Policy Research Research Articles

Reflective teaching as a form of continuous training: tata city as a case study, Morocco

ABSTRACT This study investigates EFL teachers’ perceptions, challenges, and practices of reflective teaching in the provincial directorate of the Moroccan Ministry of Education in Tata. A mixed methods research design was adopted, with 42 EFL teachers participating in the study. The data were collected through a five-point Likert scale questionnaire, semi-structured interviews, and the analysis of three official Moroccan documents. Descriptive statistics and thematic analysis were used to analyze the quantitative and qualitative data, respectively. The findings revealed that the EFL teachers perceive reflective teaching as a tool for professional growth and informed teaching practices, but face personal challenges related to schools, and the Moroccan Ministry of Education. The study highlights the value of reflective teaching and identifies the challenges that need to be overcome especially lack of interpersonal skills, heavy workload, and absence of institutional programs. It also reveals that keeping journals and holding discussions with EFL teachers are among the preferred practices of reflective teaching in the provincial directorate of the Moroccan Ministry of Education in Tata. The study has direct implications for policy makers and research.

Happiness across the borders-A cross-sectional study among patients with psoriasis and atopic dermatitis in Europe.

Dermatological research has traditionally concentrated on evaluating mental comorbidities, neglecting positive concepts like happiness. Initial studies indicate that psoriasis and atopic dermatitis (AD) impair the happiness of those affected. Considering global happiness variations, this study aimed to explore the disease- and country-specific differences in disease-related quality of life and happiness, and potential influential factors on heuristic happiness among psoriasis and AD patients in Europe. A cross-sectional multicentre study was conducted in dermatology departments of university-affiliated hospitals in eight European countries (Austria, Germany, Italy, Malta, Poland, Portugal, Romania and Ukraine) between October 2021 and February 2023. Adult psoriasis and AD patients completed a standardized questionnaire in their native languages, providing data on demographics, disease-related characteristics, disease-related quality of life (Dermatology Life Quality Index, DLQI), heuristic happiness, positive affect (PA), negative affect (NA) and satisfaction with life (SWL). Descriptive analysis and quantile regression were performed. Between psoriasis (n = 723) and AD (n = 316) patients almost no differences were observed in happiness, SWL and NA, except for DLQI and small differences in PA, with AD patients reporting greater impact than psoriasis patients. Country-wise variation emerged in DLQI, heuristic happiness, PA, NA and SWL with Austrian patients displaying the highest levels of happiness, satisfaction and positivity, coupled with higher treatment care and lower disease severity. Quantile regression revealed varying coefficients for predictor variables across quantiles, indicating, for example positive effects on heuristic happiness associated with current or previous receipt of systemic therapies at different quantiles. This study shows notable happiness differences across European countries and significant disease-related variations, particularly with AD patients being more impaired than psoriasis patients. The findings highlight the need for equality in treatment access and support the development of targeted positive psychological interventions to enhance happiness considering country-specific distinctions in future research and health policies for psoriasis and AD patients.

Developing a list of Alert Alien Species in South Korea.

Along with transportation development, climate change and socio-economic changes, invasive alien species (IAS) are causing a significant decline in biodiversity around the world. Internationally, policies for pre-invasion management of IAS are being emphasised to minimise damage from biological invasions. In South Korea, through the 2nd Alien Species Management Plan (2019-2023), IAS that are not yet present in the country but are likely to be introduced are designated as Alert Alien Species (AAS). In this study, the overall process of AAS designation is summarised and improvements to the current system are presented. To select AAS, an invasive alien species database (IASD) of 8,456 species was built by integrating the IAS lists from many countries. Amongst them, 1,534 species, included in IASD at genus, family and order level, were excluded and 3,298 species confirmed to have been introduced to South Korea were excluded from the AAS candidate species. After the creation and review of species profiles by experts, 150 species were finally designated as AAS in 2023. The AAS discovery process needs to reflect international trends of IAS and be continuously supplemented through policy research of other countries. In addition, the IAS management system in South Korea, in which various ministries play their own roles with sufficient data sharing, should be systematically linked from introduction to control of IAS.

