Institutional Level Research Articles

Building a framework to decolonize global emergency medicine.

Global emergency medicine (GEM) is situated at the intersection of global health and emergency medicine (EM), which is built upon a history of colonial systems and institutions that continue to reinforce inequities between high-income countries (HICs) and low- and middle-income countries (LMICs) today. These power imbalances yield disparities in GEM practice, research, and education. The Global Emergency Medicine Academy (GEMA) of the Society for Academic Emergency Medicine formed the Decolonizing GEM Working Group in 2020, which now includes over 100 worldwide members. The mission is to address colonial legacies in GEM and catalyze sustainable changes and recommendations toward decolonization at individual and institutional levels. To develop recommendations to decolonize GEM, the group conducted a nonsystematic review of existing literature on decolonizing global health, followed by in-depth discussions between academics from LMICs and HICs to explore implications and challenges specific to GEM. We then synthesized actionable solutions to provide recommendations on decolonizing GEM. Despite the rapidly expanding body of literature on decolonizing global health, there is little guidance specific to the relatively new field of GEM. By applying decolonizing principles to GEM, we suggest key priorities for improving equity in academic GEM: (1) reframing partnerships to place LMIC academics in positions of expertise and power, (2) redirecting research funding toward LMIC-driven projects and investigators, (3) creating more equitable practices in establishing authorship, and (4) upholding principles of decolonization in the education of EM trainees from LMICs and HICs. Understanding the colonial roots of GEM will allow us to look more critically at current health disparities and identify inequitable institutionalized practices within our profession that continue to uphold these misguided concepts. A decolonized future of GEM depends on our recognition and rectification of colonial-era practices that shape structural determinants of health care delivery and scientific advancement.

Legal anomie in the sphere of alternative (out-of-court) dispute resolution

The study aims to identify the manifestations of legal anomie in the legal regulation of alternative conflict resolution in Russia’s legal system and, based on the analysis of regulation in foreign countries, to offer possible ways to minimize anomie manifestations. Dialectical, formal-legal and comparative-legal methods were used in the research process. The article considers the legal regulation of mediation in Russia in a comparative-legal aspect with foreign countries and analyzes the current legislation and practice of its implementation. The study also revealed anomalous manifestations at the institutional and other levels of Russia’s legal system. Declarative fixation of legal responsibility of mediators, as well as insufficiency of normative requirements to their professional level; absence of normative fixation of mandatory centralized bodies (associations) of mediators, which in turn generates insufficiency of corporate regulation of their activities. The study proposes to borrow foreign experience in the legal regulation of mediators’ certification. The study also makes proposals to improve the current legislation.

Examining Institutional-Level Factors and Campus Climate on Sexual Misconduct Reporting to Title IX Coordinators and in Annual Security Reports

ABSTRACT The present study examines the relationship between institutional-level factors and perceptions of campus climate and rates of sexual misconduct reporting to Title IX coordinators and in Annual Security reports. Data is drawn from public 4-year institutions of higher education (IHEs), community colleges, and independent IHEs in Maryland (n = 42) from 2018 to 2020. Regarding institutional level factors, higher residentiality, higher percentages of graduate students and students supported by Pell grants, and higher rates of alcohol and drug use violations were associated with higher rates of sexual misconduct reporting. On campus climate measures, only higher percentages of students reporting they know whom to contact to report sexual misconduct was associated with increased reporting. Implications for sexual misconduct prevention training and the integration of alcohol and drug use prevention into sexual misconduct prevention education are discussed. Directions for future research are also outlined.

