ABSTRACT Why do women lead some political parties and not others? This article examines the organizational and institutional factors shaping women’s access to party leadership in Latin America. Drawing on an original dataset of 54 parties across 16 countries (1990–2025), V-Party/V-Dem data, and mixed-effects regression analysis, we find that gender organizational structures exhibit contingent effects conditioned by party ideology: contrary to expectations, formal gender models do not per se increase women’s presence in party leadership, but autonomous structures produce a significant positive effect among centrist parties, offsetting their otherwise negative general effect. Party institutionalization consistently predicts women’s leadership, as formal rules and standardized procedures create more inclusive conditions. Previous experiences of female leadership also generate path-dependent effects that increase the probability of repetition. The findings reveal how formal and informal dynamics interact to shape women’s opportunities and identify the organizational features most conducive to breaking the “glass ceiling” in party leadership.

Operative mortality rates in the congenital heart disease population have remained stagnant at 2.8% for the last decade, prompting a mixed-methods exploration into what institutional factors might be at play. After experiencing 0% operative mortality for 365 days, we aimed to qualitatively identify institutional factors impacting operative mortality and compare them to perceived reasons for operative mortality. A convergent mixed-methods design was used to compare quantitative and qualitative data. This study was performed in a single-center pediatric heart center by a multidisciplinary cardiac research team between January 2020 and June 2024. A retrospective review of 43 operative mortality records was conducted to determine patient characteristics and reasons for operative mortality. Semi-structured interviews were conducted with staff. Quantitative data were analyzed using descriptive statistics to describe patient characteristics and reasons for perceived operative mortality. Qualitative data were analyzed using reflexive thematic analysis to identify themes related to institutional factors influencing operative mortality. Quantitative and qualitative data were compared by matching reasons for each operative mortality to qualitative themes in a joint display. A post hoc descriptive analysis was performed to identify additional perceived reasons for operative mortality following the 0% operative mortality period. Records were assigned up to five reasons for operative mortality: technical failure, communication issues, intractable disease, management strategy, and decision-making. Semi-structured interviews identified institutional factors influencing operative mortality. Reasons for operative mortality were technical failure (n = 19 [22%]), intractable disease (n = 19 [22%]), communication (n = 18 [21%]), management strategy (n = 15 [18%]), and decision-making (n = 14 [16%]). Three qualitative themes emerged: 1) Implementing Best Medical Practices, 2) Fostering Healthy Interpersonal Relationships, and 3) Building a Responsive Organizational Structure. Upon comparison, factors encompassed by theme 1 were most comparable when the reason for operative mortality was technical failure, intractable disease, management strategy, or decision-making); theme 2 was most comparable when the reason was communication. Theme 3 was only related to one instance of operative mortality. A post hoc analysis revealed most subsequent deaths following the 0% operative mortality period were attributed to intractable disease. Efforts to implement best medical practices are critical to improve operative mortality. A considerable effort should also be made to foster healthy relationships among staff. Building a responsive organizational structure may indirectly influence outcomes and should be further explored.

• Constructs a global novel Women’s Financial Inclusion (WFI) Index integrating traditional and digital finance. • Finds a U-shaped link: early inclusion may weaken, but deeper inclusion strengthens corruption control. • Identifies actionable thresholds, with digital finance delivering earlier governance gains. • Female education, labor force participation, and institutional quality amplify the governance impact of WFI. • Emphasizes policy sequencing: inclusion must align with regulation and empowerment reforms. Financial inclusion is widely promoted as a pathway to transparency and development, yet its gender-specific governance effects remain underexplored. This study examines the impact of women’s financial inclusion (WFI) on corruption control across 150 countries from 2011 to 2023, using a dynamic System-GMM framework to address endogeneity and persistence. We construct a composite Women’s Financial Inclusion Index (WFII) integrating traditional and digital access indicators and assess robustness using alternative measures. Results reveal a statistically significant U-shaped relationship. At low levels, greater WFI is associated with weaker corruption control; beyond a critical threshold of approximately 1.86 (standardized units), deeper inclusion strengthens governance. A complementary Women’s Digital Financial Inclusion Index (WDFII) exhibits a lower turning point, indicating that digital inclusion generates earlier governance gains. The governance-enhancing impact of WFI is amplified by female education, labor force participation, and stronger institutional quality. Income heterogeneity further shows that lower-income countries experience earlier marginal benefits, whereas upper-middle- and high-income countries require deeper inclusion before governance improvements materialize. Overall, WFI acts as an institutional amplifier, strengthening accountability where supportive legal and socioeconomic conditions are present. Its anti-corruption benefits depend on complementary investments in female human capital, regulatory safeguards, and institutional strength. Effective policy must therefore align financial access expansion, particularly through digital channels, with broader empowerment and governance reforms to ensure inclusion translates into sustained corruption control and inclusive development.

