Joint Plan Research Articles

Development of fully automated models for staging liver fibrosis using non-contrast MRI and artificial intelligence: a retrospective multicenter study

Accurate staging of liver fibrosis (LF) is essential for clinical management in chronic liver disease. While non-contrast MRI (NC-MRI) yields valuable information for liver assessment, its effectiveness in predicting LF remains underexplored. This study aimed to develop and validate artificial intelligence (AI)-powered models utilizing NC-MRI for staging LF. A total of 1726 patients from Shengjing Hospital of China Medical University, registered between October 2003 and October 2022, were retrospectively collected, and divided into development (n=1208) and internal test (n=518) cohorts. An external test cohort consisting of 337 individuals from six centers, registered between June 2015 and November 2022, were also included. All participants underwent NC-MRI (T1-weighted imaging, T1WI; and T2-fat-suppressed imaging, T2FS) and liver biopsies. Two classification models (CMs), named T1 and T2FS, were trained on respective image types using 3D contextual transformer networks and evaluated on both test cohorts. Additionally, three CMs-Clinic, Image, and Fusion-were developed using clinical features, T1 and T2FS scores, and their integration via logistic regression. Classification effectiveness of CMs was assessed using the area under the receiver operating characteristic curve (AUC). A comparison was conducted between the optimal models (OMs) with highest AUC and other methods (transient elastography, five serum biomarkers, and six radiologists). Fusion models (i.e., OM) yielded the highest AUC among the CMs, achieving AUCs of 0.810 for significant fibrosis, 0.881 for advanced fibrosis, and 0.918 for cirrhosis in the internal test cohort, and 0.808, 0.868, and 0.925, respectively, in the external test cohort. The OMs demonstrated superior performance in AUC, significantly surpassing transient elastography (only for staging≥F2 and ≥ F3 grades), serum biomarkers, and three junior radiologists for staging LF. Radiologists, with the aid of the OMs, can achieve a higher AUC in LF assessment. AI-powered models utilizing NC-MRI, including T1WI and T2FS, accurately stage LF. National Natural Science Foundation of China (No. 82071885); General Program of the Liaoning Provincial Department of Education (LJKMZ20221160); Liaoning Province Science and Technology Joint Plan (2023JH2/101700127); the Leading Young Talent Program of Xingliao Yingcai in Liaoning Province (XLYC2203037).

Spectacle of Iran’s Nuclear Deal: From Settlement to Withdrawal to Re-negotiation

Iran’s nuclear program has been a constant priority agenda of international non-proliferation community for decade’s now. The Comprehensive Framework for Joint Plan of Action (JCOP) concluded as a result of intensive negotiations among negotiating parties on April 2, 2015. This deal was considered as a diplomatic breakthrough with regard to Iran’s nuclear program. President Trump withdrew from the deal unilaterally in 2018 on the pretext of being ineffective in curtailing Iran’s missile program and offensive proliferation designs. Iran also declared not to comply the provisions of deal as retaliation of US unexpected exit. After President Biden’s ascending to power prospects of renegotiations brightened. However, despite few attempts, no tangible step of concrete negotiations has taken so far. This paper endeavors to narrate the course of Iran’s nuclear deal with exclusive focus on post US withdrawal events. The paper endeavored to analyze responses of different US administrations towards the deal. For instance, nuclear deal concluded and came into force under Obama’s administration; US unilaterally withdrew from the deal under Trump administration, and Biden’s administration struggling to renegotiate the deal. A holistic review of the deal including major events, would help to understand US threat perceptions vis-à-vis a nuclear Iran and the handling of this threat perception under different administrations, reveling the fault-lines between democrats and republicans on Iranian nuclear deal issue at one hand and US and other negotiating partners at other hand. However, despite the divergent opinions to handle nuclear Iran, all parties seem to converge on one point, to avoid military confrontation in Middle East.

