Planning for implementation scale-up of a medication for opioid use disorder program across rural Colorado: Ensuring fit to context.

This study aimed to measure changes in staff perceptions of research capacity and culture in a small rural health service in Australia over time. Staff completed the Research Capacity and Culture Tool, a valid and reliable survey that measures individuals' perceptions of their own research capacity and the research capacity and culture of their team and organisation. Data from 2015 was compared to 2023, following significant changes at the health service that focused on integrating research into the organisational structure. This was a repeated cross-sectional study in which data were collected from different individuals. Data were collected from a rural health service in Victoria (Modified Monash Model 4-5). All staff working in the health service were invited to complete the survey. Research Capacity and Culture Tool. Results demonstrated improvements in eleven out of eighteen measures of research capacity and culture at the organisation level, six out of nineteen measures at the team level, but none at the individual level. Median improvements were modest, typically two points on the 10-point scale. Integrating research into the health service organisation structure may be beneficial for its research capacity and culture.

Healthcare leaders face sustained uncertainty: workforce volatility, financial pressure, and accelerating technology change. In 2024-2025, Ardent Health advanced an AI-enabled virtual care model from pilot to production across multiple markets. The model integrates virtual nursing, virtual attending physicians and providers, virtual sitting, and hospital-to-home remote patient monitoring (RPM) into routine care, with artificial intelligence (AI), providing earlier risk detection and workflow relief. Specifically, AI systems (1) analyze video streams to detect fall risks and unsafe behaviors, prompting earlier alerts to staff; (2) continuously evaluate vital sign trends from wearable sensors to identify clinical deterioration sooner; and (3) support ambient documentation with speech recognition and natural language processing (NLP) that improves note quality and coding accuracy.At Ardent's East Texas location, five months of virtual nursing contributed to reductions in contract labor, a decrease in voluntary RN turnover, and improvements in salaries, wages, and benefits (SWB) per patient day despite an increase in volume. Meanwhile, virtual attending physicians and providers increased virtual patient consultations resulting in patient retention and, generated bed-day capacity; AI-assisted vitals monitoring correlated with lower mortality and shorter length of stay; and the RPM program improved discharge continuity and avoided readmissions.This article presents a case study and playbook to help leaders manage risk, scale safely, and measure value. Readiness includes updating consent form language; data-use and retention policies; training staff to obtain patient consent; establishing algorithm oversight with internal data, analytics, and data science capabilities; and investing in network, data center, and hardware upgrades. We close with lessons learned and an organizational performance tracking accountability structure.

The independence of the Federal Reserve, long an article of faith among lawmakers, is under attack. From the attempted removal of a member of the Board of Governors to an Executive Order subjecting the Federal Reserve's regulatory and supervisory actions to executive oversight, both the formal legal architecture and informal political norms that have long insulated the central bank from presidential control are being challenged in unprecedented ways. Amidst growing calls to reevaluate the Federal Reserve's mandate and strip the central bank of its regulatory and supervisory authority, recovering the neglected history of the Federal Reserve's role as a regulator and supervisor could not be timelier. Utilizing archival sources, this Article provides a comprehensive account of the dramatic, yet largely accidental, expansion of the Federal Reserve's regulatory and supervisory power over the course of the twentieth century. As the Article argues, the rise of the bank holding company, a corporation created to acquire and hold the stock of banks and other financial entities, as the dominant organizational structure of modern American finance unexpectedly transformed the Federal Reserve into the regulator-in-chief of the American financial system. Ultimately, retracing the Federal Reserve's inadvertent path to regulatory supremacy, and the efforts to reconfigure that arrangement over the twentieth century, serves as a critical reminder of the roads not traveled and opens up new possibilities in a key moment of reform.

This research examines crisis anticipation capacities by comparing the performance of humans and artificial intelligence (AI). Through a longitudinal study of 24 crisis simulations involving various organizations and three AI models (Mistral, Claude, ChatGPT), we analyze the effectiveness of different anticipation approaches. The results reveal that AI systems used alone perform less effectively than human teams, while the use of search engines yields the best performance. The study demonstrates that the efficiency of anticipation relies on the combination of a formalized organizational structure, thoughtful use of technological tools, and openness to challenging expertise. These findings contribute to the understanding of AI’s role in crisis management and underscore the importance of a hybrid approach where technology complements, rather than replaces, human capabilities. We propose a maturity model for crisis cells’ anticipation capacities.