University teachers’ perspectives on student attendance: a challenge to the identity of university teachers before, during and after Covid-19

AbstractThis article addresses university teachers’ perspectives, gathered via interviews, on issues involved in their students’ decreasing attendance in formal taught-events, before and during the pandemic, and the implications of this for university teaching in the future. The research was part of a broad enquiry into learning and teaching during the Covid-19 pandemic, conducted in one research-led university in New Zealand by a research team of 19 university academics from multiple departments in this institution. We undertook 11 semi-structured interviews with eight professors, one lecturer and two teaching fellows, anonymous to all but the interviewer. A sub-group (authors of this article) used a general inductive approach to seek an underlying structure of experiences evident in participants’ interviews, in the form of emergent and reoccurring themes in the data. Self-determination theory was used as a theoretical framework for analysis. Themes suggest that university teachers may be stressed about attendance, increasingly uncertain about the links between how they teach and what and how students learn, and feel personally rather than collectively responsible as they address matters that they perceive to be only partially under their control. Researchers concluded that interviewed teachers may be collectively experiencing some form of crisis of confidence relating to their roles, responsibilities and identity as university teachers. Although perceptions of limited autonomy, relatedness and competence all suggest solutions at the institutional level, their combination and link to generic academic identity suggests that Covid-19 may have exposed broader limitations in university teaching as a collegiate, rather than professional, activity.

Exploring the factors influencing nutritional literacy based on the socioecological model among patients with age-related macular degeneration: a qualitative study from China

ObjectivesAlthough nutritional support is beneficial to the visual rehabilitation of patients with age-related macular degeneration (AMD), a large gap continues to exist between the relevant guidelines and the actual practices...

Relationship between Job Satisfaction and Turnover Intentions among Nurses in South America

Purpose: The aim of the study was to analyze the relationship between job satisfaction and turnover intentions among nurses in South America Methodology: This study adopted a desk methodology. A desk study research design is commonly known as secondary data collection. This is basically collecting data from existing resources preferably because of its low cost advantage as compared to a field research. Our current study looked into already published studies and reports as the data was easily accessed through online journals and libraries. Findings: Studies in South America indicate that job satisfaction among nurses is inversely related to their turnover intentions. Nurses who report higher job satisfaction tend to have lower turnover intentions. Factors such as supportive work environments, professional growth opportunities, and recognition contribute to job satisfaction, while heavy workloads and inadequate staffing elevate turnover intentions. Addressing these concerns is vital for healthcare organizations in South America to retain nursing staff and ensure quality patient care. Unique Contribution to Theory, Practice and Policy: Job characteristics theory, social exchange theory & expectancy theory may be used to anchor future studies on the relationship between job satisfaction and turnover intentions among nurses in South America. Encouraging participatory decision-making, providing avenues for feedback, and offering resources for stress management can contribute to a positive work environment conducive to job satisfaction and retention among nurses. Advocate for policy changes at institutional and governmental levels to address systemic issues impacting nurse job satisfaction and turnover intentions

Teachers Challenging Language Discrimination in England’s Schools: A Typology of Resistance

ABSTRACT Recent media coverage and academic scholarship has repeatedly demonstrated that language discrimination is embedded and normalised in England’s schools. We consider language discrimination as a structural phenomenon underpinned by language ideologies which frame the language practices of racialised and working-class communities as deficient. In this article we report on project where we worked closely with a group of teachers who identified as critical, activist educators who were seeking to challenge language discrimination in their classrooms and wider institutions. Our data stems from in-depth interviews and case studies with teachers, where we explored their anti-language discrimination efforts at individual, departmental, and institutional levels. We present a typology for anti-language discrimination efforts, capturing the importance of teacher positionality and stance; research informed practice; community organising; locating local issues of language stigma within broader geopolitical patterns of inequality; individual classroom efforts, and institutional support for critical language work.

EXPRESS: Decoding Medical Educators' Perceptions on Generative Artificial Intelligence in Medical Education.