International aid management in Afghanistan’s health sector from the perspective of national and international managers

PurposeThe primary purpose of international aid is to promote economic and social development around the world. International aid plays an important role in Afghanistan’s healthcare system. The purpose of this study is to investigate international aid management in Afghanistan’s health sector from the perspectives of national and international managers in 2022 and to provide recommendations for the improvement.Design/methodology/approachThe study has a cross-sectional design. The study participants were chosen by random sampling. The sample size was determined based on Yaman’s formula at 110. The data collection tool was the questionnaire provided by International Health Partnership and Related Initiatives. The data were analyzed in two descriptive (mean and percentage) and analytical formats. Independent t-test, Mann-Whitney, Kolmogorov-Smirnov tests and Variance analysis were used to examine the relationships between demographic variables and the scores of each dimension.FindingsThe average scores given to different dimensions of aid management were as following: 1) the donners’ support of the national health strategy: 48/68 ± 16.14 (49%), 2) the predictable financing: 50/23 ± 16.02 (50%), 3) foreign aid on budget: 55/39 ± 20.15 (55%), 4) strengthening public financial management system: 38/35 ± 19.06 (38%), 5) strengthening the supply and procurement system: 40.97 ± 19.55 (41%), 6) mutual accountability: 46.50 ± 19.26 (46%), 7) technical support and training: 50.24 ± 17.33 (50%), 8) civil society involvement: 35.24 ± 18.61(35%), 9) private sector participation: 36 ± 17.55 (36%), and in total the average score was 44.52 ± 13.27 (44%). The difference between the scores given by two groups of managers was not significant. No meaningful relationship was observed between the total score and any of the demographic variables, but there was a weak relationship between work and management experience and total score. The correlation coefficient showed a statistically significant relationship between the different dimensions of the questionnaire. To sum up, the performance in all dimensions of aid management hardly reached 50%. Donors’ support for the national health strategy was not adequate. There were challenges in evidence-based decision-making, developing national health strategies, control and evaluation, the allocation of resources and use of procurement system. The priorities of donors and government were not always similar and mutual responsibility was lacking. Technical assistance and supporting multilateral cooperation are necessary.Originality/valueMost studies on foreign aid focused on its effects on economic growth, poverty and investment and not aid management processes. Without proper aid management, parts of resources are wasted and aims of aid programs cannot be achieved. This study investigates aid management in a developing country from the perspectives of two main stakeholders, international and national managers.Research limitations and implicationsData collection coincided with the change of government in Afghanistan. The situation might be different now. Still, this study provides areas for the improvement of aid management in the studied country. Future studies can build upon the findings of this research and conduct in-depth exploration of areas of aid effectiveness and designing detailed programs of improvement.Practical implicationsInstructions of the Paris Declaration on Aid Effectiveness need to be followed. Particularly, civil society involvement and private sector participation should receive attention. A joint plan for improvement and collaboration of different stakeholders is needed.

The Practical Application of the Individual Care Plan for Pediatric Palliative Care: A Mixed-Method Study.

The Individual Care Plan (ICP) for pediatric palliative care was developed to provide person-centered care for the individual child and family. Currently, a lack of clarity remains regarding the use and function of the ICP in daily practice. To further implement the ICP, it is important to identify how parents and healthcare professionals use the ICP and which obstacles or benefits are experienced. This mixed-method study used qualitative interviews and quantitative questionnaires in (bereaved) parents and healthcare professionals with experience with the ICP. Parents and healthcare professionals used the ICP to establish a joint plan for care and treatment of the child to coordinate care and to achieve child- and family-centered care. This includes both obstacles that complicate achieving care goals and benefits that make it easier. Furthermore, responsibilities for the ICP remained unclear, and there was no set point in the illness trajectory for drawing up the ICP. Parents and healthcare professionals use the ICP as intended. However, uncertainties regarding timing, roles and responsibilities prevent optimal use of the ICP. Agreements on timing and responsibilities are needed for further ICP implementation in daily pediatric palliative care practice.

