Most-likely Case Research Articles

Cluster randomized pilot of the Best Case/Worst Case-Geriatric Oncology (BC/WC-GeriOnc) communication tool for older adults with cancer.

226 Background: BC/WC-GeriOnc is a conversation framework and graphic aid that supports shared decision making (SDM) between oncologists and older adults with cancer. Oncologists are trained to use scenario planning to discuss treatment options by describing the range of plausible outcomes—including an individualized most-likely case—and to make a patient preference-aligned recommendation. Methods: To compare BC/WC-GeriOnc vs enhanced usual care (EUC; usual care plus geriatric assessment), we enrolled 7 medical oncologists from a Comprehensive Cancer Center, Veterans Affairs clinic, and safety-net hospital. For each oncologist, we first enrolled 2 EUC patients age ≥65 with any stage solid tumor and recorded decision-making discussions. Oncologists were then randomized 1:1 to BC/WC-GeriOnc training vs EUC. We enrolled up to 5 additional patients per oncologist and recorded discussions. Patients were followed for 2 months with surveys and a one-on-one semi-structured interview. Primary outcomes were feasibility of patient recruitment/retention and oncologist-reported feasibility of using BC/WC-GeriOnc (surveys and interview). Secondary outcomes were intervention adherence, fidelity, and oncologist- and patient-reported acceptability and appropriateness. Exploratory outcomes included patient-reported SDM, decisional conflict, and regret. We used descriptive statistics to summarize results. Results: Among 43 patients (15 intervention, 28 EUC), median age was 71 (IQR 68-77). The most common cancers were gastrointestinal (30%), thoracic (26%), breast (19%), and genitourinary (19%). Treatment was palliative in 58%. Patient recruitment rate was 70%. Retention was 98% post decision, 93% at 1 month, 86% at 2 months, and 73% at the patient interview. Mean oncologist feasibility, acceptability, and appropriateness scores were each 4 out of 5, which corresponds to “agree.” Intervention adherence (93%) and fidelity were high (median score 14 out of 15, IQR 11-15). Oncologists reported that the tool improved communication: “It really kind of crystalized things in my mind and helped me communicate better.” Patients found that the tool clarified options, encouraged deliberation, and supported oncologist communication. Mean patient-reported SDM score was 85.6 (out of 100-best, SD 15) in the intervention arm and 77.5 (SD 22) in EUC (Cohen’s d 0.43). In the intervention arm, 15% of patients had high decisional conflict after the decision was made (score >37.5/100) versus 21% in EUC. At 2 months, 22% in the intervention arm had high decision regret (score >25/100) compared with 45% in EUC. Conclusions: It was feasible and acceptable for oncologists to use BC/WC-GeriOnc to support SDM for older adults with cancer. Promising patient-reported SDM and decisional outcomes support testing the tool in a full-scale efficacy trial. Clinical trial information: NCT05374304 .

Power to the People? How Participatory Budgets Affect Citizens’ Populist Attitudes

So-called populist citizens feel excluded from political decision-making, which in their eyes is dominated by an unresponsive political elite. While democratic innovation scholars suggest that empowering citizens in the decision-making process can affect populist sentiments, this article addresses the lack of theorization and empirical research on the mechanisms behind such effects as well as the scarcity of qualitative research regarding populist attitudes. It generates a theory that accounts for changes in participants’ populist attitudes and tests this theory in a most-likely case study. An analysis of pre–post survey data and 35 semi-structured interviews from three participatory budgeting events in the Netherlands shows that for populist citizens, the inclusion of politically marginalised groups and the empowerment of citizens can explain populist attitudes change. On the contrary, the representativeness of the participants and the ability to have deeper discussions are drivers of populist attitudes change for non-populist citizens.

The Limits of Enforcement in Global Financial Governance: Blacklisting in FATF as Rational Myth

Abstract How might international institutions matter? To consider this central question of International Relations, we analyze a most-likely case for the importance of materially driven enforcement: the Financial Action Task Force’s (FATF) use of blacklisting in the global regime targeting money laundering and terrorism financing. Scholars and practitioners often argue that fear of financial harm caused by FATF’s lists explains the near-global commitment to FATF’s standards, even if compliance lags. We search for statistical evidence of this impact across four different measures of financial flows and find that listing is not correlated with financial harm. To explain these null results, we examine bank decision-making and find that the lists’ impact is likely diminished by two overlooked factors: the existence of multiple, competing lists and banks’ access to more fine-grained, client-specific information provided by third-party companies. We interpret this contradiction—a commitment to compliance generated in part by a fear of enforcement, despite a lack of evidence for enforcement’s impact—as a “rational myth.” The results challenge a common understanding of a major global governance regime, confirm ideas about the limited ability of states or International Organizations to control governance outcomes, and advance a new research agenda on the impact of bank decision-making on global governance.