ABSTRACT We present a conceptual proposal of leadership on faculty engagement in a hybrid environment as higher education institutions (HEI) adjust to the post-pandemic remote working option. Due to the hierarchical organisational structure of HEIs and the long-term employment with tenure, identifying leadership behaviours attenuate actions that further push faculty towards their autonomous inclination, which results in greater disengagement with the institution. We provide (1) an analysis of ways in which recognised forms of leadership further exacerbate faculty disengagement in a remote environment and present (2) a conceptual framework of emerging forms of leadership resulting from the remote environment.

Defining Quality Metrics for Telemedicine in Surgery: A Critical Examination.

Chemical Organization Theory (COT) provides a structural and algebraic framework for analyzing reaction-based systems independently of kinetic assumptions. By identifying closed and self-maintaining sets of species, called organizations, the theory characterizes all structurally admissible persistent configurations of a reaction network. This review synthesizes the mathematical foundations of COT, including closure operators, stoichiometric feasibility, and lattice structures, together with their algorithmic and dynamical interpretations. We examine how organizational structure constrains long-term behavior in reaction-based dynamical systems, including ordinary differential equations, stochastic processes, and spatial reaction-diffusion models. Computational methods for enumerating organizations and distributed organizations are reviewed, alongside extensions to discrete and stochastic settings. Applications spanning atmospheric chemistry, virus dynamics, gene regulation, cell cycle models, and data-driven reaction systems illustrate the breadth and versatility of the framework. Relations to chemical reaction network theory, autocatalytic set theory, and constraint-based approaches are clarified to position COT within the broader landscape of mathematical reaction network analysis. We conclude by highlighting open problems related to transient dynamics, structural transitions, computational scalability, and evolutionary processes, and by emphasizing COT as a unifying structural abstraction for persistence and qualitative behavior in complex reaction systems.

Afrotropical inland waters remain poorly studied for rotifer diversity. Here, we provide new distribution data from Botswana and connect these local patterns to continental-scale biogeography using an Africa–Europe occurrence dataset. In Botswana, we analyzed rotifer species richness, functional traits, and environmental drivers using 37 samples from 15 water bodies spanning natural and anthropogenic habitats. We recorded 107 rotifer taxa: 92 identified to species or subspecies level and 14 to genus. Seventy taxa (~65%) are new records for Botswana, and one species, Donneria sudzukii, is reported for the first time in Africa. Physicochemical gradients explained community structure, with the first two constrained RDA axes accounting for 40.7% and 23.7% of variation. Axis 1 captured a mineralization gradient linked to total dissolved solids and temperature, whereas Axis 2 reflected oxygen concentration and pH. Traits tracked these gradients: warmer, more mineralized waters were associated with specific trophi types, compact body shapes, and intermediate body sizes, whereas less mineralized, better oxygenated sites were related to smaller taxa and alternative feeding morphologies. To place these trait–environment relationships in a broader geographic context, we then analyzed an Africa–Europe dataset (67,170 records) to quantify latitudinal patterns in thermal classes and morphological traits (geometric body shape and trophi type). Diversity showed clear latitudinal structuring: warm-water genera clustered at low latitudes, only Kellicottia and Didymodactylos had mean distributions above 50° N, and bdelloid families were associated with higher latitudes. Morphological traits also varied with latitude, with trilateral truncated pyramid body shapes and malleoramate trophi occurring closest to the equator. Overall, by combining new species-level data from Botswana with continent-scale occurrence patterns, we link local community assembly to macroecological structure in rotifer functional and biogeographical organization.

Risk culture has become a decisive factor in organizational resilience, ethical conduct, and strategic foresight. However, leading frameworks like COSO ERM and ISO 31000, while emphasizing culture, neglect the critical influence of structural and behavioral realities that dictate risk transparency. This paper argues that genuine improvement in risk culture is unattainable without foundational governance reform, specifically, ensuring the structural independence of the organization’s Chief Risk Officer. We integrate organizational structure theories, psychological safety research, and behavioral science to interrogate how reporting lines, incentive systems, and board dynamics fundamentally shape risk behavior. The paper proposes a new conceptual model, derived from a comparative analysis, that integrates governance reform, behavioral enablers, and structural alignment. We conclude that a positive risk culture is achievable only through a triad of board-controlled independence, active cultural reinforcement, and systemic behavioral integration. Implications for boards, regulators, and practitioners are discussed, mandating a paradigm shift from 'compliance theater' to authentic governance.