Health literacy, governance and systems leadership contribute to the implementation of the One Health approach: a virtuous circle

One Health is an important approach to addressing health threats and promoting health through interdisciplinary health, policy, legislation and leadership research to achieve better human and animal health and better outcomes for the planet. The Covid-19 pandemic has triggered an urgent awareness of the need to develop innovative integrative solutions to address root causes of such threats to health, which requires collaboration across disciplines and amongst different sectors and communities. We explore how achieving the Quadripartite Organizations’ One Health Joint Plan of Action can be supported by the concepts of ‘One Health literacy’ and ‘One Health governance’ and promote both academic and policy dialogue. We show how One Health literacy and One Health governance influence and reinforce each other, while an interdisciplinary systems leadership approach acts as a catalyst and mechanism for understanding and enacting change. Based on our understanding of how these elements influence the implementation of the One Health approach, we describe a model for considering how external triggering events such as the Covid-19 pandemic may prompt a virtuous circle whereby exposure to and exploration of One Health issues may lead to improved One Health literacy and to better governance. We close with recommendations to international organisations, national governments and to leaders in policy, research and practice to enhance their influence on society, the planetary environment, health and well-being.

Zoonotic Diseases: A Changing Landscape Demands Global Action

During recent years, the globe-wide zoonotic disease landscape has evolved drastically posing significant challenges to the health of the individual and environmental sustainability. Zoonotic illnesses, which occur in animals and are transmission-capable to people, have been an ever-present risk throughout history. According to the “World Health Organization (WHO)”, an estimated 60% of known infectious diseases and around 75% of new or emerging infectious diseases are zoonotic in origin. These illnesses have the potential to inflict widespread morbidity and mortality, along with severe economic losses. However, today's dynamics of our changing environment, which include urbanization, climate change, and growing human-animal interaction, are increasing the probability of zoonotic spillover occurrences. (1) The worldwide spread of the consequences of zoonotic illnesses underscores the critical need for collective effort through international leadership frameworks integrating government, private industry, and civil society. “The Global Health Security Agenda (GHSA)” and the WHO are collaborating on projects to address these concerns and improve global health security. The WHO launched the "One Health Joint Plan of Action," which intends to inscribe health hazards to humans, animals, plants, and the environment. It emphasizes the interconnection of human, animal, and environmental health. (2)

Animal welfare as the basis of One Health: A UN convention on animal welfare, health, and protection poses a realistic solution to improved animal welfare and human health

Abstract Animal welfare is closely linked to animal health and human welfare and health, as the World Organisation for Animal Health (WOAH) emphasizes in its Global Animal Welfare Strategy of 2017. As a result of recent pandemics, the Food and Agriculture Organization of the United Nations (FAO), the UN Environment Programme (UNEP), the World Health Organization (WHO), and the WOAH have created the One Health High Level Expert Panel (OHHLEP), committed to animal health and human health in the One Health Joint Plan of Action (2022–2026) and pledged to “[work] together for the Health of Humans, Animals, Plants and the Environment.” Despite these important acknowledgments and efforts from leading world organizations, including the One Health quadripartite, the latter has so far been reluctant to actively pursue the adoption of a legally binding commitment to improve the protection and welfare of animals globally. Animal welfare remains without relevant provisions. In the following, it is argued this must be integrated into the OHHLEP in addition to the creation of an “Animal Think and Do Tank” in the form of a technical working group, which would finalize a UN Convention on the issue, as proposed, e.g., in the drafted UN Convention on Animal Health and Protection (UNCAHP) 2018. The “Animal Think and Do Tank,” within its One Health context, must manifest a transdisciplinary approach, since – unlike globally binding legislation – policies, agreements, and declarations of various world organizations do not suffice to bring about a fundamental change in animal welfare. Acknowledging that animal protection is a complex and multifaceted issue involving ethical, cultural, social, religious, political, economic, and scientific dimensions (GAL Association, 2018 , Preamble), these aspects must be represented within the decision making process regarding the Convention’s content. Besides veterinarians, experts of further disciplines related to One Health must be consulted – such as lawyers and legal academics specializing in animal, international, and UN law, competent representatives of the animal welfare and animal rights movements, and ethicists and economists. Measures must be taken to improve transparency and overall confidence in the dialogue between the actors, including competent and not specifically scientific representatives of the animal protection and animal rights movement as elements of civil society to advocate for the fundamental interests of animals. One Health impact statement This article proposes that a UN Convention on Animal Health and Protection would further the enforceability of a One Health approach to human, environmental, and animal health. Science has proven that these elements are intertwined, but they remain disparate at a legislative level in many jurisdictions. It is suggested that placing animal welfare provisions on a UN-Convention footing by utilizing the positioning of the WOAH and UNEP is the most effective way of rendering One Health policy a global reality. Cooperation between professionals is imperative: scientists, policy makers, and lawyers must work together.

