Policy Changes Research Articles

Abstract 4138294: Medicare Utilization and Associated Spending on Icosapent Ethyl

Introduction: In 2019, Icosapent Ethyl became the first US Food and Drug Administration (FDA) approved medication for reducing cardiovascular risk beyond cholesterol-lowering therapy in high-risk patients. It was approved specifically as an adjunct to maximal tolerated statin therapy to reduce cardiovascular risk in adult patients with elevated triglyceride (TG) levels. The National Lipid Association now has a Class I recommendation for the use of icosapent ethyl (4 g/d) to reduce cardiovascular risk in patients with TG > 150 mg/dl. Methods: We analyzed available data from Medicare Part D prescription drug events published from the year 2018 to 2022. All data were de-identified and made publicly available. All costs were adjusted for inflation and represented in 2022 US dollars. Results: The number of Medicare Part D beneficiaries prescribed Icosapent Ethyl increased from 141,336 to 303,971 (215%) between 2018 and 2022 (Fig. A) and the number of claims increased from 704,334 to 1,527,133 (216%) (Fig. B). The total spending increased from $278 million to $787 million (282%) within the same timeframe (Fig. C). The average spending per claim has increased from $396 to $515 (130%) (Fig. D) and the average spending per beneficiary has also increased from $1976 to $2591 (131%) (Fig. E) between 2018 and 2022. Discussion: We observed a marked increase in the use of icosapent ethyl from 2018 to 2022. We can see a sharp rise of 187% in beneficiaries from 2018 to 2019 following FDA approval. The total number of claims and total spending also increased by 181% and 200%, respectively, from 2018 to 2019. The average spending per claim and average spending per beneficiary has increased from 2018 to 2022. It also demonstrates the cost burden to Medicare with the use of such lipid-lowering agents. Many Medicare plans include icosapent ethyl as a Tier 4 drug, which is the second most expensive drug tier. Limitations: The pattern of data used may not be generalizable to other payer demographics. Policy changes can affect the comparability of data over different periods. Conclusion: Our data highlights the increasing use of icosapent ethyl as a cardiovascular risk-reduction medication in the Medicare population. There has been a steady increase in the number of claims and beneficiaries since the approval of icosapent ethyl with an increase in average spending from 2018 to 2022.