ABSTRACT We examine whether business complexity increases firms' exposure to negative environmental, social, and governance (ESG) outcomes, specifically ESG controversies, using a global panel of firms from 37 countries over the period 2002–2021. We further investigate the moderating roles of external monitoring by financial analysts; internal governance mechanisms, including board independence and workforce gender diversity; and international policy frameworks, with particular emphasis on the Paris Agreement as a regulatory tightening mechanism. Our results show that business complexity is strongly and positively associated with ESG controversies worldwide. Analyst scrutiny amplifies, rather than mitigates, this effect, indicating that external capital market monitoring does not effectively discipline ESG risk in complex firms. In contrast, stronger internal governance, reflected in greater board independence and a higher proportion of female employees, significantly attenuates the complexity controversy link. We also find that the positive effect of complexity on ESG controversies weakens in the post‐Paris Agreement period, consistent with heightened regulatory pressure and compliance expectations imposed on firms following the Agreement. Overall, the study provides novel cross‐country evidence on how organizational structure shapes negative ESG outcomes, integrating insights from complexity and agency theories with important implications for managers, policymakers, and investors.

AI tech gets thoroughly rooted in company functions, and when it starts blending into human resource stuff, big changes happen to organizations, but it's mostly on the micro effects of singular AI tools. It doesn't look at how many org conditions together would affect change. This study bridges this gap by probing how configurations, made up of embedded technology depth, the cross-disciplinary area of human resources, organizational support structure, and data governance development, bring about those good organizational results. Using fuzzy-set qualitative comparative analysis on 6 different companies from different sectors, the research found that there are 3 equifinal pathways to substantial transformation: strategically led deep transformation, business-collaborative agile evolution, or data-driven progressive improvement. Organizational support became a necessary foundation condition. Strong cross-function collaboration and strong data governance can make up for a slightly shallower technology embedding. And provides configurational theories to the knowledge of AI-HRM literature and helps the managers make changes in organizations with AI.

The performance of Islamic banks should not be assessed solely through financial indicators but also through their ability to realize ethical values and public welfare as reflected in the Maqashid Shariah framework. However, empirical studies that komprehensif eously examine the role of Intellectual Capital and Sharia Compliance in explaining Maqashid Shariah Performance (MSP) remain limited. This study aims to analyze the influence of key components of Intellectual Capital and the level of Sharia Compliance on the variation of MSP in Indonesian Islamic commercial banks. Using panel data from 2013–2023, the research employs a quantitative approach based on secondary data extracted from annual reports of Islamic banks. The findings indicate that human capital efficiency and structural capital contribute significantly to the achievement of Maqashid, while capital employed and sharia compliance do not exhibit meaningful effects. The moderation analysis further reveals that only the interaction between sharia compliance and structural capital strengthens MSP. These results highlight that the realization of Maqashid relies more on internal systems, human resource competence, and organizational structure rather than solely on formal compliance practices. This study contributes to the development of maqashid-based performance evaluation and provides practical implications for Islamic banks to enhance governance and internalization of sharia values.

ABSTRACT This study extends Strategic Ambiguity Theory by exploring how institutional characteristics influence social media engagement in higher education. Using Instagram data from 25 U.S. universities with high international student enrollment (2023–2024), it examines the effects of institutional type, follower count, and posting frequency on two metrics: engagement rate per follower and per post, representing relational depth and content amplification. Analyses employed t tests, Spearman correlations, and multiple regression. Findings reveal no significant difference in posting frequency between public and private universities, indicating convergence in posting practices. Public universities achieved higher engagement per follower and, after controlling for audience size, higher engagement per post. Follower count showed a dual effect: negatively predicting engagement per follower but positively predicting engagement per post, underscoring a trade-off between efficiency and reach. Posting frequency neither improved engagement per post nor enhanced engagement per follower, suggesting limited value in volume-based strategies. Theoretically, these results support Strategic Ambiguity Theory by demonstrating how organizational structure and audience scale condition engagement outcomes in platform-based communication environments. By linking institutional identity to observable audience response, the study positions Strategic Ambiguity Theory as a viable middle-range framework for integrating organizational features, platform dynamics, and stakeholder engagement in digital strategic communication.