One Medicine vs One Health: Policy disconnect in India

Abstract One Health is an integrated, unifying approach to balancing and optimizing the health of people, animals, and ecosystems in a sustainable manner. It is a global movement to align our thinking and policy on human, animal, and environmental health, which is critical for effectively combating diseases at the human-animal-environmental interfaces. The Indian government intends to implement the much-needed and globally recognized ‘ One Nation, One Health System’ policy by 2030; however, given the complexity of India’s healthcare system in terms of One Health implementation, it seems to be a long way to go move and accelerate the collaboration among system stakeholders at various levels. Government of India aims to integrate modern and traditional medical systems such as allopathy, ayurveda, and homeopathy in education, medical practice, and research in the larger domain of One Health. Basically, their larger focus is on intra-human health systems integration rather than inter-system integration, which is also not aligned with the principles of One Medicine. Perhaps this could be the foundation for launching the One Health concept, and which will include more relevant stakeholders working at the human-animal-ecosystem interface in the coming years. The current initiative neither fulfils the essential principle of the One Medicine or One Health concept nor will it serve the purpose of the Global One Health joint plan of action. There is an urgent need for broadening the inter-systems stakeholders at all levels and adopting the principles of One Health more holistically in alignment with the global movement. One Health impact statement One Health, a comprehensive approach to human, animal, and ecosystem well-being, is well-recognized worldwide. India’s visionary ‘One Nation, One Health System’ policy targets 2030, focusing on integrating diverse medical practices like allopathy, ayurveda, and homeopathy. This marks a foundational stride towards broader engagement across the human-animal-ecosystem interface. Nonetheless, the current proposal has been marked as a shortfall for global One Health principles and objectives. While recognizing the significant room for improvement, this article delicately underscores the need for more comprehensive implementation aligning with One Health principles and considering inter-system harmony beyond the intra-system.

Дослідження взаємозв’язків параметрів краніоцервікального, назофарингеального комплексів та зубо-щелепного апарату пацієнтів з дистальною оклюзією (огляд літератури)

Abstract. Every year, the amount of children with diseases of the upper respiratory tract, musculoskeletal system, and maxillofacial system is increasing. The child’s body is extremely sensitive to adverse factors affecting both the growth and development of the body in general and the skull in particular. Some researchers attribute the pathological state of the upper respiratory tract and musculoskeletal system to the factors of inhibiting development of the dentition-maxillary apparatus. The prevalence and severity of dentognathic deformities in children with an existing disbalance of the Musculo-skeletal complex is greater than in somatically healthy children and increases with age, which determines the necessity for timely and multi-stage rehabilitation of these patients. In order to research the pathogenetic corellations between the parameters of the skull and the cervical spine in children with complex pathology, 21 literary sources from the scientometric database of medical research-base «PubMed» for the period 2016-2024 were included in the review and analyzed, which shed light on the issue of complex treatment of patients with dentognathic deformities and existing accompanying pathology. The analysis of articles studying the lateral cephalograms of patients with complex pathology and existing class II dentognathic deformities confirmed the presence of a statistically reliable corellations between the parameters of the cervical spine and the parameters of the jaws, which is most pronounced during the period of peak growth of the facial skeleton. Studies that included three-dimensional morphometric analysis of cone-beam computed tomography of patients with distal occlusion and concomitant pathology confirm the interconnections of average strength between the parameters of the middle and lower parts of the upper respiratory tract and the length of the bodies of the jaws. The creation of a multifactorial model of the disease based on the development and implementation of a multidisciplinary algorithm for complex rehabilitation of patients with distal occlusion and existing pathology of the upper respiratory tract and cervical spine is necessary for the objective assessment of complex pathology, the creation of a joint plan with related specialists and the achievement of a stable treatment result. Key words: distal occlusion, musculoskeletal system, upper respiratory tract, complex treatment.