Pharmacy practice and policy research in Türkiye: a systematic review of literature.

In recent decades, there has been an interest in clinical pharmacy practice in Türkiye with emerging studies in this area. Despite the recent emergence of diverse pharmacy practice studies in Türkiye, a comprehensive assessment of overall typology of studies and impact has not been conducted thus far. This systematic review aims to document and assess pharmaceutical policy and practice literature published within the last 5 years in Türkiye. The other aim is to summarise the expected impact of published studies on policy and practice research. The systematic review was conducted according to the guidelines described in the PRISMA Statement. A comprehensive search approach, incorporating Medical Subject Headings (MeSH) queries and free-text terms was employed to locate pertinent literature related to pharmacy practice and policy in Türkiye. The search covered the period from January 1, 2019, to January 1, 2024, and involved electronic databases including PubMed, Medline Ovid, Scopus, ScienceDirect, Springer Link, PlosOne, and BMC. In the final grouping, 73 articles met the inclusion criteria and were selected for this review. Among the quantitative studies, majority studies were cross-sectional survey studies. Through the rigorous thematic content analysis seven research domains were developed from the selected literature: drug utilisation and rational drug use, the emerging role of pharmacist, access to medicines and generic medicines, community pharmacy practice, pharmacovigilance/adverse drug reactions, and pharmacoeconomic studies. The pharmacist role is evolving; however, several challenges remain in fully realising the potential of pharmacists. These include regulatory barriers, limited public awareness of pharmacists' expanded roles, workforce capacity issues, and the need for ongoing professional development and training. Research studies are needed in the areas of generic prescribing, medicine adherence, intervention studies in community and hospital pharmacy practice, and on pharmacoeconomics and pharmacovigilance.

Patients’ experiences of mechanical ventilation in intensive care units in low- and lower-middle-income countries: protocol of a systematic review

BackgroundMechanical ventilation (MV) in intensive care units (ICUs) is a stressful experience for patients. However, these experiences have not been systematically explored in low- and lower-middle-income countries (LLMICs). This systematic review (SR) aims to explore the patients’ experiences of MV in ICUs in LLMICs and the factors influencing their experiences.MethodsThe PICO framework will be used to operationalize the review question into key concepts: population (mechanically ventilated adult patients in ICUs), phenomenon of interest (experiences) and context (LLMICs). PubMed, Embase, PsycINFO, CINAHL, Cochrane Library, Scopus and Web of Science will be systematically searched since database inception. Citation, reference list and PubMed-related article searching of included studies will be done to ensure literature saturation. Empirical peer-reviewed literature exploring adult patients’ (aged ≥ 18 years) experiences of MV in ICUs in LLMIC will be included. All study designs (quantitative, qualitative and mixed methods) will be included. Two independent reviewers will perform screening, data extraction and critical appraisal. The mixed-methods appraisal tool (MMAT) and Popay’s narrative synthesis will be used for critical appraisal and data synthesis, respectively.DiscussionThis SR aims to bridge a gap in knowledge as previous evidence synthesis has described this phenomenon in developed countries. The review design, with the inclusion of quantitative, qualitative and mixed-methods studies, intends to provide a rich and in-depth exploration of the issue. The findings will be presented as themes, subthemes and their explanatory narratives. The gaps in available literature will be identified, and implications of SR findings on policy, practice and future research will be presented. The strength of this SR lies in its systematic, comprehensive, transparent, robust and explicit methodology of identifying, collating, assessing and synthesizing available evidence. By prior registration and reporting of this SR protocol, we aim to ensure transparency and accountability and minimize bias.Systematic review registrationPROSPERO CRD42024507187

Challenges and opportunities for early career researchers: using the theory of practice architectures to unpack enabling and constraining conditions