Monte Carlo Simulation and Scenario Analysis Based Limestone Quarry Production Planning

The key factor behind raw mix design in the cement factory is the appropriate production planning, resultingin high-quality raw material. Quarry managers usually come up with uncertainty-related raw materials due to variationsin chemical composition. These uncertainties required efficient planning in terms of useful insight into this problem.This research provides a detailed explanation of scenario analysis of raw materials used in cement manufacturing usingMonte Carlo simulation (MCS) and indices. Scenario analysis is used to predict the possibility of best, worst and mostlikely cases of raw material’s quality. Whereas, Monte Carlo simulation is used to evaluate the inherent uncertaintyassociated with chemical composition values in order to analyze the impact of truly unpredictable scenarios. Thepredictive results help in decisions related to production planning, raw mix design optimization and increasing theprobability of designing the best plan.

Tradeoff between Gender and Class Equality: An Analysis of Tax Policy in Japan

Abstract Although conservative parties in developed countries are becoming more positive about women’s labor force participation, serious economic gender gaps persist in some conservative welfare regimes. By focusing on Japan as a most-likely case, this article reexamines the view that emphasizes conservative parties’ preference for traditional gender roles as a key factor contributing to policies that negatively affect gender equality. Analyses using text data from parliamentary statements reveal that parties’ preference for class equality, held by both conservative and leftist parties, contributes to a tax policy that suppresses women’s labor force participation. The findings illuminate a tradeoff between class and gender equality and provide implications for how conservative welfare regimes can achieve higher levels of economic gender equality.

U.S. Engagement and the Conditions for China's Socialization into the Liberal International Order

A long-standing narrative in U.S. engagement policy toward China draws a tacit causal link between engagement and Beijing’s socialization into the U.S.-led liberal international order (LIO).1 Amid recent decreasing faith in engagement, this article constructs a framework tailored to explaining the conditions for China’s state socialization into the hegemonic order when the U.S. tries to engage China. It contends that the socialization of a still-rising China is an arduous cause that hinges on four conditions: the accommodation of China’s interests in international institutions, the existence of a problematic situation, status recognition, and the absence of obstacles to domestic internalization. To test the socialization premise, the article applies the framework to a theoretically most-likely case of China’s socialization—U.S. post-2009 engagement with China on global climate governance. It finds that despite some ambiguous signs of state socialization, China’s adoption of the U.S.-promoted co-leader identity was primarily rooted in domestic changes in interest perception and was thwarted by domestic obstacles—economic development and energy security—to the internalization of the idea of Chinese climate leadership.

Participatory Bias and Participatory Neighborhood Governance: Reanalyzing the Most-Likely Case of the Stockholm Neighborhood Renewal Program

Strategies for revitalizing marginalized neighborhoods often include participatory innovations. According to the participatory bias argument, however, participatory governance arrangements benefit the privileged rather than the poor. In the present article, the validity of this argument is examined by analyzing how individual resources and social positions relates to recruitment to, participation within, and outcomes derived from participation in a most-likely case of bias in participatory neighborhood governance. Although the privileged were overrepresented in recruitment, the pattern was less clear regarding influence within the processes, and quite the opposite regarding certain outcomes of participation. Also in a most-likely case for bias, participatory neighborhood governance may induce empowerment among poor. Based on the observation that participants that differ with regard to available resources and social positions also have different motives for participation, a mechanism-based account regarding why and how bias in early phases under certain conditions may produce empowering outcomes is proposed.

Avoiding the Political Resource Curse: Evidence from a Most-Likely Case

Why do some countries escape the political resource curse while others do not? Most scholars argue that avoiding the claimed anti-democratic effects of natural resources, especially oil, largely depends on the quality of pre-existing political institutions and/or the effectiveness of contemporary resource management institutions. Drawing on the most-likely case of Timor-Leste, one of the world’s most oil-dependent countries that nevertheless successfully consolidated democracy, we challenge these dominant theories and highlight new important factors to consider. We show that Timor-Leste did not avoid the curse because of good pre-existing political institutions, good natural resource governance institutions, or an otherwise favorable environment for democracy. Instead, we find that the ideological beliefs of major political actors, their strong popular legitimacy, the absence of a hegemonic actor among them, as well as the approaches of external actors, have produced a consolidated democracy despite strong incentives for the development of authoritarianism. These findings highlight the importance of ideology and agency, of the composition of independence movements, and of constructive international engagement, in particular at critical historical junctures. In short, even countries facing serious political and economic challenges can avoid the political resource curse, and both scholars and policymakers should consider a broader approach to the phenomenon.