Tracheal extubation (TE) is a commonplace procedure, but should not be trivialized; it remains a critical yet under-standardized step in anesthesia practice. Whether performed in the operating room (OR) or the post-anesthesia care unit (PACU), the TE location reflects a compromise between patient safety and operating room efficiency and remains a concern. This national survey aimed to describe TE practices among French anesthesia professionals and identify factors influencing the choice of routine TE site. We conducted a national mixed-methods survey, combining quantitative and qualitative analyses, to assess TE practices among care-providing anesthesia professionals. An online questionnaire endorsed by the French Society of Anesthesia and Intensive Care Medicine (Société Française d'Anesthésie-Réanimation, SFAR) was distributed from June to September 2025. It included demographic data and three standardized clinical scenarios of increasing anesthetic complexity. Respondents specified their optimal TE site, operator characteristics, oxygenation methods, and rationale for decision-making. Quantitative data were analyzed descriptively; qualitative responses underwent thematic analysis. A total of 297 anesthesia professionals responded, including 194 (65.5 %) CRNAs and 102 (34.5 %) anesthesiologists. Most worked in university or general hospitals (72 %). The composition of PACU staff was heterogeneous, with nurses trained in the recovery room in 56.9 %, CRNAs in 47.5 %, and anesthesiologists in 10.8 %. TE location varied widely: 30% performed all routine TE in the OR, 23% mostly in the OR, 14% equally in both locations, 21% mostly in the PACU, and 12% exclusively in the PACU. Most operating room TE occurred after low-risk procedures (64%) and were performed by CRNAs under anesthesiologist supervision; anesthesiologist involvement increased with case severity. Most respondents reported to plan TE site before anesthesia induction. Determinants of TE site considered analgesia quality, staff competence, equipment reliability, and organizational constraints. Routine TE practices in France exhibit significant variability, shaped by clinical and institutional factors rather than standardized protocols. The predominance of nurse-based PACUs and limited anesthesiologist presence highlight the need for structured, evidence-based guidelines to optimize postoperative airway safety, even during non-difficult airway management.

Advancement of medical science is dependent on the development of clinician-scientists; however, the factors contributing to a successful transition to research independence remain unknown, especially in critical care. We aimed to determine factors associated with submission of a National Institutes of Health (NIH) R01-level award among pediatric critical care medicine (PCCM) physicians. Cross-sectional survey. Web-based survey administered from September 2024 to November 2024 in academic pediatric critical care divisions. PCCM physicians who received an NIH career development award (K award; either institutional [K12, KL2] or individual [K08, K23, K99/R00]) between 2014 and 2023. None. Participants were asked about award, recipient, and institutional characteristics and work hours. We used multivariable generalized linear regression to identify factors associated with R01 submission. Among 122 PCCM K award recipients, 102 (83.6%) completed the survey. Among 76 respondents who had completed or were within 1 year of completing K award funding, 53 (69.7%) had submitted an R01. Factors independently associated with higher likelihood of R01 submission were: 1) receipt of an individual K award (adjusted relative risk [aRR], 2.38; 95% CI, 1.30-4.38) or an institutional followed by an individual K award (aRR, 2.13; 95% CI, 1.19-3.83) relative to an institutional award only; 2) conducting basic science research (aRR, 1.45; 95% CI, 1.11-1.89); 3) receiving an NIH Loan Repayment Program award (aRR, 1.63; 95% CI, 1.21-2.19); 4) having fewer other K award recipients in the PCCM division (aRR, 2.33 for 0 vs. 3 or more; 95% CI, 1.45-3.76); and 5) working fewer nightshift hours (aRR, 1.89 for first vs. fourth quartile; 95% CI, 1.17-3.06). Among over 100 PCCM K award recipients, both individual and institutional factors were associated with R01 submission, suggesting potential targets for efforts to support the transition to independence for K award recipients and bolster growth of the clinician-scientist workforce.