Generative AI (GenAI) is a disruptive technology likely to generate a major impact on faculty and learners in medical education. This work aims to measure the perception of GenAI among medical educators and to gain insights on its major advantages and concerns.A survey invitation was distributed to medical education faculty of colleges of allopathic and osteopathic medicine. The survey comprised twelve items assessing the role of GenAI for students and educators.Responses showed a positive attitude towards GenAI and disagreed on GenAI having a very negative effect on either the students' or faculty's educational experience. Eighty-five percent responded to have heard about GenAI, while 42% have not used it at all. Generating text (33%), automating repetitive tasks (19%), and creating multimedia content (17%) were some of the common utilizations of GenAI by school faculty. The majority agreed that GenAI is likely to change their role as educator. The greatest perceived strengths of GenAI were the ability to conduct more efficient research, task automation, and increased content accessibility. The faculty's major concerns were with cheating in home assignment (97%), tendency for blunder and false information (95%), lack of context (86%), the removal of human interaction in important feedback processes (83%), and the lack of guidelines for safe use of GenAI.Consensus-based guidelines at the institutional and/or national level need to start to be implemented to govern the appropriate use of GenAI while maintaining ethics and transparency. Faculty responses reflect an optimistic and favorable outlook on GenAI's impact on learning.

Global consensus statement on simulation-based practice in healthcare

Simulation plays a pivotal role in addressing universal healthcare challenges, reducing education inequities, and improving mortality, morbidity and patient experiences. It enhances healthcare processes and systems, contributing significantly to the development of a safety culture within organizations. It has proven to be cost-effective and successful in enhancing team performance, fostering workforce resilience and improving patient outcomes. Through an international collaborative effort, an iterative consultation process was conducted with 50 societies operating across 67 countries within six continents. This process revealed common healthcare challenges and simulation practices worldwide. The intended audience for this statement includes policymakers, healthcare organization leaders, health education institutions, and simulation practitioners. It aims to establish a consensus on the key priorities for the broad adoption of exemplary simulation practice that benefits patients and healthcare workforces globally. Key recommendations Advocating for the benefits that simulation provides to patients, staff and organizations is crucial, as well as promoting its adoption and integration into daily learning and practice throughout the healthcare spectrum. Low-cost, high-impact simulation methods should be leveraged to expand global accessibility and integrate into system improvement processes as well as undergraduate and postgraduate curricula. Support at institutional and governmental level is essential, necessitating a unified and concerted approach in terms of political, strategic and financial commitment. It is imperative that simulation is used appropriately, employing evidence-based quality assurance approaches that adhere to recognized standards of best practice. These standards include faculty development, evaluation, accrediting, credentialing, and certification. We must endeavor to provide equitable and sustainable access to high-quality, contextually relevant simulation-based learning opportunities, firmly upholding the principles of equity, diversity and inclusion. This should be complemented with a renewed emphasis on research and scholarship in this field. Call for action We urge policymakers and leaders to formally acknowledge and embrace the benefits of simulation in healthcare practice and education. This includes a commitment to sustained support and a mandate for the application of simulation within education, training, and clinical environments. We advocate for healthcare systems and education institutions to commit themselves to the goal of high-quality healthcare and improved patient outcomes. This commitment should encompass the promotion and resource support of simulation-based learning opportunities for individuals and interprofessional teams throughout all stages and levels of a caregiver’s career, in alignment with best practice standards. We call upon simulation practitioners to champion healthcare simulation as an indispensable learning tool, adhere to best practice standards, maintain a commitment to lifelong learning, and persist in their fervent advocacy for patient safety. This statement, the result of an international collaborative effort, aims to establish a consensus on the key priorities for the broad adoption of exemplary simulation practice that benefits patients and healthcare workforces globally.

A cost comparison of pembrolizumab: Fixed and weight-based dosing.