Cross-sectoral collaboration and negotiation about the patient's transition to home. Analytical results of video conversations between patients, relatives, and health professionals from hospitals, municipalities, and general practice.

Background: As in many countries, Danish health care intensively focuses on improving cross-sectoral collaboration between the sectors: general practitioners (GP), municipalities, and hospitals. Collaboration between the sectors is often siloed and fragmented, making it challenging to coordinate and plan the patient's transition across sectors. The issue is exacerbated by the increasing number of complex multimorbid patients who need specialized treatment across sectors. Health professionals (HP) must engage in circular thinking, focusing on the patient's needs and involvement. To strengthen cross-sectoral collaboration with the multimorbid patient, we have designed a model for cross-sectoral hybrid video conferencing (Cross-sectorial Hybrid Video Conferencing, CHVC) during the patient's admission at the hospital. The patient, relatives, and HP from the hospital were physically present in the patient's ward. HP from the municipality, GP, and relatives participated by video link on a video screen. We examined if and how CHVC can strengthen collaboration and coordination across sectors.
 Method: The CHVC was developed in a participatory design with HP from hospitals, municipalities, researchers, and patient and relatives' representatives. The meetings lasted a maximum of 30 minutes and started with questions for the patient and relatives: What is important to you? What do you expect from the admission? What worries you and your family? Subsequently, we asked HP about what they found worrying and their expectations of the patient's admission. Inclusion Criteria: aged 65+, complex multimorbid patients with a need for municipal help before and after admission, and health professionals with knowledge of and responsibility for the patient's care and course of treatment. The video meetings were audio recorded and transcribed into text. Researchers carried out content and thematic analysis. 
 Result: We conducted 11 CHVC. The overall theme is a negotiation between patients, relatives HPs and GPs. They negotiated about how the patient could be at home despite a fragile and unstable situation. In addition, there was a negotiation regarding the discharge date. The discharge date was negotiated from the perspectives of the HP and GPs opportunities to support the patient's care and treatment needs at home.
 Discussion and Conclusion: The health professionals across specialties and sectors, together with patients and relatives, exchanged knowledge essential for the patient's safe and satisfactory discharge and subsequent care course. A noteworthy finding in our study is that, during CHVC with the patient's needs as a starting point, the health professionals included their worries about the patient's overall situation and their expectations for the patient's hospitalization. This resulted in dialogical communication in which they asked questions about each other's practice and collaborated on a joint plan for the patient. The hybrid, interdisciplinary, cross-sectoral dialogue between the four parties gave the patients safe transitions and care paths. 
 It is our experience that CHVC is a medium by which negotiation about the patient's course can strengthen coordination and collaboration between sectors. However, this study was limited to 11 patient pathways; in future research, we will test CHVC for 200 complex multimorbid patients admitted to a regional hospital in Denmark. 

‘It was a joint plan we worked out together’. How the I-WOTCH programme enabled people with chronic non-malignant pain to taper their opioids: a process evaluation

BackgroundThe Improving the Wellbeing of people with Opioid Treated CHronic pain (I-WOTCH) randomised controlled trial found that a group-based educational intervention to support people using strong opioids for chronic non-malignant...

One Health good practices across the European Region: the co-production of a Compendium