Migrant Deaths in California’s Borderlands, 2018–2023

Executive Summary We examine the deaths of undocumented migrants in southern California (i.e., San Diego and Imperial counties) for fiscal years (FYs) 2018–2023 using data obtained from the San Diego County Medical Examiner’s Office (SDCMEO) and Imperial County Coroner’s Office (ICCO). We recorded 314 deaths of undocumented migrants, with 157 in San Diego County (SDC) and 157 in Imperial County (IC). We describe trend fluctuations in migrant deaths and both the overall and county-specific proportions as they relate to causes of death and demographic characteristics (biological sex and age at death). Additionally, to capture the potential effects of the 2019 border wall expansion and COVID-19 pandemic on migrant deaths, we examined differences in these factors between two periods: FY 2018–2019 and FY 2020–2023. We conclude by comparing migrant deaths reported by the medicolegal authorities to estimates published by US Customs and Border Protection’s (CBP) Border Patrol for southern California. From 2018 to 2020, there were approximately 30 known migrant fatalities annually in California. This increased to about 88 deaths per year in 2021 and 2022 before dropping to 50 in 2023. Across the study period, the leading causes of death were drowning (35.4 percent), environmental exposure (23.6 percent), and blunt force trauma (16.9 percent), with the latter cause being largely associated with falls from the border wall. However, we found significant differences between SDC and IC. For instance, 51.6 percent of migrant deaths in IC were due to drowning, compared to 19.1 percent in SDC. Conversely, 21.7 percent of deaths in SDC were due to blunt force trauma, while just 12.1 percent of deaths in IC occurred in this manner. Overall, we found that 75.2 percent of decedents were male, 20.4 percent were female, and 4.5 percent were of unknown sex. Among cases in which a precise age at death was listed, the average age was 34.6 years. Nevertheless, sex and age differed by county in that SDC had a higher proportion of female decedents (28 percent in SDC vs. 12.7 percent in IC) and a higher average age at death (SDC x¯ = 36.8 vs. IC x¯ = 32.0). We also found significant differences between the two periods examined. Perhaps most striking, deaths due to blunt force trauma increased from 3.4 percent of cases in FY 2018–2019 to 19.9 percent of cases in FY 2020–2023. Decedent characteristics also appear to have changed across time. The share of male decedents decreased from 84.5 percent to 73.0 percent, while the share of females increased from 5.2 percent to 23.8 percent between the two periods, while the proportion of decedents ages 50 to 64 years increased significantly (from 4.7 percent to 12.7 percent). Finally, for FYs 2018–2022, CBP reported 25.6 percent fewer migrant deaths than medicolegal authorities in southern California. High numbers of migrant deaths in 2021 and 2022 can be attributed to circumstances during and following the COVID-19 pandemic, including a Trump Administration policy aimed at blocking access to the US asylum system. The expansion of the border wall during the Trump era may also explain increased migrant mortality in 2021 and 2022. Decreases in deaths in California in 2023 may be because of a novel entry location in the San Judas Break or result from a shift in migration trends toward other border states (i.e., Arizona, New Mexico, and Texas). County differences in drowning and blunt force trauma deaths were likely due to the presence of the All-American Canal in IC (drowning), and greater coverage of the pedestrian border wall in SDC (blunt force trauma), respectively. Although speculatory, the higher percentage of female decedents and older age of decedents in SDC may be because these vulnerable individuals perceive San Diego to be a safer route. Changes between FYs 2018–2019 and FYs 2020–2023 in blunt force trauma deaths (3.4 percent to 19.9 percent) are a result of falls from the newly expanded and constructed border wall. We suggest that after more than 30 years of implementation, the United States should eliminate the use of “deterrence” strategies to prevent further and unnecessary loss of life. Additionally, the following actions could reduce migrant mortality in California: installing buoys or other anti-drowning devices in the All-American Canal, making potentially life-saving resources (e.g., blankets and water) available on known migrant routes, and reducing the height of or removing the border barrier. We call for both CBP and medicolegal authorities to provide disaggregated data on migrant fatalities, which would facilitate an accurate accounting these deaths, increase understanding of where and why deaths occur, and therefore be used to support policy changes.

The EU Changing Policies towards Israeli- Palestine Conflict: The Interplay of Regional and International Parameters

The EU adopted “balanced” position towards Arab-Israeli conflict since 1980s. However, starting from the 2000s, the EU left its neutral position and addressed Palestinian conflict within the context of security. This paper aims to explore the reasons behind changing policies of the European Union towards Israeli-Palestinian dispute since 2000s by making reference to the shifts in international and regional settings, particularly after Arab uprising and Russia-Ukraine war. Firstly, the EU/EC's approach to Palestine-Israeli conflict over time is explored. Secondly, how the regional and international setting, which is based on multi-polarity and regional conflicts, altered the EU’s policies will be discussed at theoretical level. Lastly, institutional constraints that prevent the EU to carry out normative policy will be explored.

Abstract 4138420: Impact of the American Heart Association Get-With-The-Guidelines Heart Failure A.S.I.A. Program in Taiwanese hospitals

Introduction: The American Heart Association (AHA) Get With the Guidelines – Heart Failure program has been implemented for years in the United States with extensive literature supporting its benefits. In 2022, the AHA Heart Failure Adherence to Science Implementation in Asia (HF A.S.I.A.) powered by Get With The Guidelines program was first introduced in five Asian countries. Research Question: This study aims to explore the impact of this program's implementation in Taiwanese hospitals. Methods: Data were sourced from the Taiwan Society of Cardiology-HF-Registry 2020, a prospective registry that tracks HF cases from 27 hospitals in Taiwan between 2020 and 2024. Among these, four hospitals began participating in the HF A.S.I.A. program in January 2022. This study compared patients from hospitals that participated and did not participate in the HF A.S.I.A. program. Results: A total of 1,933 HF patients with a left ventricular ejection fraction ≤ 40% were included, comprising 460 participants from the HF A.S.I.A. program and 1,473 non-participants. The HF A.S.I.A. group was younger, had significantly lower systolic blood pressure, larger left ventricular diameter, and experienced more frequent prior hospitalizations for HF. However, there were no significant differences between the two groups in terms of baseline heart rate, estimated glomerular filtration rate, blood potassium levels, and most comorbidities. During the study period, due to changes in payment policies, the use of angiotensin receptor neprilysin inhibitor (ARNI) decreased in the non-participant group, while the use of sodium glucose co-transporter 2 inhibitor (SGLT2i) increased. Conversely, the use of ARNI in the HF A.S.I.A. group continued to rise in line with guideline recommendations and the usage of SGLT2i was higher than in the non-participant group. After adjustment, one-year lost to follow-up rate was significantly lower (3.0% vs. 5.6%, p =0.032) and all-cause mortality rate trended non-significantly lower (7.6% vs. 11.4%, p =0.096) among the HF A.S.I.A. group. Conclusion: Despite enrolling sicker patients, participation in HF A.S.I.A. program was associated with higher quality of HF care.