ABSTRACT Globally, there are growing examinations of what it means to be ‘early career’ in contemporary academia. Across international contexts, the experiences of early career researchers appear to be similar. This paper explores the similarities and differences of the Australian early career experience, through the lens of pathways to the academy and career stage. We use the autoethnographic reflections of two early career researchers, one following the ‘traditional’ pipeline to the academy and the other as a ‘second career’ academic. We use the theory of practice architectures to frame the study and to generate and analyse our reflections: we identify the enabling and constraining conditions and how these differ depending on previous life and professional experiences. The autoethnographic reflections illuminate how practices are shaped by the organisational arrangements within the site of the institution. This study makes a theoretical contribution by using the theory of practice architectures to illuminate early career researcher experiences. By using a practice theory, our analysis and insight provide guidance for institutional policy, professional learning, and development strategies for early career researchers.

Exploring the road to public healthcare accessibility: a qualitative study to understand healthcare utilization among hard-to-reach groups in Kerala, India

BackgroundKerala, a southern state in India, is known to be atypical due to its high literacy rate and advanced social development indicators. Facing competition from a dominant private healthcare system, recent government health system reforms have focused on providing free, high-quality universal healthcare in the public sector. We carried out an analysis to ascertain the initial impacts of these measures among ‘hard to reach groups’ as part of a larger health policy and systems research study, with a focus on public sector health service utilisation.MethodsWe conducted Focus Group Discussions (FGDs) among identified vulnerable groups across four districts of Kerala between March and August of 2022. The FGDs explored community perspectives on the use of public healthcare facilities including enablers and barriers to healthcare access. Transliterated English transcripts were coded using ATLAS.ti software and thematically analyzed using the AAAQ framework, supplemented with inductive code generation.ResultsA total of 34 FGDs were conducted. Availability and cost-effectiveness were major reasons for choosing public healthcare, with the availability of public insurance in inpatient facilities influencing this preference. However, accessibility of public sector facilities posed challenges due to long journeys and queues. Uneven roads and the non-availability of public transport further restricted access. Gaps in acceptability were also observed: participants noted the need for the availability of special treatments available, reduced waiting times for special groups like those from tribal communities or the elderly mindful of their relatively greater travel and need for prompt care. Although quality improvements resulting from health reform measures were acknowledged, participants articulated the need for further enhancements in the availability and accessibility of services so as to make public healthcare systems truly acceptable.ConclusionThe ‘Kerala Model of Development’ has been applauded internationally for its success in recent years. However, this has not inured the state from the typical barriers to public sector health care use articulated by participants in the study, which match global evidence. In order to deepen the impact of public sector reforms, the state must try to meet service user expectations– especially among those left behind. This requires attention to quality, timeliness, outreach and physical access. Longer term impacts of these reforms – as we move to a post-COVID scenario - should also be evaluated.

The differential impact of evidence types in policy decisions: comparing evidence priorities in employment and education ministries

ABSTRACT Evidence-based policy-making has received increasing attention among governments in recent decades. However, comparative research examining patterns of evidence impact and administrative priorities for different forms of evidence remains scarce. In response, this article investigates the impact of different evidence types in two Danish ministries – the Ministry of Employment and the Ministry of Children and Education – characterized by similar analytical capacities but different strategies and criteria for prioritizing and using evidence. Applying a novel document matching method to analyze 1159 research publications and policy decisions from 2015–2021 about Danish active labor market policies and public school policies, the article shows how causal effect evidence has to a greater extent influenced policy decisions in the Ministry of Employment than in the Ministry of Children and Education. The article proposes that the observed variation between the policy domains can be attributed to ministerial evidence strategies, shaping administrative perceptions of the relevance and usefulness of different types of evidence. Based on the results, the article discusses the implications of prioritizing particular evidence types in ministries, considering variations between study designs and their appropriateness for different policy needs and purposes.

