effective. Methods and Materials. The neoinstitutional, sociological, and political-cultural approaches were used in the research, as were the comparative-historical and comparative-typological methods, which made it possible to scrutinize the available facts and draw respective conclusions. Analysis. It was stated that starting in the 1980s, the transformation of the typical Soviet republics took place in two directions. The first included the formation of the electoral autocracies, institutional design, and social and cultural image, which were determined by the “nucleus” – the president-leader. Such political dynamics turned out to be characteristic of Turkmenistan, Tajikistan, Kazakhstan, Uzbekistan, Azerbaijan, and Belarus. The formation of the “front-end democracies” was the second direction. These democracies are characterized by institutional, social, and identity fragmentation hiding behind the glass cases of democratic structures and practices borrowed from the West. Kirghizia, Georgia, Armenia, Ukraine, and Moldavia have moved in this direction. Results. The authors’ conclusion is that both the first and second directions do not ensure the stable development of new independent states in the foreseeable future. Authors’ contribution. A.V. Abramov formulated the concept of the article, developed the comparison parameters, and studied the post-Soviet elites’ and citizens’ struggle for power and their identity evolution. R.A. Alekseev analyzed the transformation of the political institutions in the post-Soviet political systems in the context of their constitutional reforms.

Anticipating the Threat of Democratic Majoritarianism: Ambedkar on Constitutional Design and Ideology Critique, 1941–1948

This article analyses B. R. Ambedkar’s works written between 1941 and 1948, and it discerns a central set of concerns and arguments in this otherwise diverse corpus. It argues that since universal franchise as a political principle is uncontroversial, Ambedkar’s primary concern is geared towards the danger of democratic majoritarianism in a society riven by historically, legally and ideologically determined forms of inequality and their logic—a danger that can only be addressed at the dual levels of institutional design and ideological critique. Reading together Pakistan or the Partition of India and What Congress and Gandhi have done to the Untouchables, the initial sections argue that Ambedkar was critical of Congress and Muslim league politics because he saw in them both, albeit in distinct ways, the affirmation of religious identity as central to the formulation of political identity. Such an orientation, in the actual mechanics of mass politics and constitutional negotiation, is therefore read as inevitably leading to conflicts including demands for Partition, but at the same time such politics avoided fundamental questions of internal critique and instituted forms of socialized inequality. It is in this context, and the imminence of Partition, that the article analyses Ambedkar’s argument for the need of both a specific institutional design (constitutional provisions) and an ideology critique (his historical research including Who were the Sudras and The Untouchables). The analysis of the demand for partition and the category of the minority can only be understood through Ambedkar’s acute historical and theoretical understanding of the nation and its history, as well as the normative demands required for institutional justice, as will be shown through a reading of this corpus.

Designing a User-Friendly Context-Specific Assessment Tool for Community-Based Teachers.

Graduate medical education (GME) programs must ensure that they are able to collect accurate information about resident competence through assessment tools that are fit for purpose. An assessment form or process is called “fit for purpose” when there is good alignment between the tool (how something is assessed) and the intent (the specific knowledge, skill, or attitude/belief that is being assessed).In our family medicine GME program, we identified that the generic workplace-based summative assessment tool provided to community-based family medicine obstetrics (FMOB) clinical teachers was not fit for purpose. As a result, these teachers were uncertain about program expectations regarding competence, the assessment form was challenging and frustrating to complete, and our program struggled to extract useful assessment data from completed assessment forms. To address this issue, we took a systematic approach to develop a workplace-based assessment tool that was specific to the clinical context of FMOB and user-friendly for clinical teachers.Our goals were to develop: (1) a fit-for-purpose workplace-based assessment tool for community-based FMOB teachers that could be used for accurate assessment without the need for faculty development, and (2) an evidence-guided process for designing similar context-specific tools in the future. We met our first goal through designing the FMOB competence rubric (FMOB-CR) tool. The FMOB-CR is comprised of 2 elements. The first is a rubric containing specific statements and examples of resident performance. The rubric clearly outlines the expected level of competence on a 3-point rating scale (“cause for concern,” “acceptable competence,” “exemplary competence”), organized by the 6 Skill Dimensions of Family Medicine (similar to CanMEDS roles).1 The second element is a simple online assessment form in which FMOB teachers specify their resident's level of competence in each Skill Dimension, guided by the statements and examples in the rubric.The FMOB-CR uses plain language and context-specific clinical examples along with a simple online assessment form to clearly communicate expectations of competence to teachers (and residents) without additional faculty development. This user-friendly tool should make it easier for FMOB clinical teachers to better identify residents who are underperforming, which will allow the program to be more effective in intervening and supporting residents in difficulty.To meet our second goal, we developed an evidence-guided process for designing workplace-based assessment tools that are fit for purpose for specific clinical contexts. Our design process included: assembling a tool development team with relevant expertise, including a resident; consultations with FMOB teachers and residents; environmental scan and review of local assessment forms and assessments used by other FMOB GME programs; a modified Delphi process with local GME program faculty to develop and refine the table of competence statements; a consensus-building process within the research team to revise the statements for the rating scale; and implementation of the assessment rubric with concurrent collection of validity evidence. For both the FMOB-CR and the development process, we collected validity evidence according to Messick's unified concept of validity.2The Table details the validity evidence collected to date. Fifteen FMOB teachers surveyed showed strong agreement across 5 items about the utility of the rubric in allowing them to accurately assess residents (overall M=3.25/4, Likert scale 1=strongly disagree to 4=strongly agree), and across 3 items about the usefulness of the rubrics in helping them to understand program expectations of resident competence (overall M=3.36/4); 14 of 15 teachers preferred the new form to the old one.We hope that the worked example of the FMOB-CR and its development process may serve as a blueprint for other institutions to develop context-specific assessment tools.