Pembrolizumab, an immune checkpoint inhibitor, indicated to treat multiple cancers, was initially approved in Australia as weight-based dosing at 2 mg/kg every 3 weeks (Q3W). Subsequent approvals used 'fixed' dosages of 200 mg Q3W or 400 mg every 6 weeks (Q6W). Pharmacokinetic equivalence was demonstrated between dosing strategies, with no significant differences in efficacy or toxicity. Fixed dosing regimens are routinely used in Australia. To model and compare the cost of weight-based dosing of pembrolizumab to standard fixed dosing regimens. A single centre, retrospective review was conducted. Patients, identified from dispensing software, who commenced on pembrolizumab between January and December 2022 were included. Patient demographic and treatment data was extracted from electronic medical records. Costs of weight-based doses were calculated and compared to the cost of fixed dosing. Variables such as acquisition cost, funding mechanisms and 'vial sharing' were considered. Fifty-two patients were included (63% male, median age 68 years). Of the 211 doses of pembrolizumab administered (average 4.1 doses/patient), 161 were Q3W doses, and 50 were Q6W doses. The acquisition cost for a fixed 200 mg and 400 mg dose was $7646, and $15,292, respectively. The average patient weight was 77.6 kg (SD 19 kg), which equated to $5933 for a weight-based Q3W dose, and $11,867 for the Q6W dose; a potential cost avoidance of $1965 and $3930 per dose, respectively. This represented a possible 23.5% avoidance in medication acquisition cost. Over the study period of 1 year, using weight-based dosing for pembrolizumab had the potential to reduce medication expenditure by $467,996. Significant cost avoidance could be achieved via weight-based pembrolizumab dosing. Given the substantial total cost of pembrolizumab, the growing number of indications and the expected equivalent treatment outcomes with weight-based pembrolizumab, the potential cost reductions of weight-based pembrolizumab at both institution and government level should be further explored.

Co-authorship between doctoral students and supervisors: motivations, reservations, and challenges

ABSTRACT Co-authorship between doctoral students and their supervisors is a mostly occluded practice, generalised according to the candidates’ disciplines. There is limited understanding of the practice, particularly in humanities, arts, and social sciences (HASS) disciplines. This study explores HASS doctoral students’ and supervisors’ perceptions towards co-authorship during candidature. Focus is given to participants’ motivations, perceived challenges, and reservations about engaging in supervisor-candidate co-authorship. Surveys of 121 doctoral students and 126 supervisors representing 12 HASS disciplines across 18 Australian universities revealed divergent interpretations of co-authorship: although many viewed it as a collaborative process, more than a third of supervisors approached it through the lens of ‘divide and conquer’. Such findings raise important ethical and pedagogical concerns, highlighting the need for clearer terminology and guidelines. We respond to this ambiguity by proposing a new term, ‘collaborative co-authorship’, reconceptualising supervisor-candidate co-authorship in a way that clarifies perceptions towards the practice and presents it as a pedagogical approach to apprentice doctoral students to become fully-fledged academics. It is our hope that this reconceptualisation will equip stakeholders at individual, institutional, and national levels to engage more confidently and intentionally with collaborative co-authorship through PhD candidature.

Frontline perspectives on barriers to care for patients with California Medicaid: a qualitative study.

While insurance is integral for accessing healthcare in the US, coverage alone may not ensure access, especially for those publicly insured. Access barriers for Medicaid-insured patients are rooted in social drivers of health, insurance complexities in the setting of managed care plans, and federal- and state-level policies. Elucidating barriers at the health system level may reveal opportunities for sustainable solutions. To understand barriers to ambulatory care access for patients with Medi-Cal (California's Medicaid program) and identify improvement opportunities, we performed a qualitative study using semi-structured interviews of a referred sample of clinicians and administrative staff members experienced with clinical patient encounters and/or completion of referral processes for patients with Medi-Cal (n = 19) at a large academic medical center. The interview guide covered the four process steps to accessing care within the health system: (1) scheduling, (2) referral and authorization, (3) contracting, and (4) the clinical encounter. We transcribed and inductively coded the interviews, then organized themes across the four steps to identify perceptions of barriers to access and improvement opportunities for ambulatory care for patients with Medi-Cal. Clinicians and administrative staff members at a large academic medical center revealed barriers to ambulatory care access for Medi-Cal insured patients, including lack of awareness of system-level policy, complexities surrounding insurance contracting, limited resources for social support, and poor dissemination of information to patients. Particularly, interviews revealed how managed Medi-Cal impacts academic health systems through additional time and effort by frontline staff to facilitate patient access compared to fee-for-service Medi-Cal. Interviewees reported that this resulted in patient care delays, suboptimal care coordination, and care fragmentation. Our findings highlight gaps in system-level policy, inconsistencies in pursuing insurance authorizations, limited resources for scheduling and social work support, and poor dissemination of information to and between providers and patients, which limit access to care at an academic medical center for Medi-Cal insured patients. Many interviewees additionally shared the moral injury that they experienced as they witnessed patient care delays in the absence of system-level structures to address these barriers. Reform at the state, insurance organization, and institutional levels is necessary to form solutions within Medi-Cal innovation efforts.