From Salon to Home: The Professional Journey and Challenges of Beauticians

The practice of beauticians providing home services has grown significantly, driven by consumer demand for convenience and personalized care. This study explores the professional experiences of beauticians delivering home services, emphasizing factors such as career duration, continuous training, effective time management, and the diverse challenges encountered. Using descriptive phenomenology, the research delves into the lived experiences of beauticians, revealing that extensive career length, ongoing professional development, and efficient time management are critical to service quality and client satisfaction. However, challenges such as inconsistent product availability, transportation issues, and maintaining sanitation standards in varied home environments complicate service delivery. The study also highlights the importance of innovative marketing strategies, including the use of social media and client referrals, to expand the client base and ensure business growth. Findings suggest that beauticians must navigate logistical complexities and develop robust problem-solving skills to succeed. The study underscores the need for continuous skill enhancement and strategic marketing to maintain competitiveness in the evolving beauty industry. By understanding these professional experiences, the research provides insights that can inform practice, policy, and future research, ultimately benefiting both service providers and clients in the beauty industry.

Exploring Cancer Incidence Trends by Age and Sex Among 14.14 Million Individuals in China From 2007 to 2021: Population-Based Study.

Sex is a crucial factor in the development, progression, and treatment of cancer, making it vital to examine cancer incidence trends by sex for effective prevention strategies. This study aimed to assess the incidence of cancer in China between 2007 and 2021, with a focus on sex-based trends. A population-based cancer registry comprising 14.14 million individuals was maintained between 2007 and 2021 by the Beijing Municipal Health Big Data and Policy Research Center. The age-standardized rates (ASRs) of cancers were calculated using the Segi population. The average annual percentage of change (AAPC) was evaluated using the joinpoint regression model, while the Bayesian age-period-cohort model was used to predict cancer incidence in the next 10 years. From 2007 to 2021, the study included 651,342 incident patients with cancer, of whom 51.2% (n=333,577) were women. The incidence indicated by the ASR for all cancers combined was 200.8 per 100,000 for women and 184.4 per 100,000 for men. The increase in incidence indicated by AAPC for all malignancies combined significantly increased in women between 2007 and 2021 (AAPC=3.1%; P<.001), whereas it remained constant in men (AAPC=0.3%; P=.30). Although the overall incidence of all cancers indicated by AAPC increased in young men (AAPC=3.2%; P=.01), the greatest increase was observed among young women (AAPC=6.1%; P<.001). The incidence rate ratio for cancer in women increased among subsequent younger generations compared with patients born in the 1962-1966 cohort. The ASR in women will increase 1.6-fold over the next 10 years, with women having twice the incidence rate of men by 2031. The rising incidence of cancer among women in China has become a growing concern, emphasizing the need for increased efforts in cancer prevention and early screening, especially among young women.

IoT Applications in Rural Areas: Opportunities, Challenges and Future Directions

The advent of the Internet of Things (IoT) has revolutionized various industries, offering new capabilities and efficiencies. In rural areas, IoT presents unique opportunities to enhance agricultural productivity, improve healthcare delivery, manage natural resources, and provide better connectivity. This paper explores the current state of IoT applications in rural regions, examining the benefits, challenges, and potential future developments. We analyse case studies across agriculture, healthcare, environmental monitoring, and smart infrastructure, highlighting successful implementations and lessons learned. The paper also discusses the technological, economic, and social barriers to IoT adoption in rural settings and proposes strategies to overcome these obstacles. Finally, we outline future research directions and policy recommendations to maximize the impact of IoT in rural areas. This paper reviews the current landscape of IoT applications in rural settings, focusing on key areas such as agriculture, healthcare, environmental management, and infrastructure development.