Aid accessibility: Equity & education in Kenya

While we hope that the needs of recipients determine the allocation of foreign aid, we know that aid also involves the interests of donors. Substantial evidence suggests that supply-side factors dominate aid delivery, with both donor and recipient governments allocating aid according to their own domestic political agendas. Are there ever conditions under which need drives allocation and aid flows primarily to those that need it most? The distribution of education aid across regions in Kenya offers a most-likely case for such equitable, need-driven aid allocation. Kenya’s political stability and history of collaboration with aid organizations, paired with still high levels of need create favorable conditions for aid delivery to occur equitably. Yet, statistical analysis suggests that even there, the highest volume of aid does not flow to the neediest areas. This paper introduces new subnational data on aid location and maps the concentration of aid allocation in relation to the level of need across regions within Kenya. In the education sector, while most aid flows to high-need locations, aid is nearly absent in Somali-majority areas that have the highest levels of need but the fewest interventions. Such inequitable distribution of both education and assistance in its provision demonstrates how the political preferences of donors and recipient governments can divert aid away from the populations and places that need it most, reducing its effectiveness.

Corruption and Political Support: The Case of Peru’s Vacuna-gate Scandal

AbstractClassic theories of public opinion suggest that negative shocks can undermine system support in weak democracies, but scant work has systematically assessed this thesis. We identify Peru’s explosive Vacuna-gate scandal as a most-likely case for finding a connection between corruption and political support. The scandal’s unexpected revelation in the middle of the 2021 AmericasBarometer Peru survey created conditions for a natural experiment. Applying an unexpected-event-during-survey design, we consider the consequences of the scandal for perceptions of corruption, system support, and support for democracy. We find robust evidence that the scandal increased even already high perceptions of corruption and lowered system support. Contrary to expectations derived from prior theories, we find no effect on explicit support for democracy. In the conclusion, we discuss the nuanced ways that scandal may shape democratic stability.

Article 10 - The good geopolitical trade actor? The European Union’s discursive justification of the Anti-Coercion Instrument

Traditionally, the EU has presented itself as a normative trade actor, as opposed to other geopolitical trading powers. However, today, it is increasingly recognized that the EU is undergoing a geopolitical turn which also manifests itself in its trade policy. Yet, confusion remains regarding what a ‘geopolitical EU trade policy’ entails and how the EU sells this new perspective in its trade policy. This article contributes to the ongoing debate on this topic by investigating how the European Commission discursively justifies its geopolitical turn in trade. Methodologically, we analyze EU trade discourse with particular attention for othering strategies. Empirically, we study a most-likely case of ‘geopoliticization of trade’, namely the Commission’s initiative to launch an Anti-Coercion Instrument, by analyzing the most important EU documents covering the ACI so far and EU statements on the ACI in relevant media. We find that the Commission distinguishes a ‘defensive’ and ‘offensive’ variant of geopoliticization of trade, whereby the former is conceived as ‘good’ and pursued by the EU, while the latter is seen as ‘bad’ and employed by non-EU trading powers. This diverges from previous EU trade discourses since the 2000s, which portrayed the EU as transcending geopolitics – a normative power pursuing free trade and multilateralism – and other powers as essentially geopolitical – self-interested, protectionist, and regionalist. The EU’s new othering strategy legitimizes the EU’s geopolitical turn in trade, by simultaneously turning away from its previous, ‘naively’ normative trade discourse, while also contrasting the EU’s trade policy to the ‘offensive’ geopolitical trade from ‘bad’ trade actors.

Under the Umbrella: Nuclear Crises, Extended Deterrence, and Public Opinion

How robust is public support for extended nuclear deterrence in patron and client states? Recent studies have improved scholarly understanding of US public opinion about nuclear weapon use against non-nuclear adversaries. Yet, there is limited knowledge of public attitudes regarding retaliation for nuclear strikes against US allies. We develop a theoretical typology of nuclear crises and investigate this phenomenon with a novel survey experiment ( n = 6,623). Americans, Japanese, and South Koreans viewed realistic emergency alert messages about a most-likely case for nuclear retaliation: a North Korean missile attack on a US ally protected by the nuclear umbrella. Support for nuclear retaliation is low in all three countries, with important cross-national differences. Favorability increases with North Korean nuclear first-use, but it remains limited nonetheless. Surprisingly, US “tripwire” troop casualties do not increase Americans’ demands for nuclear retaliation. These findings have important implications for the study of nuclear crises and practice of extended deterrence.