Children and adolescents with developmental disabilities often encounter substantial barriers to physical activity. However, prior research has rarely provided a comprehensive understanding that integrates multiple perspectives. We conducted semi-structured interviews with nine parents and seven sports professionals in South Korea. Data were analysed thematically using Braun and Clarke's six-phase framework. Identified barriers included inaccessible or poorly maintained facilities, societal stigma, insufficient instructor qualifications, fragmented administrative systems, and uniform, short-term programmes. Parents also reported discomfort in inclusive settings and a preference for designated disability-friendly spaces. Facilitators included government-supported infrastructure, disability awareness training, family psychoeducation, structured instructor certification, and long-term, individualised programmes tailored to individual support needs. Participation in physical activity is shaped by interconnected physical, attitudinal, institutional, social, and programmatic factors. Addressing these challenges requires inclusive infrastructure, standardised qualification systems, emotional and informational support for families, and sustained, tailored programme development.

This study aimed to evaluate the impact of socioeconomic status (SES), as measured by Child Opportunity Index (COI) 3.0 and insurance type, on access to orthopaedic care among pediatric patients with osteochondral defects (OCDe) of the knee. A secondary aim was to determine whether delays in care were associated with differences in lesion severity or return-to-sport (RTS) outcomes. We conducted a retrospective cohort study of 109 patients aged 21 years or younger who underwent surgery for knee OCDe between 2012 and 2023 at a tertiary academic center. Demographic and clinical variables were extracted from the chart review. The time interval between injury to diagnosis was categorized as prompt (30d or fewer) or delayed (more than 30d). COI 3.0 scores, including total and domain-specific scores for education, health, and SES, were assigned using patient zip codes and stratified into quintiles. χ 2 and the Fisher exact tests were used to assess associations between SES indicators and time to care. The cohort (mean age 16.1±2.6y) was predominantly male (64.2%), Spanish/Hispanic/Latino (52.6%), and publicly insured (62.0%), with 75.2% residing in low or very low total COI neighborhoods. Neither insurance type nor COI scores were associated with delayed care. There were also no significant differences in lesion size, ligament injury, or RTS outcomes between prompt and delayed groups at an average follow-up of ∼1.5 years. In this predominantly minority and socioeconomically disadvantaged cohort, neither lower COI scores nor public insurance were associated with delayed orthopaedic care for OCDe of the knee. Delays in care did not impact lesion severity or short-term RTS outcomes. Institutional and community-level factors may have mitigated traditional barriers to access in this safety-net pediatric setting. Level III.