Abstract 4137135: Trends in Mechanical Circulatory Support After the New Heart Allocation Policy

Background: In October 2018 a new heart allocation policy (NHAP) was implemented, which resulted in patients with Intra-aortic balloon pumps (IABP) being upgraded to status-two. We sought to determine practice pattern changes in mechanical circulatory support (MCS) use as a result of the NHAP. Hypothesis: Changes in the new heart allocation policy may lead to shifts in choice of mechanical circulatory support. Methods: A retrospective analysis was conducted using the National Inpatient Sample (NIS) between 2017–2020. Hospitalizations for cardiogenic shock were identified, and stratified based on whether the patients were admitted before or after the NHAP. Baseline characteristics were compared between these cohorts, and the primary outcome of interest was the use of MCS and transplant before and after the NHAP. Subgroup analyses included patients only in transplant centers, non-transplant centers, and those who eventually underwent transplant. Results: A total of 689,935 hospitalizations were included in the final analysis, of which 279,230 (40.5%) were before the NHAP, and 410,705 (59.5%) were after. In allcomers, hospitalizations after the NHAP were less likely to undergo IABP (Adjusted odds ratio [OR] 0.81, p<0.01) and LVAD (Adjusted OR 0.73, p<0.01). These findings were consistent in most subgroup analyses. Patients who underwent transplant after the NHAP however were more than twice as likely to have received a IABP compared to those admitted prior to the NHAP (adjusted OR 2.58; p<0.01). Conclusion: IABP placement after the NHAP increased in patients who underwent transplant, as opposed to allcomers or patients who did not undergo transplant. This change in utilization of MCS may be reflective of perceived benefits and biases in regards to transplantation candidacy.

Luigi Pasinetti: an appreciation

Abstract This article presents an appreciation of the lifetime contributions of Luigi Pasinetti to economics. In a career spanning 70 years, Pasinetti operated at the frontiers of economic theory and analysis. The article covers his contributions to the economics of growth, distribution, capital, structural change, production and fiscal policy. It also provides an account of his intellectual formation and a checklist of his published works.

Abstract 4118641: Trend, Survival, and Disparity Analysis of Heart Transplantation in a Single Large Transplant Center

Background: In the landscape of organ transplantation, heart transplantation stands as a life-saving procedure for patients with end-stage heart failure. Comprehensive analyses of transplant programs are imperative to optimize outcomes and understand the complexities. Hypothesis: This study hypothesizes that an increasing trend of heart transplant service and short-term mechanical circulatory support (STMCS) is the bridge to transplant; the UNOS (United Network for Organ Sharing) guideline positively impacts STMCS utilization. Even with the standard of care, there might be a disparity in receiving care in terms of gender and race. Goal/ Aims: By examining this center's collective experience, this research provides valuable insights into the evolving landscape of heart transplantation, ultimately contributing to advancements in patient care and transplant policy. Methods: This retrospective cohort study includes heart transplant patients in a single large transplant center. For statistical analysis, Cox regression, Mann-Whitney test, Kruskal Wallis, and Chi-Square test were used in IBM SPSS 25. Result: Trends: This retrospective study covering 2010 to 2022 comprehensively analyzed 1513 heart transplant patients. The cohort consisted of 1071 (70.78%) males and 442 (29.21%) females, 31.9% were bridged through STMCS. 76.7% of Caucasian and 16.1% were African American.The mean utilization of STMCS was 20.08% before the UNOS policy change, increasing to 53.81% after that (p < 0.001). Disparity Analysis: There was a statistically significant difference in STMCS utilization between white and black patients (p= 0.008) but no difference in between obese and non-obese cohorts (P=0.362).Wait time was similar among the genders (p=0.161) and different races (p=0.302). Survival Analysis: There is a significant survival discrepancy between patients bridged through MCS and those without STMCS(p< 0.001). However, yearly trend analysis showed an evolving survival trajectory favoring STMCS users. There are statistically significant survival differences among whites and blacks (P =0.008) but similar among the genders (p=0.589). Summary: The study reveals significant changes in the trend of transplants regarding STMCS utilization since the UNOS guideline. There are substantial differences in survival between STMCS vs. non-STMCS groups and among the races.There was a significant difference in STMCS utilization among the races.