Collaboration, cooperation, coordination: a history of the Bretton Woods twins’ efforts to work together

Why and how international organizations (IOs) collaborate, cooperate and coordinate (the 3Cs) are important but understudied issues in international political economy today. The three terms are rarely defined in the IR literature or by the IOs themselves and are often used interchangeably. However, the differences matter in terms of when, how and why staff of different IOs are expected to work together, and whether and how such efforts contribute to IO performance. This article develops the concepts of the 3Cs, drawing from work in the public administration, management and organizational design fields. It illustrates ways in which the differences matter by examining the history of efforts by the International Monetary Fund (IMF) and World Bank to work together. The two Bretton Woods siblings were explicitly designed to be complementary partners at the apex of the post-World War II global economic order. I argue that formal collaboration efforts between the Fund and the Bank took place through at least 25 attempts by the two institutions to define how to work together, and may be categorized into four different, sometimes overlapping approaches, from basic information sharing to fully engaged joint initiatives. What they have called ‘collaboration’ is in fact a range of engagement. Efforts by the Fund and Bank to work more closely together have been an ongoing struggle, driven by unavoidable institutional overlap, which intensified at times of systemic change and external shock. This case is important to the study of how IOs work together, given these institutions have a unique relationship and may be seen as a most-likely case of successful collaboration.

Trump and the Shifting Meaning of “Conservative”: Using Activists’ Pairwise Comparisons to Measure Politicians’ Perceived Ideologies

Although prior scholarship has made considerable progress in measuring politicians’ positions, it has only rarely considered voters’ or activists’perceptionsof those positions. Here, we present a novel measure of U.S. senators’ perceived ideologies derived from 9,030 pairwise comparisons elicited from party activists in three 2016 YouGov surveys. By focusing on activists, we study a most-likely case for perceiving within-party ideological distinctions. We also gain empirical leverage from Donald Trump’s nomination and heterodox positions on some issues. Our measure of perceived ideology is correlated withnominatebut differs in informative ways: senators with very conservative voting records were sometimes perceived as less conservative if they did not support Trump. A confirmatory test shows these trends extended into 2021. Even among activists, perceived ideology appears to be anchored by prominent people as well as policy positions.

How do international bureaucrats affect policy outputs? Studying administrative influence strategies in international organizations

The article investigates how international public administrations, as corporate actors, influence policymaking within international organizations. Starting from a conception of international organizations as political-administrative systems, we theorize the strategies international bureaucrats may use to affect international organizations’ policies and the conditions under which these strategies vary. Building on a most-likely case design, we use process tracing to study two cases of bureaucratic influence: the influence of the secretariat of the World Health Organization on the “Global action plan for the prevention and control of noncommunicable diseases”; and the influence of the International Labour Office on the “Resolution concerning decent work in global supply chains”. We use interview material gathered from international public administration staff and stakeholders to illustrate varying influence strategies and the conditions under which these strategies are used. The study shows how and when international public administrations exert policy influence, and offers new opportunities to extend the generalizability of public administration theories. Points for practitioners International bureaucrats influence the outcomes of multilateral negotiations by means of their technical expertise and strategic involvement in the decision-making process. Their influence is primarily geared toward achieving organizational goals. However, the perception of too much influence can threaten the implementation of a decision. Political leadership needs to find the right balance between encouraging entrepreneurial behavior and providing sufficient political steering. Civil servants themselves need a well-functioning political radar to sense how far they can push with their ambitions.

Financial sanctions and political risk in the international currency system

Scholarship on international currencies has traditionally emphasised how an issuing state’s foreign policy can enhance the attractiveness of its currency for cross-border use. Yet, foreign policy actions need not only boost a currency’s international appeal—they may also undermine it. This study introduces a general theory of how US foreign policy can influence governments’ policy orientations toward the dollar in positive or negative ways. Policies like financial sanctions generate ‘political risk’ that weaken the dollar’s attractiveness for international use. The study tests the claim that the United States’ use of financial sanctions incentivises targeted governments to implement de-dollarization policies. I employ a most-likely case study design, presenting evidence from three countries targeted by US sanctions: Russia, Venezuela and Turkey. In each instance, the evidence shows that financial sanctions created political risk concerns by generating expectations of future direct costs of dollar use. These expectations set off policy efforts by targeted governments to reduce their economies’ exposure to the currency. This study raises important questions about the long-term efficacy of an approach to foreign policy that relies on financial sanctions as a primary means of leverage over foreign adversaries as overuse may undermine the effectiveness of the tool itself.