Neurosurgical workforce inequities remain a major barrier to timely access to essential neurosurgical care in low- and middle-income countries (LMICs). Because workforce capacity depends not only on the number of trainees but also on the quality, geographic distribution, and sustainability of training systems, neurosurgical training is a critical determinant of global neurosurgical equity. We aimed to synthesize the principal barriers and scalable solutions in neurosurgical training across LMICs and to illustrate these patterns through a national case study of adult neurosurgery residency positions in Peru. We conducted a structured narrative review of the literature on neurosurgical training in LMICs, focusing on historical development, residency training, mentorship, digital education, simulation, and international collaboration. In parallel, we performed a descriptive national case study of adult neurosurgery residency positions available in Peru in 2025, assessing their geographic and institutional distribution. Across the reviewed literature and the Peruvian national case study, barriers to neurosurgical training appeared to be predominantly related to structural and institutional factors, including geographic centralization, limited educational infrastructure, inconsistent subspecialty exposure, financial constraints, and unequal access to mentorship. This does not exclude the role of individual motivation or institutional culture, but suggests that trainee interest alone is insufficient to overcome system-level barriers. Promising scalable strategies included competency-based curricula, structured virtual learning, low-cost simulation models, and partnership frameworks centered on local capacity-building. In Peru, 31 adult neurosurgery residency positions were identified across 20 hospitals in 7 regions, with marked concentration in Lima and repeated clustering within a small number of high-complexity referral institutions. This distribution reflects a centralized training model with limited regional expansion. Neurosurgical training inequities in LMICs appear to be strongly shaped by the structural concentration of training capacity, although local institutional culture, trainee motivation, and national policy contexts may also influence access to high-quality training. Expanding the neurosurgical workforce will require coordinated national planning, investment in regional training hubs, and sustainable educational partnerships that strengthen local ownership and workforce sustainability.

This conceptual paper examines ethical challenges and professional misconduct in the Malaysian legal profession, with a focus on identifying key causes, consequences, and potential reforms. Despite the existence of regulatory frameworks such as the Legal Profession Act 1976, incidents of misconduct including conflicts of interest, dishonesty, negligence, and breaches of confidentiality remain prevalent. The study adopts a qualitative, literature-based approach to analyse how individual, organisational, and institutional factors contribute to unethical behaviour. The findings indicate that ethical challenges arise from competing professional duties, financial pressures, workplace culture, and weak regulatory enforcement. Systemic issues such as lack of transparency, inconsistent disciplinary actions, and insufficient monitoring mechanisms further exacerbate misconduct. Additionally, existing ethics education is found to be inadequate in influencing practical decision-making. The paper concludes that professional misconduct is not solely an individual failing but a product of broader structural weaknesses. Addressing this issue requires a holistic strategy involving stronger enforcement mechanisms, continuous professional development, improved regulatory clarity, and the promotion of an ethical legal culture. These measures are essential to restore public trust and uphold the integrity of the legal profession in Malaysia.

Abstract Agricultural extension services (AES) have been playing a vital role in technology adoption, improving agricultural productivity and food security of smallholders in developing countries like Ethiopia. Although the Ethiopian government has made substantial investments to increase the accessibility of the service, a significant number of the farming community are still unaddressed. However, studies on the perception of smallholders on its effectiveness and the effect of climatic and market shocks on smallholders’ access to this service are limited. The specific objectives of this study are to evaluate effectiveness perceptions, access, and the impact of AES on climate-smart agriculture (CSA) in the South Gondar Zone, Amhara Regional State, Ethiopia. A multi-stage sampling technique was employed to select 590 sample household heads, and data were collected using a structured questionnaire. Descriptive analysis, logistic regression, and a multivariate Probit (MVP) model were used as methods of analysis. The descriptive analysis showed that the majority of smallholders perceived AES as “effective” or “very effective” in terms of overall effectiveness (59%) and productivity (63%), but only 39% perceived it as “effective” or “very effective” when it comes to technology adoption. Furthermore, the logit model results revealed that farm characteristics (own farm size and number of plots), geographic factors (perceived soil fertility), institutional factors (farmer training center, farmer association, and radio), climatic shocks (perceived temperature increase and unwanted rain), and market shocks (increase in input price) significantly increase smallholders’ likelihood of seeking out AES. The chi-square test of independence and the MVP showed that AES consistently drives the adoption of CSA practices among smallholder farmers to bring sustainable agricultural development. The findings suggest that there is a significant limitation in technology adoption, farm characteristics, geographic factors, institutional factors, climatic, and market shocks affect smallholders’ access to AES, and the service has the potential to promote CSA practices in the study area. Thus, AES should be designed to be accessible, inclusive, and adaptive for it to effectively contribute to sustainable agricultural and rural development.