The Biopolitical Kindergarten: A Critical Qualitative Examination of the Intersection Between Policymakers’ Neoliberal Reforms and Children’s Figuring of Themselves as Learners

This critical qualitative policy research study examines the intersection between policymakers’ neoliberal kindergarten reforms and children figuring themselves as learners within a publicly funded schooling community. Engaging in this examination of the biopolitical kindergarten space, which is shaped by standardized teaching and learning experience designed to prepare kindergarteners for the high-stakes reforms that await them in later grades, creates the opportunity to consider whether school spaces are designed to prepare the next generation of democratic citizens. It also provides insight as to how critical qualitative policy researchers can investigate as well as propose tangible policy responses through their work that seek to change the current era of policymakers schooling children through their neoliberal reforms.

Key Informants' Visions and Solutions to Improve Home- and Community-Based Services for Older Adults and Persons With Dementia.

Recent decades have seen state successes in rebalancing Medicaid long-term care from institutional care (e.g., nursing homes) into home and community settings. However, significant barriers can prevent access to home and community-based services (HCBS) among older adults and persons with dementia. Qualitative research on potential innovations and solutions in the contemporary context with attention to a wider range of state-level policy contexts is limited. Drawing on interviews with 49 key informants including state Medicaid officials, HCBS providers, and advocates for persons with dementia across 11 states, we examined perceived solutions to barriers. Key informants articulated a range of potential solutions and innovations, ranging from tangible or realized policy changes to 'magic wand' solutions. Policy research has typically focused on the former; excluding the latter may miss opportunities to envision and design a more effective long-term care system for persons living with dementia and older adults.

Learning From Countries on Measuring and Defining Community-Based Resilience in Health Systems: Voices From Nepal, Sierra Leone, Liberia, and Ethiopia

Background: The best approach for defining and measuring community health care resilience in times of crisis remains elusive. We aimed to synthesise definitions and indicators of resilience from countries who had recently undergone shocks (i.e., outbreaks and natural disasters). Methods: We purposively selected four countries that had recently or were currently experiencing a shock: Nepal, Ethiopia, Sierra Leone, and Liberia. Focus group discussions and key informant interviews were conducted with participants at the community, facility, district, sub-national, national, and international levels. Interviews and discussions were translated and transcribed verbatim. Data were open coded in ATLAS.ti using a grounded theory approach and were thematically collated to a pre-specified framework. Results: A total of 486 people participated in the study (n=378 community members, n=108 non-community members). Emergent themes defining community-based health system resilience included: the importance of communities, health system characteristics, learning from shocks, preventing and preparing for shocks, and considerations for sustainability and intersectoral engagement. Participants identified 193 potential indicators for measuring resilience, which fell into the domains of: 1) preparedness, 2) response and recovery, 3) communities, 4) health systems, and 5) intersectoral engagement. Conclusion: Despite varying definitions and understanding of the concept of resilience, community-centred responses to shocks were key in building resilience. Further insight is needed into how the definitions and indicators identified in this study compare to other shocks and contexts and can be used to further our understanding of health system resilience. Metrics and definitions could assist policy makers, researchers, and practitioners in evaluating the readiness of systems to respond to shocks and to allow comparability across health systems. We must build health systems that can continue to function and ensure quality, equity, community-focused care, and engagement, regardless of the pressures put upon them and ensure they are linked to strong primary health care.

Validating a Pragmatic Measure of Evidence-Based Practice (EBP) Delivery: Therapist Reports of EBP Strategy Delivery and Associations with Child Outcome Trajectories.