Predictors of intention to use contraceptives among married and cohabiting women in Ghana: A cross-sectional study

BackgroundContraceptive use is a cost-effective intervention for reducing unintended pregnancies and sexually transmitted infections and their negative consequences. It is vital to increase contraceptive use among women to improve their reproductive health outcomes. This study examines the factors associated with contraceptive use intention among married and cohabiting women in Ghana.MethodsWe analysed data from the 2022 Ghana Demographic and Health Survey. A total of 5,846 married and cohabiting women were included in the study. A multivariable binary logistic regression analysis was used to examine the factors associated with the intention to use contraceptives. The regression results were presented using an adjusted odds ratio (aOR) with 95% confidence intervals (CIs).ResultsThe proportion of intention to use contraceptives among married and cohabiting women was 33.0% [31.1, 35.0]. Compared to women living in the Greater Accra, those living in Central (aOR = 1.69; 95% CI = 1.06, 2.69), Bono East (aOR = 1.63; 95% CI = 1.02, 2.61), Oti (aOR = 2.68; 95% CI = 1.63, 4.40), and Upper West Regions (aOR = 4.48; 95% CI = 2.68, 7.48) were more likely to have contraceptive use intention. The odds of intention to use contraceptives increased with increasing parity, with the highest odds among women with four or more births (aOR = 2.41; 95% CI: 1.66, 3.51). The intention to use contraceptives decreased with increasing age, with the lowest odds among those aged 45–49 (aOR = 0.04, 95% CI = 0.25, 0.07). Women with no education (aOR = 0.42, 95% CI = 0.28, 0.63), primary education (aOR = 0.56, 95% CI = 0.37, 0.86), and secondary education (aOR = 0.65, 95% CI = 0.45, 0.92) had lower odds of intention to use contraceptives compared to those with higher education. Married women (aOR = 0.61, 95% CI = 0.49, 0.76) had lower odds of contraceptive use intention relative to cohabiting women.ConclusionOur study revealed a low contraceptive use intention among women, signalling a barrier in access to family planning services in the country. Various factors, including age, region, marital status, parity, and educational level play a role in determining the intention to use contraceptives. These findings underscore the importance of implementing policy changes and enhancing existing programmes to improve the availability of information, contraceptive education, and family planning services, especially for younger women, those living in rural areas, and those with lower levels of education. Additionally, it is vital to address socio-cultural barriers and empower women to address the factors associated with intention to use contraceptives.

Peran Politik Islam Dalam Dinamika Pemerintahan Perspektif Dalam Negeri dan Luar Negeri

This study discusses the role of Islamic politics in government dynamics, with a focus on domestic and foreign perspectives. Islamic politics is a key factor influencing political policies and processes in many countries with a majority Muslim population. The aim of this research is to analyze how political Islam plays an important role in shaping government systems and public policies, both domestically and at the international level. This research uses a qualitative approach by combining literature analysis and case studies from several countries that represent differences within the country and abroad. The analysis was carried out by considering aspects such as Islamic political participation, the influence of Islamic politics on policy changes, and the impact of Islamic politics in international relations. The research results show that Islamic politics has a significant role in the dynamics of government in the country. Islamic political participation, through Islamic-based political parties or social movements, can influence the policy-making process and change the political orientation of the country. Factors such as religious identity, social justice, and the aspirations of Muslims often form the basis of Islamic politics in taking positions in government. At the international level, political Islam also plays an important role. Countries with a majority Muslim population often use Islamic politics as a tool to maintain their sovereignty and fight for their interests in the international arena. This can be seen in relations between Muslim countries and Western countries and in issues such as Palestine and the role of Islam in global affairs.