Top IT Challenges in ARL Libraries

The practice of information technology (IT) in academic libraries is changing rapidly, not only with new and evolving developments in the technologies themselves but also with the organization and management of IT at both the library and institution levels. This study presents the results of an online survey of Association of Research Libraries (ARL) academic library members to identify the biggest challenges they perceive in the area of information technology organization and management. This article compares their responses with challenges reported in earlier studies to identify new and changing trends as well as ongoing challenges that remain.

Student involvement in quality assurance: perspectives and practices towards persistent partnerships

Students are, in some regions and countries in the world, one of the key stakeholders that are included in quality assurance processes, although their participation is missing in others. However, there is an increasing interest in including students in quality assurance processes, both internally at the institutional level and externally as part of the national and regional accreditations or evaluations of institutions or their educational offerings. This article identifies key practices and dilemmas when involving students in quality assurance and discusses the conditions facilitating a partnership with students in these processes. In the conclusion, it is argued for an approach where students are recognised as having expertise that is valuable in quality assurance.

Global consensus statement on simulation-based practice in healthcare.

Advocating for the benefits that simulation provides to patients, staff and organizations is crucial, as well as promoting its adoption and integration into daily learning and practice throughout the healthcare spectrum. Low-cost, high-impact simulation methods should be leveraged to expand global accessibility and integrate into system improvement processes as well as undergraduate and postgraduate curricula. Support at institutional and governmental level is essential, necessitating a unified and concerted approach in terms of political, strategic and financial commitment.It is imperative that simulation is used appropriately, employing evidence-based quality assurance approaches that adhere to recognized standards of best practice. These standards include faculty development, evaluation, accrediting, credentialing, and certification.We must endeavor to provide equitable and sustainable access to high-quality, contextually relevant simulation-based learning opportunities, firmly upholding the principles of equity, diversity and inclusion. This should be complemented with a renewed emphasis on research and scholarship in this field. We urge policymakers and leaders to formally acknowledge and embrace the benefits of simulation in healthcare practice and education. This includes a commitment to sustained support and a mandate for the application of simulation within education, training, and clinical environments.We advocate for healthcare systems and education institutions to commit themselves to the goal of high-quality healthcare and improved patient outcomes. This commitment should encompass the promotion and resource support of simulation-based learning opportunities for individuals and interprofessional teams throughout all stages and levels of a caregiver's career, in alignment with best practice standards.We call upon simulation practitioners to champion healthcare simulation as an indispensable learning tool, adhere to best practice standards, maintain a commitment to lifelong learning, and persist in their fervent advocacy for patient safety.This statement, the result of an international collaborative effort, aims to establish a consensus on the key priorities for the broad adoption of exemplary simulation practice that benefits patients and healthcare workforces globally.