Abstract Issue/problem The international and scientific community has been calling for many years to strengthen prevention and preparedness to threats at the human-animal-environment interface by integrating a systemic approach, such One Health (OH). Furthermore, the COVID-19 pandemic highlighted the importance of OH to enhance health security. However, at the national level, governments are delaying the integration of OH in their public health systems or in national health plans. Description of the problem The WHO Regional Office for Europe is supporting the elaboration of a Compendium of operationalized and/or implemented OH practices within the Region, highlighting enabling factors and lessons learnt to promote OH adoption, in line with the One Health Joint Plan of Action 2022-2026 (OH JPA) of the Quadripartite Organizations. The Compendium is part of the efforts of the WHO European Region 2024-2030 strategy and it responds to the recommendations of the 2021 Pan-European Commission on Health and Sustainable Development. Results OH practices within the European Region are identified through a rapid review and are validated with stakeholder interviews to select those concretely supporting OH operationalization and implementation. The practices are described according to the following characteristics: country, sector, OH JPA action track, OH principles, disciplines and stakeholders involved. Specific additional attributes, like innovation, sustainability, efficacy, replicability and advancement of the Sustainable Development Goals (SDGs), are supporting the process of inclusion in the Compendium. Lessons Lessons learned from the practices provide a framework for action to scale up OH within the Region and globally. Collective action for OH operationalization and implementation in preventing, preparing for, detecting, and managing health threats at national and local level is advanced, supporting the achievement of key SDGs, with an up-to-date vision according to the OH JPA. Key messages • OH good practices within the European Region are collected in a Compendium to promote and guide OH approaches integration in national plans and to enhance health security in the Region and globally. • The Compendium supports multisectoral and multistakeholder actions for OH operationalization and implementation, with an up-to-date vision supporting the OH JPA and the achievement of key SDGs.

Building a European One Health workforce for prevention and preparedness to health threats

Abstract Background The Quadripartite has elaborated the One Health Joint Plan of Action (2022-2026) (OH JPA) to promote health sustainably and prevent the next pandemic through the One Health (OH) approach. One of the action track of the OH JPA is to create a training program for environment, medical and veterinary sector professionals. Objectives The Italian National Institute of Health is developing a training curriculum about OH prevention and preparedness to health threats within the European Region to promote the OH workforce capacities and capabilities and to support the OH JPA execution. The training curriculum would be developed through a literature review and a stakeholder consultation process, validated by a steering committee and presented during a workshop. Results A modular training curriculum about OH prevention and preparedness to health threats within the European Region is developed and it includes modules to strengthen soft and hard skills around 5 OH domains (OH thinking, OH design, OH implementation, OH evaluation, OH cross-cutting competences) with case studies encompassing different threats. The curriculum would be further developed into a training hybrid course for National Public Health Institutes, decision and policy-makers at all level, International and European organizations and agencies, Academia, professionals working in the area of environmental and agricultural sciences, social sciences, human and animal health. Conclusions The training curriculum would contribute to build a European OH workforce by strengthening OH prevention and preparedness skills and competences and networking opportunities. It would support OH action and practice at national, regional and global level and the execution of the OH JPA. Key messages • A training curriculum for OH prevention and preparedness to health threats within Europe has been elaborated. • The OH workforce, OH action, and the OH JPA execution are strengthened and supported.

Older Persons' and Health Care Professionals' Design Choices When Co-Designing a Medication Plan Aiming to Promote Patient Safety: Case Study.

Harm from medications is a major patient safety challenge among older persons. Adverse drug events tend to arise when prescribing or evaluating medications; therefore, interventions targeting these may promote patient safety. Guidelines highlight the value of a joint plan for continued treatment. If such a plan includes medications, a medication plan promoting patient safety is advised. There is growing evidence for the benefits of including patients and health care professionals in initiatives for improving health care products and services through co-design. This study aimed to identify participants' needs and requirements for a medication plan and explore their reasoning for different design choices. Using a case study design, we collected and analyzed qualitative and quantitative data and compared them side by side. We explored the needs and requirements for a medication plan expressed by 14 participants (older persons, nurses, and physicians) during a co-design initiative in a regional health system in Sweden. We performed a directed content analysis of qualitative data gathered from co-design sessions and interviews. Descriptive statistics were used to analyze the quantitative data from survey answers. A medication plan must provide an added everyday value related to safety, effort, and engagement. The physicians addressed challenges in setting aside time to apply a medication plan, whereas the older persons raised the potential for increased patient involvement. According to the participants, a medication plan needs to support communication, continuity, and interaction. The nurses specifically addressed the need for a plan that was easy to gain an overview of. Important function requirements included providing instant access, automation, and attention. Content requirements included providing detailed information about the medication treatment. Having the plan linked to the medication list and instantly obtainable information was also requested. After discussing the needs and requirements for a medication plan, the participants agreed on an iteratively developed medication plan prototype linked to the medication list within the existing electronic health record. According to the participants, the medication plan prototype may promote patient safety and enable patient engagement, but concerns were raised about its use in daily clinical practice. The last step in the co-design framework is testing the intervention to explore how it works and connects with users. Therefore, testing the medication plan prototype in clinical practice would be a future step.