Dental students experience high levels of stress, which may negatively affect wellbeing, learning and clinical performance. Although stress in dental education is well documented, fewer studies have explored students' perspectives alongside their views on educational practices using mixed-methods approaches. A mixed-methods cross-sectional study was conducted among third-, fourth- and fifth-year undergraduate dental students at an Australian dental school. A validated questionnaire assessed sociodemographic characteristics, perceived sources of stress, and satisfaction with educational practices. Quantitative data were analysed using non-parametric statistical tests and correlational analysis. Free-text responses were analysed using invivo coding and integrated with quantitative findings. Eighty students participated (response rate 62%). Examinations, managing complex treatment plans and fear of making mistakes on patients were the highest-rated stressors. Fourth-year students reported the highest overall stress, particularly related to clinical supervisory feedback. Stress was negatively correlated with satisfaction with educational practices (ρ = -0.26, p = 0.02). Qualitative findings reinforced the importance of assessments, clinical responsibility and supervisory support as key stress-related themes. Undergraduate dental students experience substantial stress, particularly during the transition to clinical training. Institutional factors, especially clinical supervision and feedback, appear to influence students' stress and educational experiences. Addressing these areas may support student wellbeing and optimise the clinical learning environment.

Medicare's New Technology Add-On Payment (NTAP) incentivizes the adoption of innovative technologies. We examined factors associated with the use of NTAP-billed artificial intelligence (AI) software for detecting large vessel occlusion (LVO) in acute ischemic stroke (AIS) patients requiring thrombolytic treatment. Using nationally representative Medicare 5% Research Identifiable Files, inpatient AIS episodes billed under diagnosis-related groups (DRGs) 61-63 from October 2020 to December 2023 (NTAP period) were analyzed. AI use was identified via NTAP ICD-10 code 4A03X5D. Stroke severity and access to care were assessed using validated scales and the Area Deprivation Index. Associations between NTAP-billed AI use and patient, clinical, and facility characteristics were evaluated using chi-square tests. Odds of NTAP-billed AI use at the AIS inpatient visit level were evaluated with logistic regression models employing random effects to account for facility-level clustering. Among 2,116 AIS episodes across 1,076 facilities, NTAP-billed AI use among inpatient AIS episodes requiring thrombolytic treatment increased annually, peaking at 21% in 2022. NTAP-billed AI use was most common in episodes with CT imaging, at comprehensive stroke centers, and in facilities with ≥1000 beds. No disparities in NTAP-billed AI use were observed across patient demographics or stroke severity measures. In adjusted logistic regression models, odds of NTAP-billed AI use were highest in 2022 (OR 6.0, 95% CI 2.7-13.3), among beneficiaries in the Stroke Belt (OR 2.0, 95% CI 1.3-3.0), and at comprehensive stroke centers (OR 1.5, 95% CI 1.1-2.0). NTAP-billed AI adoption for LVO detection in AIS episodes requiring thrombolytic treatment increased from 2020 to 2022 and appeared to be driven by institutional factors, suggesting facility characteristics, rather than patient factors and stroke severity, may influence NTAP-billed AI use, potentially contributing to geographic variability in stroke care.

Complex congenital cardiac surgery demands precise three-dimensional (3D) spatial understanding, yet preoperative planning continues to rely predominantly on two-dimensional (2D) image interpretation. Contemporary cardiac computed tomography (CT) and magnetic resonance imaging (MRI) are volumetric by design, but their value is constrained by how data are ultimately converted into shared spatial understanding. The growing availability of CT-based segmentation, virtual reality (VR) visualization, and three-dimensional printing offers a practical means to externalize patient-specific anatomy into manipulable, immersive representations. Current evidence, though modest and largely single-centre, consistently shows that 3D models can faithfully represent complex anatomy and that clinicians repeatedly report improved comprehension of spatial relationships through their use. In this perspective, we argue for a deliberate, case-selected approach to 3D image visualization in complex congenital cardiac surgery, identify the human and institutional factors that determine real-world utility beyond hardware and software alone, and propose criteria for systematic adoption. Prospective outcome data are needed; in their absence, thoughtful incorporation of these tools into surgical planning workflows represents a clinically rational approach.