Global consensus statement on simulation-based practice in healthcare

Simulation plays a pivotal role in addressing universal healthcare challenges, reducing education inequities, and improving mortality, morbidity and patient experiences. It enhances healthcare processes and systems, contributing significantly to the development of a safety culture within organizations. It has proven to be cost-effective and successful in enhancing team performance, fostering workforce resilience and improving patient outcomes.Through an international collaborative effort, an iterative consultation process was conducted with 50 societies operating across 67 countries within six continents. This process revealed common healthcare challenges and simulation practices worldwide. The intended audience for this statement includes policymakers, healthcare organization leaders, health education institutions, and simulation practitioners. It aims to establish a consensus on the key priorities for the broad adoption of exemplary simulation practice that benefits patients and healthcare workforces globally.Key recommendations Advocating for the benefits that simulation provides to patients, staff and organizations is crucial, as well as promoting its adoption and integration into daily learning and practice throughout the healthcare spectrum. Low-cost, high-impact simulation methods should be leveraged to expand global accessibility and integrate into system improvement processes as well as undergraduate and postgraduate curricula. Support at institutional and governmental level is essential, necessitating a unified and concerted approach in terms of political, strategic and financial commitment.It is imperative that simulation is used appropriately, employing evidence-based quality assurance approaches that adhere to recognized standards of best practice. These standards include faculty development, evaluation, accrediting, credentialing, and certification.We must endeavor to provide equitable and sustainable access to high-quality, contextually relevant simulation-based learning opportunities, firmly upholding the principles of equity, diversity and inclusion. This should be complemented with a renewed emphasis on research and scholarship in this field.Call for action We urge policymakers and leaders to formally acknowledge and embrace the benefits of simulation in healthcare practice and education. This includes a commitment to sustained support and a mandate for the application of simulation within education, training, and clinical environments.We advocate for healthcare systems and education institutions to commit themselves to the goal of high-quality healthcare and improved patient outcomes. This commitment should encompass the promotion and resource support of simulation-based learning opportunities for individuals and interprofessional teams throughout all stages and levels of a caregiver’s career, in alignment with best practice standards.We call upon simulation practitioners to champion healthcare simulation as an indispensable learning tool, adhere to best practice standards, maintain a commitment to lifelong learning, and persist in their fervent advocacy for patient safety.This statement, the result of an international collaborative effort, aims to establish a consensus on the key priorities for the broad adoption of exemplary simulation practice that benefits patients and healthcare workforces globally.

Student Progression and Dropout Rates Using Convolutional Neural Network: A Case Study of the Arab Open University

Pre-trained convolutional neural network (CNN) structures are considered as one of the emerging education management tools that can help improve the quality of education by allowing decision makers to manipulate important indicators. These indicators, which are categorized as student and institution specific factors, may influence student progress, retention or dropout rates. In this paper, we develop a deep learning model of predicting students’ satisfactions and their expected outcomes and associated early failures. The model can also predict dropout rates and identify the main baseline risk factors that influence such rates. The academic data of 12,000 students enrolled from 2018 in the Arab Open University student information system are used as CNNs training dataset to ensure that all institution levels are represented. Then, the trained network provides a probabilistic model that indicates, for each student, the probability of dropout. Based on the prediction model, the study presents an early warning system framework to generate alerts and recommendations to allow early and effective institutional intervention. Experiments are achieved by using the proposed dataset and the performance of our approach is considerably better compared to the competitive models in terms of training/validation accuracy and mean square errors.

The effect of COVID‐19 lockdown periods and societal restrictions on blood product usage in adult trauma patients: A retrospective observational study

Background. Blood products, though potentially lifesaving, are a scarce and costly resource. Trauma injuries, which contribute to the demand for these resources, increase in proportion to alcohol consumption. South Africa’s COVID-19 lockdown measures included a ban on alcohol sales and curfews.Objective. To investigate the effect of these societal measures on blood product usage. Methods. We retrospectively compared medical patient data from the South African National Blood Service database of red cell concentrate (RCC) usage in four disciplines during the COVID-19 period with data from the 3 years preceding the pandemic. We also examined trauma case patterns using an institutional database from the Harry Gwala Regional Hospital (HGRH) Emergency Department during the same periods. Results. In total, 16 922 RCCs at HGRH and 528 734 RCCs in KwaZulu-Natal were issued across the four disciplines, from March 2017 - March 2021. RCC usage significantly decreased among trauma patients at institutional and provincial levels during the COVID-19 period (provincial pre-lockdown mean 10.99 units per day; SD 6.89, 95% CI 10.63 - 11.35 v. lockdown 7.46 units per day; SD 5.42, 95% CI 6.14 - 8.79; p<0.01). Further, RCC usage significantly increased during the weekend immediately following the lifting of the first alcohol ban, along with a significant decrease in the number of trauma patients seen during hard lockdown periods. Conclusions. Societal restrictions, including curfews and banning alcohol consumption, decreased the use of RCCs in trauma patients. Government policies aimed at reducing alcohol-related traumatic injuries would likely have a significant impact on RCC usage.