Global Trends and Performances of Acupuncture Therapy on Bell's Palsy from 2000 to 2023: A Bibliometric Analysis.

Recent studies have shown that acupuncture may have great potential in the treatment of Bell's palsy. However, the bibliometric analysis of this field has not been summarized properly. Thus, the purpose of this study is to analyze the hotspot of acupuncture for Bell's Palsy. The core collection database of Web of Science was searched for relevant publications from 2000 to 2023, and countries, institutions, authors, keywords, and literature were analyzed and visualized by bibliometric softwareCiteSpace 5.1.R6, Vosviewer, BICOMB, and gCLUTO to explore the scientific achievements, research collaboration networks, research hot spots, and research trends. 229 publications were included in this study. The most cited journal is Journal of Otolaryngology-Head & Neck Surgery; the most prolific country is China; the most prolific author is Li Ying, moreover, the collaboration among scholars is poor; Kyung Hee University is the most prolific institution studying acupuncture for Bell's Palsy. Reference burst detection indicates that traditional Chinese Medicine philosophy, the role of acupuncture in the prognosis of facial palsy, mechanism of acupuncture to improve facial nerve function, and the use of electroacupuncture are starting to become new research hotspots. The field of acupuncture for Bell's Palsy has developed rapidly in recent years, and new research trends are mainly: combination with traditional Chinese medicine, the role of acupuncture in the prognosis of facial palsy, mechanism of acupuncture to improve facial nerve function, and the use of electroacupuncture. However, research in this field is still dominated by case reports and clinical trials, and there is a lack of large-scale, multicenter clinical trials and animal experiments there are still many problems in institutional cooperation and experimental design, which requires relevant researchers to strengthen cooperation and improve experimental design.

Can democracy accelerate sustainability transformations? Policy coherence for participatory co-existence

The 2030 Agenda envisages a world “in which democracy, good governance and the rule of law […] are essential for sustainable development” (Transforming our world: The 2030 Agenda for sustainable development, 2015, paragraph 9). However, the extent to which democratic practices can help or hinder sustainable development remains contested. I show how the relationship between democracy and environmental sustainability can be illuminated by recent advances in research on policy coherence for sustainable development. I apply a framework developed by Shawoo et al., (2022), to illustrate how (in)coherence between these two objectives is driven by a mix of ideas, institutions and interests. This framework can, in turn, help to identify policy options for strengthening coherence between democratic and environmental aims, spanning pluralisation of integrative frames and discourses, inclusive institutional design and reforms that broaden the range of public interests included in decision-making while restraining undue influence of vested interests.