Introduction for One Health Joint Plan of Action (2022-2026)

Four organizations, including the Food and Agriculture Organization of the United Nations, the United Nations Environment Programme, WHO, and the World Organization for Animal Health, recently launched a new One Health Joint Plan of Action (2022-2026) which was the first time that the Quadripartite had issued a joint action plan on One Health. The action plan aimed to address the health challenges in the human, animal, plant, and environment, focusing on improving capabilities in six action tracks including One Health capacities, emerging and re-emerging zoonotic diseases, neglected tropical and vector-borne diseases, food safety, antimicrobial resistance and environment. This introduction will give an overview and brief translation of the background, content, and the plan's value, to help readers understand the joint action plan quickly.

Exploring epistemic agency in students’ problem-solving activities

This case study presents an exploration of epistemic agency in a middle school context. The main focus of this study was to identify and characterize the actions indicative of epistemic agency that emerged in student interactions. The study was conducted with sixth graders. Data were collected from multiple sources including records of student participation in the classroom and in the virtual space, student-created artifacts, and non-participant observations. A qualitative data analysis was conducted to identify actions indicative of epistemic agency. The findings showed that eleven actions emerged in students’ activities: generating new ideas, revising ideas, negotiating new ideas, sharing ideas, sharing data/information, drawing on other group’s ideas, drawing on other groups’ data/findings, collecting additional information, engaging in shared construction of data collection instruments, examining research data–seeking support for ideas, and creating a joint plan of actions. Future research identified by this study suggests further investigations of the interactional processes that may reveal key actions that trigger subsequent actions.

Advancing One Health: Updated core competencies

Abstract One Health recognises the interdependence between the health of humans, animals, plants and the environment. With the increasing inclusion of One Health in multiple global health strategies, the One Health workforce must be prepared to protect and sustain the health and well-being of life on the planet. In this paper, a review of past and currently accepted One Health core competencies was conducted, with competence gaps identified. Here, the Network for Ecohealth and One Health (NEOH) propose updated core competencies designed to simplify what can be a complex area, grouping competencies into three main areas of: Skills; Values and Attitudes; and Knowledge and Awareness; with several layers underlying each. These are intentionally applicable to stakeholders from various sectors and across all levels to support capacity-building efforts within the One Health workforce. The updated competencies from NEOH can be used to evaluate and enhance current curricula, create new ones, or inform professional training programs at all levels, including students, university teaching staff, or government officials as well as continual professional development for frontline health practitioners and policy makers. The competencies are aligned with the new definition of One Health developed by the One Health High-Level Expert Panel (OHHLEP), and when supported by subjectspecific expertise, will deliver the transformation needed to prevent and respond to complex global challenges. One Health Impact Statement Within a rapidly changing global environment, the need for practitioners competent in integrated approaches to health has increased substantially. Narrow approaches may not only limit opportunities for global and local solutions but, initiatives that do not consider other disciplines or social, economic and cultural contexts, may result in unforeseen and detrimental consequences. In keeping with principles of One Health, the Network for Ecohealth and One Health (NEOH) competencies entail a collaborative effort between multiple disciplines and sectors. They focus on enabling practitioners, from any background, at any level or scale of involvement, to promote and support a transformation to integrated health approaches. The updated competencies can be layered with existing disciplinary competencies and used to evaluate and enhance current education curricula, create new ones, or inform professional training programs at all levels-including for students, teachers and government officials as well as continual professional development for frontline health practitioners and policymakers. The competencies outlined here are applicable to all professionals and disciplines who may contribute to One Health, and are complimentary to, not a replacement for, any discipline-specific competencies. We believe the NEOH competencies meet the need outlined by the Quadripartite’s (Food and Agriculture Organisation, United Nations Environment Programme, World Health Organisation, World Organisation for Animal Health) Joint Plan of Action on One Health which calls for cross-sectoral competencies.