Organisational Enablers of Artificial Intelligence Adoption in Public Institutions: A Systematic Literature Review

Purpose: The purpose of the presented study was to develop a set of recommendations for decision-makers (policymakers and public managers) and public employees to enhance the effectiveness and efficiency of organisational elements in the adoption of artificial intelligence (AI) in public institutions. Design/methodology/approach: Utilising a systematic literature review following the PRISMA protocol, the study examines the organisational enablers of AI adoption in public institutions. Comprehensive search queries in the Scopus database identified relevant literature focusing on the intersection of AI technologies and various organisational elements. The analysis was facilitated by NVivo 12, enabling a structured examination of key organisational facets for people, culture, structure, processes, and technology within public institutions. Findings: Previous studies on AI adoption in public institutions identified numerous enablers of AI adoption associated with organisational elements like people/employees, structure, culture, technology, and processes. Several surveys and case studies stress the importance of concentrating on the introduction or transformation of these organisational elements prior to or concurrently with the adoption of AI. Academic contribution to the field: By applying a systematic literature review protocol, the study represents the first holistic and systematic review of specific organisational elements that can serve as enablers of AI adoption in public institutions. Research limitations/implications: This systematic literature review was subject to several limitations. Firstly, the division of AI literature between natural and social sciences, with the former focusing on technical aspects and the latter on broader organisational themes, may have resulted in an incomplete depiction of the intersection of AI and organisational change. Secondly, despite the broad search queries, inherent limitations of keyword-based searches may have excluded some relevant studies. Thirdly, considering the rapid evolution of AI technology, our review may not fully encapsulate the very latest developments in the field as it covers literature published until May 2023. Finally, the interpretation and coding of literature, despite the use of NVivo 12, involved subjective elements that could affect the study’s outcomes. Practical implications: Drawing from experiences in the private sector, public institutions are increasingly adopting AI technologies across various subsectors such as public finance (taxation), research, healthcare, law enforcement, defence, education. This requires a transformation in both hard (structure, processes etc.) and soft aspects (people, organisational culture etc.). Therefore, the enablers identified in the study can serve as guidelines for decision-makers and implementers of AI at all levels of public institutions. Social implications: If adopted effectively and efficiently and used professionally and ethically, the use of AI in public institutions can bring many benefits to society, such as transparency, justice, cost and time efficiency, high quality services, and improved collaboration between different stakeholders in society. Originality/significance/value: Our study makes a distinct contribution by shifting the focus from technological barriers to organisational enablers of AI adoption in public institutions. It bridges a critical gap in the literature by integrating both technical and social science perspectives, providing valuable insights for theory and practice in the fields of organisation and management.

Does the military lose public confidence without compliance with civilian control? Experimental evidence from Japan

The military’s compliance with civilian control – a requisite of democracy – is believed to be a key determinant of public confidence in the military. However, this claim is empirically inconclusive, and its analytical framework is underdeveloped at an institutional and individual level. Furthermore, most extant studies focus on the USA, and its validity in other environments is unknown. Hence, this study examined the causal relationship via an online survey experiment using hypothetical scenarios in Japan, an established democracy with a considerable armed force and civil–military norms imported from the USA decades ago. The results showed that the Japanese participants significantly lost their trust in the military for incompliance with civilian control amid an armed conflict. However, the magnitude of the impact was context-dependent; it substantially differed per the directions of incompliance (arbitrary action or inaction), the actors involved in the control (the prime minister and legislature), and the respondents’ attributes (partisanship). These findings reduce empirical inconclusiveness regarding the mechanism of public confidence in the military and could help to detect ominous signs regarding public attitudes toward democratic principles in modern society. Moreover, this study provides clues to understanding what people in Japan think about the aspect of control of their de facto military and how they evaluate this organization. These findings have significant implications for understanding international security dynamics, particularly at a time when Japan is launching its largest arms build-up since World War II to make its defense budget the third-largest worldwide, after the USA and China.