Pragmatic measures of evidence-based practice (EBP) implementation can support and evaluate implementation efforts. We examined the predictive validity of therapist reports of EBP strategy delivery for children's mental health outcomes. Data were obtained from 1,380 sessions with 248 children delivered by 76 therapists in two county systems. Children (Mage=11.8 years, SD = 3.7) presented with internalizing (52%), externalizing (27%), trauma (16%), and other (5%) concerns. Therapists reported their delivery of EBP strategies on a revised version of the EBP Concordant Care Assessment (ECCA; Brookman-Frazee, et al., Administration and Policy in Mental Health and Mental Health Services Research, 48, 155-170, 2021) that included 25 content (e.g., parenting, cognitive behavioral) and 12 technique strategies (e.g., modeling, practice/role-play). On average, 5.6 ECCA session reports (SD = 2.3) were obtained for each client, and caregivers reported symptoms on the Brief Problem Checklist (Chorpita, et al., Journal of Consulting and Clinical Psychology, 78(4), 526-536, 2010) at baseline, weekly over two months, and again at four months. Multilevel models examined whether the mean extensiveness of each EBP strategy predicted trajectories of child outcomes. More individual technique (6 of 12) than content strategies (1 of 25) were associated with outcome trajectories. For techniques, more extensive use of Performance Feedback and Live Coaching and less extensive use of Addressing Barriers were associated with greater declines in total symptoms, and more extensive use of Establishing/Reviewing Goals, Tracking/Reviewing Progress, and Assigning/Reviewing Homework was associated with declines in externalizing symptoms. For content, more extensive use of Cognitive Restructuring was associated with declines in total symptoms. In addition, higher average extensiveness ratings of the top content strategy across sessions was associated with greater declines in total and externalizing symptoms. Therapist-reported delivery of some EBP strategies showed evidence of predictive validity and may hold utility in indexing quality of care.

Evaluating the influence of digital strategy on the interplay between quality certification and sales performance using data science and machine learning algorithms

In the context of international trade with information asymmetries, business certifications can serve as signals of product quality and reliability for customers and stakeholders. Recognizing this, the current study unbraces “signalling theory” to explore the impact of digital transformation strategy (DTS) on firm’s international quality certification status and sales performance in the global economy. To this end, treating quality certification endogenously, the study relies on bivariate copula regression modeling of 121429 firms’ responses data extracted from the World Bank’s Enterprise Surveys. Consistent with the hypothesized theoretical predictions, the findings revealed that DTS, in the form of website ownership, has a significantly positive impact on sales performance due to increasing firm’s reach, visibility, engagement, conversion, and retention of customers across different channels and touchpoints. As theoretically conjectured, quality certification is also found to positively impact sales performance by enhancing the firm’s reputation, trustworthiness, and attractiveness in the global marketplace. Most importantly, the study found empirical evidence that DTS significantly moderates the relationship between quality certification and sales performance, such that quality certification has a stronger effect on sales performance for firms with a well-defined DTS (web=1) than those without (web=0); leading therefore to the conclusion that DTS can amplify the signal of quality certification by making it more visible, transparent, and consistent across different digital channels and touchpoints. Hence, the study provides valuable empirical and theoretical insights that inform current business practices, future research, and potential policy measures to support business growth, and enhanced competitiveness in the global market place.

Integrated policy of medical expense subsidies and clinical registry for patients with liver cancer and decompensated cirrhosis in Japan.

Chronic hepatitisB and C are among the most significant infectious diseases worldwide, and are major risk factors for liver cirrhosis and liver cancer. In Japan, comprehensive hepatitis measures are implemented for the testing and treatment of viral hepatitis, thus enabling the early diagnosis of liver cancer. Nevertheless, patients with decompensated cirrhosis and liver cancer often have unfavorable prognoses and require repetitive long-term treatment. In fiscal year 2018, an integrated policy of medical expense subsidies and research was established in Japan that aimed to alleviate patients' financial burden and launch the clinical registry of advanced liver disease. Over time, updates to the eligibility for the subsidy increased access to patients and has led to an increased number of beneficiaries. Additionally, the accumulation of clinical data in the registry has revealed the treatment choices for these diseases. However, the disparities in efforts across prefectures have also become evident. Raising public awareness of the policy and tightening the multisector healthcare network are keys to success in supporting qualifying patients with advanced liver disease.