Evil Within: Effects of Gray Zone Coercion on Foreign Policy

Why do states fail to stand firm against coercers? Considerable literature ascribes the failure to the shortage of domestic cohesion and alliance credibility, seldom have scholars investigated whether challengers proactively exploit division within target groups. In this article, I argue, by coercing actors within rival groups, coercers avoid a costly standoff by manipulating victims’ strategic interests. Coercive diplomacy can be used to divide target states’ domestic politics and change states’ preference in an ongoing dispute. It is more likely to succeed with the political division within a target state and asymmetric economic dependence on a challenger. Widening the political and economic gap, coercers indirectly dampen targets’ foreign policy. I test my theory by examining the classic case that succeeds and the most-likely cases that fail to coerce targets: Russia’s hybrid warfare during the Ukraine revolution, China’s interference against Australia, and China’s coercion against Taiwan during the Tsai administration. With these case studies and comparison, I conclude as follows: (1) Divide-and-rule is more probable to fail when a target can respond promptly with resilience; (2) multiple instruments and covert actions increase the likelihood of successful coercion; (3) coercion needs to be tailored and is highly context-dependent.

Reconstruction under siege: the Gaza Strip since 2007.

This paper examines the siege of the Gaza Strip, a self-governing Palestinian territory, since 2007. Research on sieges tends to concentrate on the coping strategies of besieged communities, humanitarian issues associated with the impacts, humanitarian access, and the prioritisation of needs, with little or no attention paid to reconstruction. However, Gaza is unusual as a siege environment within which reconstruction has become a high priority in the aftermath of its three destructive wars with Israel. Following an overview of research on sieges in contemporary warfare and a brief contextualisation of Gaza, this paper examines why reconstruction outcomes have varied over time through the application of a theoretical framework that stipulates the importance of four key factors: time; needs; scarcity; and political context. Based on an analysis of these variables, Gaza was found to be a most-likely case for reconstruction under siege. Nonetheless, the large-scale reconstruction necessary to transform Gaza has not been actualised.

How sovereign is a populist? The nexus between populism and political economy of the AKP

ABSTRACT This article investigates the effects of populist discourse on leadership and state behavior at the international level. From 2002 to 2013, Turkey’s Justice and Development Party (AKP) gradually consolidated its power, largely by deploying populist discourses and actions. However, after the party faced a number of challenges, including the Gezi protests, corruption allegations, and a failed coup, its populist rhetoric did not only begin to weaken but also seems to have created a problem of path dependency, which limited the decision-making capability at the hands of its leadership. By comparing the 2001–2002 and 2018–2019 economic crises based on the most-likely case research design, we assert that the AKP’s discursive turn into anti-Western and anti-establishment politics pushed the party into a corner, making it less likely to collaborate with international organizations, such as the IMF and even private consulting companies despite the country’s high inflation rates and currency depreciation.

Awakened: The Potential for Mobilization to Reshape Interest in Politics

Interest in politics has been repeatedly shown to be a substantively important precursor to political participation. Unfortunately, sources of its variation beyond childhood socialization remain under-explored. This is likely due to a widespread belief that interest is intractable: “You’ve either got it or you don’t.” In response, I enumerate several mechanisms through which political mobilization might be expected to shift interest. This potential is then tested using a well-established most-likely case: the 2012 presidential campaign. A difference-in-differences analysis finds that residents of battleground states exhibit a notable increase in political interest between 2010 and 2014 compared to those in “spectator” states and an alternative specification using field office placement implicates campaign mobilization directly in precipitating this change. The magnitude of the estimated effect is equivalent to over 150,000 entirely disinterested North Carolinians becoming fully engaged who would have remained apathetic had they lived in Georgia. The change is concentrated among those without college degrees, indicating mobilization may compensate for marginalizing conditions. Further evidence shows the effect resulted in increased political knowledge and lingered into 2016. Overall, this analysis demonstrates that political mobilization can shift interest and underscores the importance of understanding how recruitment can reshape the motivations of the electorate.