The purpose of the research. Development of a set of business requirements for the software of digital educational platforms, intended for the formation and implementation of networked educational programs in continuing professional education. Research methods. The study employed methods of comparative analysis and decomposition. Analysis of the regulatory framework and scientific literature resulted in the identification of key characteristics of the network form of educational program implementation. A comparative analysis of seven russian-developed educational platforms was conducted to assess their support for these characteristics. Based on the identified limitations of existing solutions, a set of business requirements was formulated. Results. Five key characteristics of the network form of educational program implementation were identified (shared resource pool, heterogeneous modules, flexible organizational structure, integration with the labor market, personalized learning), distinguishing it from traditional models of network education organization. The comparative analysis revealed incomplete support for these characteristics by modern platforms, particularly regarding the flexible organization structure. Based on these characteristics, a set of five business requirements (business requirements - 1 – business requirements - 5) for the architecture of network digital educational platforms was formulated, aimed at ensuring horizontal network interaction, modular program assembly, and dynamic adaptation of educational trajectories. Conclusion. The developed set of business requirements provides a methodological foundation for designing a new class of information systems – network digital educational platforms – that overcome the technological gap between existing solutions and the needs of networked continuing professional education organization. The requirements have an engineering nature and can be used for drafting technical specifications when creating specific platforms that realize the advantages of network form of educational program implementation.

Background and ObjectiveThe similarities in organizational structure and microenvironment between the brain and kidneys suggest the potential utility of kidney biomarkers in the detection of cerebrovascular diseases. Cystatin C (CysC) and neutrophil gelatinase-associated lipocalin (NGAL), well-established sensitive biomarkers of kidney injury, may also recognize as indicators of neuroinflammation. However, their diagnostic capabilities for ischemic stroke (IS) attacks under different kidney function states remain unclear. This case-control study aims to evaluate the diagnostic value of serum kidney biomarkers for ischemic stroke (IS) attack, with focus on NGAL and CysC.MethodsA total of 498 patients with first IS attack, 173 patients with risk-related diseases (designated as the disease control [DC] group), and 293 healthy subjects (serving as the healthy control [HC] group) were enrolled. A comprehensive comparative analysis was performed to examine the associations between common kidney biomarkers (Specifically, NGAL and CysC) and IS.ResultsSerum NGAL levels were significantly elevated in patients with first IS compared with both the HC group (z=5.964, P<0.001) and the DC group (z=12.191, P<0.001). In contrast, serum CysC levels were significantly higher in these patients relative to the HC group (z=5.762, P<0.001), but no statistically significant difference was observed when compared with the DC group (z=1.663, P=0.289). Partial correlation analysis revealed: 1) among IS patients with normal kidney function, NGAL exhibited the strongest partial correlation with IS (rpartial=0.341, P<0.001), whereas the other four kidney markers showed no statistically significant association (all P>0.05); 2) among IS patients with chronic kidney disease (CKD), CysC showed the highest partial correlation (rpartial=0.460, P<0.001), followed by estimated glomerular filtration rate (rpartial=−0.373, P<0.001), creatinine (rpartial=0.279, P<0.001), NGAL (rpartial=0.233, P<0.001), and urea (rpartial=0.182, P<0.001). Stratified multiple linear regression analysis based on kidney impairment demonstrated: 1) in patients with preserved kidney function, only NGAL was correlated with IS risk (OR=6.54, P<0.001), with moderate diagnostic effect (AUC=0.734, P<0.001); and 2) for CKD patients, CysC outperformed NGAL in diagnosing IS attack, demonstrating a stronger correlation with IS risk (OR=5.97, P<0.001) and a higher discriminatory ability (AUC=0.835, P<0.001).ConclusionIS is intricately linked to both kidney injury and neuroinflammation. NGAL and CysC serve as appropriate biomarkers for diagnosing IS attack in patients with normal kidney function and those with CKD, respectively. Respective monitoring of CysC and NGAL in individuals with and without CKD could facilitate early diagnosis, prevention and targeted management of stroke in high-risk populations.