Perspectives on Academic Training in Clinical Oncology in the United Kingdom: A National Cross-Sectional Analysis

AimsThere are longstanding concerns relating to clinical academic training pipelines, with evidence for multiple barriers and enablers to clinical academic career progression. We sought to assess the extent to which these and other factors apply to academic training in clinical oncology in the United Kingdom. Materials and methodsA cross-sectional survey was undertaken using a bespoke, pre-piloted online electronic questionnaire that was distributed to clinical oncology specialty trainees and consultants who had at any point between January 2013–January 2024 commenced an academic post whilst in training. Collated information included demographic data, location and stage of training, research experience and ambitions, research skill confidence and academic career progression. ResultsSeventy eligible responses were included, representing 84% (n = 16/19) of UK training deaneries. Thirty-seven (53%) of the respondents had obtained their certificate of completion of training (CCT) whilst 11% (n = 8/70) and 40% (n = 28/70) were at specialty trainee level and respectively pre- or within-/post-doctoral studies. Of 34 post-CCT respondents, 58% (n = 20) had ongoing research commitments but this reached 30% of their overall activity for just 30% (n = 10). Barriers to academic progression included clinical training requirements, post availability and limited mentorship. Most (60%; n = 35/58) undertook doctoral studies in their final two training years. A majority of respondents lacked confidence in radiation oncology (RO) skills relevant to their career ambitions, with 60%, 40% and 30%, respectively, confident in RO clinical research outcome evaluation, in vitro radiation analyses and using RO animal models. ConclusionThese data provide a granular, long-term analysis of academic clinical oncology training at a national level; identifying poor progression to research independence underlined by limited confidence in RO research skills and multiple barriers to academic career progression. These data provide areas in which policy makers, research funders and training programmes can focus to improve academic training in clinical oncology.

Crossing national borders for transplantation: A focused evaluation of deceased donor lung exports from the United States

Organ transplantation is a life-saving treatment for end-stage organ failure patients, but the United States (US) faces a shortage of available organs. US policies incentivize identifying recipients for all recovered organs. Technological advancements have extended donor organ viability, creating new opportunities for long-distance transport and international sharing. We aimed to assess organ exports from deceased US donors to candidates abroad, a component of allocation policy allowed without suitable domestic candidates. Based on the national Scientific Registry of Transplant Recipients data from January 2014 to September 2023, 388 342 organs were recovered for transplantation, with 511 (0.13%) exported. Most exported organs were lungs (80%). Exported lung donors were older (41 vs 34 years, P < .001), more likely hepatitis C positive (22% vs 4%, P < .001), and more likely donors after circulatory death (20% vs 7%, P < .001). Lungs that were eventually exported were offered to more US potential transplant recipients (median = 65) than those kept in the US (median = 21 and 41 for lungs recovered by nonexporting and exporting organ procurement organizations, respectively; P < .001). Our study highlights the necessity for further research and clear policy initiatives to balance the benefits of cross-border sharing while considering potential opportunities for more aggressive organ allocation within the US.

How can bottom-up citizen science restore public trust in environmental governance and sciences? Recommendations from three case studies

Citizen science is currently at the forefront of environmental scientific research and public policy for its potential to improve environmental governance, restore epistemic trust and help address some of the most stressing environmental challenges. Although citizen science is gaining increasing popularity, there is little empirical evidence to support these claims and demonstrate how bottom-up citizen science shapes public trust in environmental governance and science. In this paper we reflect on three grassroot environmental citizen science initiatives in Cameroon, Japan, and the UK to identify and present an instrumental framework which includes trustee attributes and conditions that influence how epistemic trust is shaped, and which should inform citizen science and other participatory practices. We explain that citizen science is an approach which enables political processes through the construction of well-informed techno-scientific arguments, which expose deficit assumptions about the public’s ability to participate in knowledge co-production process. To avoid repeating the failures of the past and risk amplifying issues of public distrust further, we provide suggestions built around key trustee attributes which can be incorporated in citizen science practices and we urge that environmental policy needs to create clear policy frameworks to enable the generation of actionable data, especially when such approaches are initiated and implemented as instrumental public participation methods.