Despite substantial public investment in rice breeding programs in Iran, the adoption of improved rice cultivars (IRCs) remains limited, particularly in Mazandaran Province, the country's largest rice-producing region. This study aimed to identify, categorize, and prioritize the principal barriers limiting farmers' adoption of IRCs. A qualitative and applied research design was employed using a three-phase framework consisting of: (i) literature review and interviews with subject-matter specialists (SMSs), (ii) evaluation by experienced and knowledgeable rice farmers (EKRFs), and (iii) prioritization using the Fuzzy Delphi Method (FDM). Initially, 49 potential barriers across nine dimensions were identified, of which 42 were validated through the FDM consensus process. The findings revealed that the most influential barriers were price imbalance in the sale of IRCs, weak stakeholder interaction and knowledge-sharing systems, poor marketability of IRCs, farmer-related psychological resistance, and inadequate institutional support packages. Key constraints included low market prices, absence of guaranteed purchasing systems, limited farmer participation in cultivar development, weak extension services, poor sensory quality of IRCs, and farmers' risk aversion toward replacing traditional cultivars. The findings further demonstrate that adoption decisions are shaped not only by agronomic performance, but also by interconnected economic, institutional, behavioral, and market-driven factors. Methodologically, the study contributes to agricultural innovation research by applying a multidimensional and uncertainty-aware prioritization framework using the FDM. Practically, the results provide evidence-based insights for policymakers, extension systems, and breeding institutions seeking to promote sustainable agricultural intensification and farmer-centered cultivar dissemination strategies.

ABSTRACT This study examines the relationship between educational attainment and occupations in Italy, focusing on how education aligns with job categories and how this relationship evolves over time. Using Labour Force Survey data, we construct education – occupation matrices for 2014, 2019, and 2024, providing a detailed view of changes in the joint distribution of workers across education and occupations. We introduce a theoretical model in which each education – occupation combination is treated as a labour sub-market, and employment levels result from equilibrium between labour supply and demand. The model provides a structural benchmark to assess whether observed changes can be explained by standard market mechanisms. Comparing observed and predicted matrices over the periods 2014–2019 and 2019–2024, we identify non-negligible deviations from benchmark-consistent reallocation. These deviations are interpreted as signals consistent with structural change in the labour market, potentially reflecting technological developments, institutional factors, or shifts in educational supply. The framework is intended as a diagnostic tool rather than a causal test: deviations between predicted and observed allocations signal unexplained reallocation patterns rather than provide direct evidence on specific underlying mechanisms.

Persistent reading difficulties remain a significant concern in elementary education because they affect learners’ academic performance, motivation, confidence, and participation in school activities. This study explored the meanings attached to persistent reading difficulties and the factors contributing to their persistence among elementary learners in the Bangui–Dumalneg District. Guided primarily by Rosenblatt’s Transactional Theory of Reading and supported by the Simple View of Reading and Vygotsky’s Sociocultural Theory, the study employed a qualitative, interpretive research design. Data were gathered through semi-structured interviews and focus group discussions involving 46 participants, including struggling readers, parents or guardians, teachers, and school heads. Purposive sampling was used to select participants with direct experience related to persistent reading difficulties, and data were analyzed using thematic analysis. Findings revealed that learners associated reading difficulties with embarrassment, dependence, and reduced confidence; parents viewed them as a challenge accompanied by hope and concern; teachers regarded them as instructional and professional challenges; and school heads perceived them as school-wide concerns requiring coordinated action. The persistence of reading difficulties was attributed to repeated failure, loss of confidence, limited practice and guidance, avoidance of reading situations, inconsistent home support, instructional constraints, and systemic limitations within schools. The study concluded that persistent reading difficulties are shaped by interacting emotional, social, instructional, and institutional factors rather than by skill deficits alone. It recommends strengthening home–school collaboration, providing sustained literacy support, and addressing contextual factors that influence reading development. The study aligns with Sustainable Development Goal (SDG) 4 on Quality Education by promoting inclusive and equitable learning opportunities through improved literacy support. It also supports SDG 10 on Reduced Inequalities by highlighting barriers that affect learners’ access to quality literacy development. The findings contribute to educational, community, and institutional sustainability by informing literacy practices, stakeholder collaboration, and school-based interventions that support long-term learner development.