This study evaluates the impact of implementing progression-of-care huddles on diagnosis and discharge times. It contributes to understanding how adaptive coordination among healthcare professionals enhances decision-making and streamlines care transitions. Guided by coordination theory, this study tests hypotheses using negative binomial regression models applied to 6,794 patient episodes from two observation wards in a U.S. hospital over 14months. The analysis compares pre- and post-huddle periods, controlling for patient and operational factors, with outcomes including time to diagnosis and discharge. Huddles reduced diagnostic decision time by 14%. The impact on post-diagnosis discharge time was only significant for patients discharged to a facility, resulting in a 39% reduction. Effectiveness was contingent on organizational structure: the impact was reduced within focused units. In contrast, huddling remained equally effective in the presence of clinical protocols. Huddles did not compromise care quality, as 30-day readmission rates remained unchanged. The findings show that communication structures can partly substitute for specialization. Protocols and huddling operate as complementary systems to jointly manage uncertainty and complexity. Huddles are particularly effective when intricate workflow interdependencies constrain the speed of decision-making. Healthcare organizations can benefit from huddles even when clinical protocols are implemented. The study advances research on care huddles by demonstrating that high-frequency huddles enhance decision-making in dynamic healthcare environments. It offers insights into how huddles can complement or substitute other organizational mechanisms and demonstrates their capacity to provide adaptive coordination even without dedicated teams.

The study aims to assess the reality of strategic clarity in sustainable development within selected Iraqi universities by measuring dimensions such as clarity of activities, purpose, ref-erences, organizational structure, leadership roles, and staff roles. The study also explores the differences between public and private universities, focusing on academic leadership and analyzing them using statistical methods. The study highlights gaps in strategic clarity and their impact on sustainability. The study targeted leaders (deans, assistant deans, and department heads) from six univer-sities: three public universities (Tikrit, Kirkuk, and Northern Technical University) and three private universities (Al-Kitab, Al-Qalam, and Imam Jaafar Al-Sadiq). 259 responses were collected via an online questionnaire, reflecting a relatively good level of overall strategic clarity. The scientific value of the study is determined by addressing the knowledge gap by focusing on academic leadership and using advanced statistical methods. The results contrib-ute to providing practical insights for improving resource management and enhancing strate-gic planning in educational institutions. The results showed no statistically significant differ-ences in most dimensions except for resource clarity. Private universities have outperformed public universities, which face challenges in allocating resources due to their flexible funding and administrative independence.

Robotic liver surgery has gradually increased within the realm of minimally invasive hepatobiliary surgery; nevertheless, worldwide adoption rates, educational systems, and thought processes are various. An online worldwide survey was devised to collect data from hepatobiliary surgeons with experience or interests in robotic liver surgery. The design explores the use of robotic platforms, adoption rate, learning opportunities, learning curves, procedural options based on complexity, safety in perioperative phases, and limiting factors. Descriptive statistics are used to analyze the collected responses. The da Vinci platform is the most commonly used, while the new systems are still in the early adoption stages. Variability of use patterns has been identified. Structured learning, including simulation, proctoring, and learning at a second console, has been identified as essential to ensure safe adoption. The learning curve is a multi-step process that is dependent on procedure type, inherent surgical skills, and prior training. The laparoscopic, robotic, and open methods are considered to be relatively similar in low-complexity resections, while robotic, open, or a combination of robotic or open would be preferred for directing posterosuperior, major hepatectomy, as well as reconstruction cases, respectively. Robotic liver surgery is gradually being adopted within the realm of hepatobiliary surgery, but has been unevenly distributed. Uniform models of training, organizational structure, and equal availability of systems are essential factors that define how such systems are expanded.

Purpose Hydropower engineering-procurement-construction (EPC) megaprojects are characterized by persistent coordination and integration challenges within project consortia. This study aims to examine the critical governance factors that influence internal coordination and integration and explore how these factors interact to shape sustainable value co-creation. Design/methodology/approach Employing an exploratory dual-case study grounded in value co-creation theory and the relational coordination framework, this study analyzed primary and secondary data from two representative hydropower EPC megaprojects. Grounded theory methodology with substantive coding was applied to extract critical factors of integrated governance. Findings This study presents a theoretical framework that explains the critical governance factors influencing sustainable value co-creation in hydropower EPC megaprojects. The framework identifies four interdependent governance dimensions that form a self-reinforcing cycle. Capability configuration provides the foundation for value co-creation, organizational structure safeguards value distribution, relational collaboration underpins sustainability and institutional environment accelerates value realization, collectively forming the capability–organization–relationship–environment (CORE) framework. Originality/value This study extends corporate governance theory to the unique joint venture (JV) structure in hydropower EPC megaprojects. It contributes a qualitatively grounded, four-dimensional governance framework that advances understanding of consortium integration and offers practical insights into how EPC consortia can be governed to support sustainable value co-creation in complex infrastructure projects.