THE IMPACT OF THE CUBAN MISSILE CRISIS ON SOVIET MIDDLE EASTERN POLICY. HOW IT LED TO THE SIX-DAY WAR, 1967

The widespread perception of the “Caribbean” crisis as a setback for the Soviet Union overlooks the major achievement that Moscow did score. This was Khrushchev’s success – which, unfortunately for his future in the Soviet leadership, he agreed to the Kennedys’ demand not to publicize – to gain the withdrawal of American Jupiter missiles from Turkey. But within three years, the joint French-Israeli development of nuclear weapons and missile delivery systems threatened to plug the gap that had thus been created in the ring of nuclear-armed western pacts that were the subject of perennial Soviet fears. Documents and memoirs that surfaced in the early years after the USSR’s collapse, cross-checked against US and Israeli sources, reveal this motivation for, and the hitherto unknown features of, the Soviets’ response when in late 1965 an authoritative informant confirmed that despite domestic political change and US pressure, Israel was about to cross the nuclear threshold. This added urgency to Moscow’s regional considerations in favor of supporting an Arab attack on Israel, and produced what was in several respects a mirror-image of the Cuban affair. A joint plan was developed with Egypt, to provoke an Israeli first strike that would legitimize Soviet military intervention to “aid the victims of aggression” and ensure Israel’s defeat. The provocations included overflights of Israel’s nuclear facility by advanced Soviet aircraft; the intervention was to include targeting of the facility by Soviet strategic bombers. This plan’s fiasco in the Six-Day War of June 1967 shaped the Middle East as well as Soviet policy there for decades to come, as an indirect but distinct consequence of the Cuban crisis

Negotiation and honesty in artificial intelligence methods for the board game of Diplomacy

The success of human civilization is rooted in our ability to cooperate by communicating and making joint plans. We study how artificial agents may use communication to better cooperate in Diplomacy, a long-standing AI challenge. We propose negotiation algorithms allowing agents to agree on contracts regarding joint plans, and show they outperform agents lacking this ability. For humans, misleading others about our intentions forms a barrier to cooperation. Diplomacy requires reasoning about our opponents’ future plans, enabling us to study broken commitments between agents and the conditions for honest cooperation. We find that artificial agents face a similar problem as humans: communities of communicating agents are susceptible to peers who deviate from agreements. To defend against this, we show that the inclination to sanction peers who break contracts dramatically reduces the advantage of such deviators. Hence, sanctioning helps foster mostly truthful communication, despite conditions that initially favor deviations from agreements.

Insights into effects of individual, dyadic, and collaborative planning interventions on automatic, conscious, and social process variables

Objective: Going beyond the effects of individual planning (“I-for-me”), we investigate the associations of dyadic (“we-for-me”) and collaborative (“we-for-us”) planning with automatic, conscious, and social process variables that may elucidate the differences through which these three types of planning operate. We tested the effects of three planning interventions on: (1) habit strength, representing an automatic process, (2) the use of individual planning, representing a conscious process, (3) the use of collaborative planning, representing conscious and social processes, and (4) collaborative social control, representing a social process.Methods: N = 320 adults were randomly assigned to one of four conditions: (1) the active control condition, (2) the individual planning condition, (3) the dyadic planning condition, or (4) the collaborative planning condition. Self-reported data on habit strength, the use of individual planning, the use of collaborative planning, and collaborative social control were assessed at baseline and at the 9-week follow-up. Analyses used linear mixed modelling.Results: Compared to the control group, participants in the individual planning condition had stronger habits at the 9-week follow-up. Those in the dyadic planning condition reported higher levels of the use of collaborative planning and higher levels of collaborative social control at the follow-up. Finally, compared to those assigned to the control group, participants in the collaborative planning condition reported stronger habits, higher levels of the use of both individual and collaborative planning, and higher levels of collaborative social control at the follow-up.Conclusions: Individual, dyadic, and collaborative planning interventions may result in distinct patterns of changes in the variables representing automatic, conscious, and social processes. In particular, changes in automatic, conscious and social process variables, evoked by the collaborative “we-for-us” planning intervention may reflect the major regulatory effort of forming joint plans and subsequently integrating regular joint exercise into the weekly schedule.