Civil society is crucial for societal transformation, but how its engagement can scale up and become institutionally embedded at the regional level remains widely unclear. We enhance the knowledge in this area by linking civic engagement with transformative social innovation (TSI) research. Our aim is to understand how cognitive, social, institutional, organizational and geographical proximity factors strengthen and hinder civic-led TSI initiatives by applying the proximity approach. The object of this case study was the ‘Mitmach-Region Saale-Holzland-Kreis’, an initiative which aims to establish mutual cooperation at a regional level based on solidarity and ‘commoning’. We found that engagement was based primarily on cognitive proximity, whereas organizational distance was the biggest hurdle, also suppressing positive effects from cognitive proximity. We also, most importantly, discovered that contributing to societal transformation played a role in a participant’s engagement, but was particularly suppressed by missing institutional proximity through disapproval from society or the immediate environment. Altogether, strengthening the proximities to promote engagement in civic-led TSI initiatives holds great potential for contributing to societal transformation.

The lack of healthcare trust is strongly associated with low rates of access and utilization of care, adherence to medical advice, and adverse health outcomes, especially among vulnerable populations. We used a descriptive qualitative design and employed thematic analysis to examine the contributing factors to the lack of trust in healthcare among African immigrants in Florida, US. We conducted in-depth interviews with 19 participants selected through purposive and snowball sampling. The interviews were audio-recorded, transcribed verbatim, and thematically analysed using Nvivo14 software. The findings revealed two overarching themes: (a) personal and (b) institutional factors of lack of healthcare trust. Personal factors included language and communication challenges, lack of knowledge, past negative healthcare experiences, fear of losing legal status, and the use of traditional medicine and prayer as a substitute for modern medicine. Institutional factors included providers' lack of knowledge, wrong assumptions and ignorance, lack of diversity in healthcare, repeated tests and burdensome documentation, malpractice, lack of financial transparency and unfair cost, over-medicalisation, racial divide and discrimination, and unfavourable policy conditions. The findings suggest a holistic approach that involves improving healthcare navigation skills among African immigrants; adopting a patient-centred approach; enhancing health literacy; strengthening cultural competency training and education on tropical medicine for healthcare providers; promoting diversity within the healthcare workforce; and engaging in anti-racism practices that ensure provider accountability. It is also critical to promote policies that ensure financial transparency and coordinated care, reduce unnecessary testing and documentation, and promote safe and equitable access to healthcare for African immigrants.

The power imbalances in South Africa’s linguistic landscape perpetuated a monolingual approach to education, marginalising Indigenous languages and creating challenges for educators and students. Translanguaging addresses the gap between multilingual repertoires and monolingual approaches to teaching and learning. However, little is known about the role of lecturers’ language histories, shaped by social, cultural, and institutional factors, in shaping attitudes towards translanguaging practices. Research on how lecturers’ personal and professional language experiences mediate engagement with translanguaging in linguistically and culturally diverse settings is limited. Drawing on the translanguaging paradigm, socio-cultural theory, and cultural-historical activity theory (CHAT), this qualitative case study investigates the impact of the language histories of seven lecturers on the translanguaging practices at a selected South African university. Semi-structured interviews and thematic analysis uncovered recurring influences, patterns, and contradictions in the lecturers’ narratives. The study reveals that lecturers’ language histories shape their attitudes towards translanguaging both positively and negatively.

ABSTRACT Secondary school subject choices play a crucial role in shaping enrolment in science and maths in higher education and are influenced by academic, social, and institutional factors. Using data from the Growing Up in Ireland study, we document substantial socioeconomic gaps in enrolment in science and maths and show that choices made by age 13 strongly predict later participation. Applying SHAP (Shapley Additive exPlanations) based decompositions, we find that these gaps are largely predicted by differences in ability already evident at age nine. Our findings highlight early numeracy and lower-secondary choices as key margins in science-and-maths inequality.