Stories of Gender Inclusion, Power-Sharing and the Good Friday Agreement

Abstract Marking the 25th anniversary of the Good Friday Agreement, we review the gendered legacy of power-sharing and peacebuilding in Northern Ireland. The participation of an all-women’s political party in the 1996–1998 peace talks and world-class commitments to human rights and equality enshrined in the Good Friday Agreement suggested that Northern Ireland would stand as a conflict resolution and institutional design model par excellence. While the intervening years have been largely peaceful, and women’s political representation has improved, years of political stalemate and poor equality and human rights protections for women suggest a mixed legacy of gender inclusion and power-sharing. In this paper, we chart the ups and downs of Northern Ireland’s power-sharing institutions in the context of feminist peace activism over two and a half decades and offer a set of feminist reflections on the promise and peril of power-sharing in Northern Ireland.

Analysis of Strategy Selection in Third-Party Governance of Rural Environmental Pollution

In the context of increasingly prominent rural environmental problems, the third-party pollution governance model has become an important initiative for the comprehensive governance of rural environmental problems in China. However, the current third-party governance initiatives continue to suffer from governance failures caused by unclear responsibility sharing and opportunistic behavior. To analyze the reasons behind the behavioral choices of the various stakeholders involved in rural environmental third-party governance and to provide policy insights for formulating more reasonable rural environmental third-party governance solutions, a game model was constructed between local governments and third-party governance institutions. Specifically, the model examined the different evolutionary game strategies that appear between local governments and third-party governance institutions in different institutional design contexts when responsibility disputes arise in third-party governance. These disputes involve the re-governing of pollution control responsibility, which can be borne either by the local governments or the party causing the damage. The results shown are as follows: It is crucial to define the boundaries of re-governance responsibility in the third-party governance of rural environmental pollution. When local governments bear the primary responsibility for governance, regardless of whether they provide regulatory oversight, third-party governance institutions tend to adopt a passive approach. In such cases, the third-party governance market fails to effectively fulfill its role in governance. By reconstructing the third-party governance market model and dividing the main responsibility for pollution governance among the damaging parties, it is possible to achieve active governance by third-party governance institutions without the need for regulation by local governments.

Decisional conflict in American parents regarding newborn circumcision

Decisional conflict surrounding the topic of circumcision in the newborn male is assumed in some parents but has not been quantified or qualified. It is known that parents often base their decision on cultural and social factors and that physician discussions do affect ultimate decision-making. Information on parents' decision-making surrounding newborn circumcision and ways to mitigate conflict or uncertainty around the decision-making process is needed to better counsel them appropriately. To identify the presence or absence of decisional conflict in parents-to-be deciding whether or not to circumcise their child as well as to identify determinants of this conflict to direct future educational measures. Parents presenting to obstetrics clinic as well as contacted by institutional email were recruited using convenience sampling and completed the validated Decisional Conflict Scale (DCS). A smaller subset of subjects were recruited via institutional email to complete semi-structured interviews regarding the decision-making process and specifically uncertainty regarding the decision. Descriptive statistics and unpaired t tests were used for analysis of survey data. For interview data, an iterative, grounded theory methodology was used. 173 subjects completed the DCS. 12% of all participants had high decisional conflict. Intuitively, those who had not yet decided whether to circumcise had the highest proportion of high DCS (69%), followed by those who had decided to circumcise (9.3%) and those who had decided not to circumcise (1.7%). 24 subjects were interviewed, and based on their DCS scores and interview responses were classified as low, intermediate and high conflict. Three primary themes emerged delineating the high from low conflict groups. There were notable differences in the feelings of subjects regarding knowledge and feeling informed, the importance of particular values and clarity of the roles of these values in decision-making, and feelings of supported decision-making. These themes were used to create a visual model depicting the individual needs of each decision-maker (Fig.1). This study highlights the need for decision support for parents that is not only information-based but focuses on values clarity and supported decision-making. This study provides a jumping-off point for creation of shared decision-making tools directed at individual needs. The limitations of this study are a single institution design and homogeneous population, so when designing materials, additional unrecognized needs will likely be identified. A small, but real proportion of parents-to-be experience significant uncertainty around the decision to circumcise their newborn boys. Identified needs of parents include feeling informed, feeling supported and clarification of important values related to the problem.