DISP-05. SUPERVISED MACHINE LEARNING PREDICTION OF THERAPEUTIC CLINICAL TRIAL ENROLLMENT FOR MINORITY PATIENTS AND WOMEN IN NEURO-ONCOLOGY

Abstract BACKGROUND Despite changes in national policy, women and minority patients remain under-accrued in glioma clinical trials. Supervised machine learning may serve as a novel approach to understanding which variables and their complex interplay most influence enrollment for underrepresented patients. We aimed to design and externally validate machine learning models to predict therapeutic clinical trial enrollment for a) all patients, b) women, and c) NIH-designated minority patients with low- and high-grade glioma. METHODS In a 20-year retrospective cohort of 1042 adult patients with low- and high-grade glioma, boosted neural network (BNN) models for the whole, women, and minority cohorts were used to analyze the combined effects of demographic, socioeconomic, and oncologic variables on clinical trial enrollment. These models were validated using an external cohort (n=103). RESULTS In the development cohort (445 [42.7%] women; 151 [14.5%] minorities; median age, 51.5 [interquartile range: 39.4-62.5] years), 350 patients (33.6%) enrolled in a therapeutic clinical trial. The whole cohort BNN (AUC: 0.827, misclassification rate (MR): 0.175), the women cohort BNN (AUC: 0.895, MR: 0.125), and the minority cohort BNN (AUC: 0.983, MR: 0.053) models accurately predicted trial enrollment on external validation. For the whole cohort and women models, several demographic (race, ethnicity, minority status, sex), socioeconomic (insurance, employment status), and oncologic variables (seizure, chemotherapy, KPS, WHO grade, tumor lobe) were equally influential (Main effect (ME): 1.000, Total effect (TE): 1.000) on enrollment. For the minority model, socioeconomic variables including insurance status (ME: 0.089, TE: 0.417) and occupation classification (ME: 0.087, TE: 0.381) drove enrollment. CONCLUSION We designed and externally validated the first machine learning model for predicting therapeutic clinical trial enrollment for patients with diffuse glioma. Model features driving trial enrollment varied for underrepresented patients. These results may help prioritize personalized patient-specific initiatives to address barriers to equitable patient accrual.

Türkiye-China relations revisited: a neo-Gramscian perspective

ABSTRACT A considerable number of studies have attempted to analyse changes in Turkish foreign policy under the Justice and Development Party administration. These changes triggered the debate about whether Turkish foreign policy shifted its Western orientation. Departing from rising anti-West rhetoric in Turkish foreign policy, this study sets out to explain the recent rapprochement between Türkiye and the People’s Republic of China. From a critical perspective, it proposed a new way of viewing Türkiye’s relations with China as a counter-hegemonic rapprochement reshaped by internal/external dynamics in the post-western world order. Consequently, it shows which ideas, material capabilities, and institutions have played roles in the Erdogan administration’s challenge to Western hegemony by utilizing relations with China.

Evolution of Episiotomy Incidence and Obstetric Anal Sphincter Injury Over 10 Years: A Mixed-Methods Study.

To assess the association between the decrease in the use of episiotomy and the incidence of obstetric anal sphincter injuries (OASIS) over a 10-year period and understand their reasons by interviewing obstetricians and midwives. Mixed-methods study. A tertiary university public maternity hospital, Paris, France. All patients who delivered vaginally between January 2012 and December 2021 in the maternity hospital and 20 interviews with obstetrician-gynaecologists and midwives. Quantitative data analysis using a multivariate logistic regression model, stratifying on the mode of delivery. Semi-structured interview with 20 obstetricians and midwives, with an interview guide. Obstetric anal sphincter injuries. The quantitative study of 37 942 women (16.1% of whom had an episiotomy and 1.4% OASIS) shows that, the incidence of episiotomy decreased from 25% to 7.6% over this 10-year period. Allow on the known risk factors for OASIS, we demonstrate that its incidence rose (adjusted odds ratio 1.35, 95% confidence interval 1.09-1.67) for the years in which the episiotomy incidence fell below 10% for the overall population. The interviews showed professionals' apparent awareness that the decreased incidence in episiotomy (achieved by changes in departmental policy, redefining its benefit/risk balance and acquiring new skills to manage the expulsion phase) could lead to an increased incidence of OASIS. Decreasing the episiotomy incidence appears to be associated with a rising incidence of OASIS. The optimal incidence of episiotomy remains controversial in the literature and among professionals.