Decentralization in Public Policy and Governance of Public Services in Alaska, USA

Public policy is developed through a process of policy analysis, debate, and decision-making, involving various stakeholders such as government officials, civil society organizations, and citizens. . Effective decentralization requires careful planning, institutional design, and monitoring and evaluation to ensure that it promotes good governance and produces positive outcomes for citizens. Effective governance structures and processes are necessary to develop and implement effective public policies, while well-designed public policies can help to promote good governance by fostering transparency, accountability, and participation. The research used the descriptive research design. The target population was 40 public officers in Alaska, USA. Questionnaires were utilized to gather the data. The study found that decentralization in the public policy and governance of public services in Alaska, USA have significant effects on the efficiency, effectiveness, and responsiveness of the system. By transferring decision-making authority and responsibilities from central government entities to local or regional authorities, decentralization allows for increased local autonomy and tailored decision-making. Local authorities, such as municipalities or regional governments, have a better understanding of the specific needs and priorities of their communities. The study concluded that decentralization in public policy and governance of public services in Alaska has the potential to enhance local responsiveness, citizen engagement, and overall effectiveness of public service delivery, while also necessitating careful attention to address potential challenges and ensure equitable outcomes.  The study recommended that effective implementation of decentralization in the public policy and governance of public services requires strengthening governance structures, capacity building, fostering citizen participation, ensuring equitable resource allocation, and continuous monitoring and evaluation. Decentralization requires solid institutional capacity at all levels of government to ensure that policies are effectively implemented and resources are efficiently utilized. Monitoring and evaluation are critical to assessing the effectiveness of decentralization efforts and identifying areas for improvement Keywords: Decentralization, public policy, governance, public services, USA

Study on Health Effect and Health Equity of Long-term Care Insurance Pilot Policy in China

Long-term care insurance (LTCI) is an important measure to actively cope with the aging population in China. In this paper, CHARLS data is used to study the health effects of pilot policies of LTCI through DID model and PSM-DID model, and Dagum Gini coefficient is used to analyze the sources of differences in health equity between urban and rural areas. Results show that the implementation of LTCI has an improvement effect on self-reported health status, but the results after propensity score does not significantly support the conclusion of the improvement effect. In addition, the health inequality mainly comes from the internal differences respectively existed in urban and rural areas, and the difference in self-reported health status of the elderly in the treatment group is more obvious. Therefore, future institutional design should focus on policy coverage of the population and improving services.

A comparative analysis of resource networks of intermediary support organizations for nonprofit development: Evidence from incubators for nonprofit organizations

AbstractIncubators for nonprofit organizations (NPOs) are agencies that provide diverse services to support the creation, survival, and early stage growth of NPOs. A primary task of such agencies is to provide NPO clients access to resources through networking. Drawing on the literature on intermediary support organizations (ISOs) and tie formation and a comparative case study of three incubators for NPOs in China, this study examines differences in their resource networks for supporting NPOs and the various factors associated with those different network characteristics. The analysis shows that the types of organizations that play a pivotal role in each case's resource network—business organizations, governmental organizations, and NPOs—are different. Each of these distinctive network characteristics is individually associated with organizational influence, resource dependence, and institutional design. These differences in resource networks and the mechanisms underlying network formation contribute to the literature on ISOs.

Study on the Factors Influencing and Mechanisms Shaping the Institutional Resilience of Mega Railway Construction Projects

With mega railway construction projects (MRCPs) facing various natural disasters and extremely difficult engineering construction tasks, there is an urgent need to improve the resilience management capability of engineering construction to cope with complex and changing internal and external risks. As a key element of the construction management system, the level of institutional resilience directly determines the adaptability of the construction system in the face of crisis. However, the research on the influencing factors and the formation mechanism of institutional resilience is slightly insufficient. Therefore, this paper defines the connotation of institutional resilience in MRCPs on the basis of existing research. Secondly, it codes authoritative journals and expert interview reports related to MRCPs in China by applying a rooting theory. Finally, the paper analyses the formation mechanism of institutional resilience based on an Interpretative Structural Modeling and proposes strategies to enhance it. The results show that the institutional environment is the fundamental influencing factor, institutional implementation, institutional supervision, institutional guarantee and institutional feedback are the direct influencing factors, and institutional stakeholders and institutional design are indirect influencing factors. The mechanism of interaction between the institution and the institutional environment, the mechanism of interaction between the institution and the institutional stakeholders, the mechanism of generation of institutional rules and the mechanism of operation of institutional rules work together to generate institutional resilience. This paper, as an exploratory study on institutional resilience in the field of engineering management, has sorted out the ideas for the subsequent research on institutional resilience in this field and provided the directions for project managers of MRCPs to improve their institutional systems.

The perinatal outcomes of women treated for Asherman syndrome: a propensity score-matched cohort study.

Do the perinatal outcomes of patients following hysteroscopic treatment for Asherman syndrome (AS) differ from that of a control population? Perinatal complications including placental issues, high blood loss, and prematurity in women after treatment for AS should be considered as moderate to high risk, especially in patients who have undergone more than one hysteroscopy (HS) or repeated postpartum instrumental revisions of the uterine cavity (Dilation and Curettage; D&C). The detrimental impact of AS on obstetrics outcomes is commonly recognized. However, prospective studies evaluating perinatal/neonatal outcomes in women with AS history are sparse, and the characteristics accounting for the respective morbidity of AS patients remain to be elucidated. We conducted a prospective cohort study utilizing data from patients who underwent HS treatment for moderate to severe AS in a single tertiary University-affiliated hospital (enrolled between 01 January 2009 and March 2021), and who consequently conceived and progressed to at least 22nd gestational week of pregnancy. Perinatal outcomes were compared to a control population without an AS history, retrospectively enrolled concomitantly at the time of delivery for each patient with AS. Maternal and neonatal morbidity was assessed as well as the characteristics-related risk factors of AS patients. Our analytic cohort included a total of 198 patients, 66 prospectively enrolled patients with moderate to severe AS and 132 controls. We used multivariable logistic regression to calculate a propensity score to match 1-1 women with and without AS history based on demographic and clinical factors. After matching, 60 pairs of patients were analysed. Chi-square test was used to compare perinatal outcomes between the pairs. Spearman's correlation analysis was utilized to investigate the correlation between perinatal/neonatal morbidity and the characteristics-related factors of AS patients. The odds ratio (OR) for the associations was calculated by logistic regression. Among the 60 propensity matched pairs, the AS group more frequently experienced overall perinatal morbidity, including abnormally invasive placenta (41.7% vs 0%; P < 0.001), retained placenta requiring manual or surgical removal (46.7% vs 6.7%; P < 0.001), and peripartum haemorrhage occurrence (31.7% vs 3.3%; P < 0.001). Premature delivery (<37 gestational weeks) was reported more frequently also for patients with AS (28.3% vs 5.0%; P < 0.001). However, no increased frequency of intra-uterine growth restriction or worsened neonatal outcomes were observed in AS group. Univariable analysis of risk factors for AS group morbidity outcomes revealed that the main factor related to abnormally invasive placenta was two or more HS procedures (OR 11.0; 95% CI: 1.33-91.23), followed by two or more D&Cs preceding AS treatment (OR 5.11; 95% CI: 1.69-15.45), and D&C performed postpartum as compared to post abortion (OR 3.0; 95% CI: 1.03-8.71). Similarly, two or more HS procedures were observed as the most important factor for retained placenta (OR 13.75; 95% CI: 1.66-114.14), followed by two or more preceding D&Cs (OR 5.16; 95% CI: 1.67-15.9). Premature birth was significantly associated with the number of preceding D&Cs (OR for two or more, 4.29; 95% CI: 1.12-14.91). Although the cohort of patients with AS was enrolled prospectively, a baseline imbalance was intrinsically involved in the retrospective enrolment of the control group. However, to reduce the risk of bias, confounding factors were adjusted for using propensity score matching. The limitation to the generalization of our reported results is the single institution design in which all patients were treated for AS in one tertiary medical centre. Within our search scope, our study represents one of the first and largest prospective studies of perinatal and neonatal outcomes in moderate to severe AS patients with a prospectively analysis of the risks factors of characteristics significantly influencing reported morbidities among patients with AS. The study was supported by the Charles University in Prague [UNCE 204065] and by the institutional grant of The General Faculty Hospital in Prague [00064165]. No competing interests were declared. N/A.

A network approach to understanding distance learners’ experience of stress and mental distress whilst studying

Research has shown that learners’ stress and mental distress are linked to poorer academic outcomes. A better understanding of stress and mental distress experiences during study could foster more nuanced course and intervention design which additionally teaches learners how to navigate through to protect their academic performance. The current study draws on data collected via validated self-reported questionnaires completed by final year undergraduate students (n = 318) at a large distance education university. We examined how common features of stress, depression and anxiety link to each other using a network analysis of reported symptoms. The results included findings demonstrating the symptoms with the greatest relative importance to the network. Specifically, these included the stress symptom ‘I found it difficult to relax’ and the depression symptom ‘I was unable to become enthusiastic about anything’. The findings could help institutions design interventions that directly correspond to common features of students’ stress and distress experiences.