Operation strategies of the supplier, demander, and third party under the DRG/DIP reform

In this study, we analyze the operation strategies of the supplier, demander, and third party involved in the current process of China’s health insurance reform. Specifically, we summarize the relevant literature on the reform of healthcare insurance both in China and abroad, explore the current changes in healthcare policy, and identify the main problems in the current diagnosis-related group/diagnosis-intervention packet (DRG/DIP) payment method reform. Based on our analysis, we propose strategies that can satisfy the needs of the supplier, demand side, and third parties and offer valuable suggestions to enhance the healthcare security system and promote the DRG/DIP payment method reform.

Technology-enhanced Learning in Information Systems Education

The COVID-19 pandemic significantly disrupted higher education but also accelerated the adoption of technology-enhanced learning and innovative teaching practices to promote student-centred learning in higher education. Nevertheless, traditional, didactic, teacher-centred approaches in university teaching are still prevalent. Specifically, Information Systems (IS) and other technology-related disciplines are expected to adopt technological innovations more readily. Moving beyond the pandemic, there is a need to reassess the current state of Information Systems education and explore technologies that have been effectively deployed to identify best practices. This study involves reviewing thirteen subjects as part of a Master of Information Systems course offered by one of Australia’s leading universities. It aims to identify innovative technology-enhanced practices that promote student-centred learning, assess their adoption levels and impact, and reflect on any difficulties hindering their adoption. We identified three innovative technology applications that effectively facilitate student-centred learning: web-based interactive content, online collaborative workspaces, and simulation games. However, we found that these technologies are primarily adopted for tutorials. Nevertheless, the use of technology has led to a notable shift from the traditional teaching approach to a flipped classroom model. The findings highlight the need for university-wide support, policy changes, and investments in time, resources, and staff training to enhance student-centred learning through the use of technology.

EU Cohesion Policies and interregional inequalities in disruptive times

Despite the numerous contributions assessing the efficiency and effectiveness of Cohesion Policies, their role in stimulating growth and cohesion in different macroeconomic settings and in different business cycle periods remains highly debated. This article aims at contributing to this literature by investigating the link between Cohesion Policy, economic growth and interregional inequalities over periods of crisis and recovery. In particular, the article analyses whether Cohesion Policy is beneficial for the recovery of those regions mostly hit by the crisis and contributes to narrowing interregional gaps enhanced by the crisis. In addition, the paper analyses how the link between Cohesion Policy and interregional inequalities changes by investment axes, as it is the case of Research, Technology Development and Innovation funds, targeted to different goals. Based on an analysis covering all EU27 and UK NUTS2 regions in the period 2008–2019, the article confirms the multifaceted nexus between Cohesion Policy and interregional inequalities. It also raises warnings about the potential conflicts between its overarching goals and its multiple and expanding strategic objectives.

Category-Based Administrative Access Control Policies

As systems evolve, security administrators need to review and update access control policies. Such updates must be carefully controlled due to the risks associated with erroneous or malicious policy changes. We propose a category-based access control (CBAC) model, called Admin-CBAC , to control administrative actions. Since most of the access control models in use nowadays (including the popular RBAC and ABAC models) are instances of CBAC, from Admin-CBAC , we derive administrative models for RBAC and ABAC, too. We present a graph-based representation of Admin-CBAC policies and a formal operational semantics for administrative actions via graph rewriting. We also discuss implementations of Admin-CBAC exploiting the graph-based representation. Using the formal semantics, we show how properties (such as safety, liveness, and effectiveness of policies) and constraints (such as separation of duties) can be checked, and discuss the impact of policy changes. Although the most interesting properties of policies are generally undecidable in dynamic access control models, we identify particular cases where reachability properties are decidable and can be checked using our operational semantics, generalising previous results for RBAC and ABAC α .

Fifty years of teacher education in South Africa: towards systematic learning and social transformation

ABSTRACT The article tracks key moments in teacher education policy and curriculum in South Africa from the 1970s to the present day. Political and social features of education in each decade are outlined, from a racialised and fragmented system of teacher education, to the imagining of alternatives, and the imperative for educational transformation. The article pays special attention to the role of teacher education in a national agenda of social reconstruction within the goals of the 1996 Constitution of South Africa, to establish a post-apartheid society based on democratic values, social justice and fundamental human rights. Drawing on a conception of teaching as organising systematic learning, we track ways in which changes in teacher education policy have enabled or restricted opportunities for systematic learning for students in different social contexts, and towards advancing equity. We argue that insights from strong theoretical frameworks create conditions of possibility for student teachers to analyse and interrogate their observations and experiences within the existing schooling system. In so doing, they potentially become agents of transformation, as they imagine practical possibilities for improving teaching in and beyond their immediate school and contextual realities. At the same time, we note the limitation of too narrow a focus on systematised knowledge, without sufficient attention to the life histories and aspirations of student teachers themselves. We suggest that a crucial way forward is to consider how personal development, teacher knowledges and classroom experiences and interactions work symbiotically to support student teachers’ pedagogic learning, even against the enduring challenges of severe inequalities in South Africa. This requires attention to how knowledge informs teaching, how curricula can support the process of learning to teach, and how systematic learning can be nurtured in the pursuit of social transformation.

Perinatal Loneliness and Isolation Early in the COVID-19 Pandemic in New York City: A Qualitative Study.

During the COVID-19 pandemic, birthing parents were identified as a high-risk group with greater vulnerability to the harms associated with SARS-CoV-2. This led to necessary changes in perinatal health policies but also to experiences of maternal isolation and loneliness, both in hospital settings, due to infection mitigation procedures, and once home, due to social distancing. In this study, we qualitatively explored birthing and postpartum experiences in New York City during the early days of the pandemic when lockdowns were in effect and policies and practices were rapidly changing. Using thematic analysis, our focus was on experiences of isolation, navigating these experiences, and the potential impacts of isolation and loneliness on maternal health for 55 birthing people. Participants described numerous stressors related to isolation during the birthing process, including reconciling their hopes for their birth with the realities of the unknown and separation from partners, family, and friends in the hospital. During the postpartum period, loneliness manifested as having limited or no contact with family and friends, which led to feelings of a need for strengthened social support systems. The impact of these negative experiences shaped mental health. Overall, we found that solitary experiences during birthing and postpartum isolation were major sources of stress for participants in this study. To support impacted families and prepare for future crisis events, clinicians and researchers must prioritize the development of strong clinical and social support structures for perinatal people to ensure both maternal and child health.

Confronting the idealised ‘Nordic model’ in education with contemporary realities of special education in Sweden

ABSTRACT For decades, the Nordic countries have been admired for their inclusive education systems within egalitarian societies, bolstered by PISA studies and global calls to ensure inclusive education as a human right. This paper contrasts idealised perspectives on Nordic education with internal experiences, exploring recent challenges to the relationship between special and inclusive education. Using Sweden as a case study, it highlights internal diversity within the Nordic region, showing differing paths and gaps between research, policy and school realities. The risks of idealising past educational models are discussed, noting that Sweden, once known for its egalitarian education and low special education needs classification rates, now faces higher classification rates and more separate provision due to policy changes. Recent trends have shown a shift towards increased diagnosis and classification, influenced by marketisation and decentralisation policies. The paper focuses on neurodivergence, analysing shifts in government priorities, teacher education, school practices and research agendas. Analysis of recent policies, reports and educational data reveals winners and losers in school participation, providing insights into the implications for educational discourse, the future of the ‘Nordic model’, and Swedish education in a global context.

Immigration Policy and Latinx/é Children from Mixed-Status Families: Mental Health Consequences and Recommendations for Mental Health Providers

The impact of immigration policies on Latinx/é mixed-status families and their children is undeniable. Changes in immigration policy, focused on increased deportation enforcement, within the last three decades have led to an increased fear of deportation and unique circumstances mixed-status families must navigate. These circumstances, combined with fear of deportation, have had deleterious effects on the psychological well-being of the family, in general, and the children, in particular. This paper reviews the impact of immigration policies on Latinx/é mixed-status families, the unique circumstances of mixed-status families, and the mental health implications these have on the children specifically. Articles and books were selected from various sources that addressed Latinx/é mental health, mixed-status families, and immigration. After a review of the literature, these circumstances emerged: familial separation, citizen children second-class citizenry, developmental implications, psychological implications, and coping mechanisms and strategies of mixed-status families. Recommendations for mental health providers who work with children from mixed-status families are provided.