Reform Of System Research Articles

Health Workers Perception On The Key Drivers Of Maternal Mortality

Maternal mortality remains a critical public health issue, particularly in low- and middle-income countries. Health workers play a pivotal role in addressing this challenge, offering insights into the key drivers of maternal deaths. This study explores the perceptions of healthcare workers on the systemic, socioeconomic, cultural, and healthcare-related factors contributing to maternal mortality. Health workers identify systemic barriers, including understaffing, lack of resources, inadequate training, and inefficient referral systems, as significant contributors. Cultural and religious influences also impact maternal care, with societal norms often discouraging women from seeking professional healthcare. Additionally, socioeconomic factors like poverty, illiteracy, and unemployment further exacerbate the problem, limiting access to quality maternal care. Health workers’ insights are crucial in designing effective interventions, emphasizing the need for improved training, better healthcare infrastructure, and community engagement to address cultural barriers. This study highlights the importance of empowering healthcare professionals to deliver high-quality maternal care, suggesting that systemic reforms, including enhanced emergency obstetric care and better access to medical supplies, are essential for reducing maternal mortality rates. Understanding these perspectives can inform policies and programs aimed at improving maternal health outcomes, particularly in resource-limited settings

Unwanted cardiopulmonary resuscitation against patients' "Do Not Attempt Resuscitation" orders in community settings in Japan: A narrative review.

We aimed to synthesize existing research to elucidate the underlying factors and causes responsible for the high prevalence of unwanted cardiopulmonary resuscitation (CPR) occurring outside a hospital setting in Japan despite patients' Do Not Attempt Resuscitation (DNAR) orders. We conducted a narrative review by searching PubMed, EMBASE, and Scopus for English literature, and Google Scholar for Japanese literature. The key factors we identified included lack of documentation of resuscitation preferences, variation in the perception of other life-sustaining measures associated with DNAR, non-inclusion of the patient in discussions of goals of care, unlegislated and unstandardized DNAR orders, emergency medical service activation by the family or facility, the Fire Service Act that mandates life-saving measures irrespective of the presence of advance directives, fire department protocols and CPR decision-making, and death pronouncement authorization limited to physicians. This study identified the multifaceted factors and the potential triggers for unwanted CPR despite DNAR orders. These findings underscore the urgent need for comprehensive interventions encompassing educational initiatives, ethical considerations, systemic reforms, and legal adjustments to prevent future unwanted CPRs in Japan. Geriatr Gerontol Int 2024; ••: ••-••.

Policy and organisational learning in judicial reform: evidence from Italy

The Italian judicial system is well-known for its substandard performance by comparison with its European peers. In this article, we analyse the implementation of an important reform of the Italian judicial system designed and implemented in the context of the National Recovery and Resilience Plan funded by Next Generation EU. The reform, launched in February 2022, involves the introduction of a new organisational structure (The Office for the Trial) staffed with 16,500 newly appointed judicial assistants, representing an increase of about one third of the total judicial workforce employed in Italy. By leveraging the concepts of policy and organisational learning (OL), we show that variation of the modes of policy learning observed in implementation design is linked with variation in the organisational models adopted by different judicial offices to implement the reform. Then, by connecting organisational models to OL and focusing on the performance of five selected sections within the Court of Appeal of Milan, we show that organisational models informed by reflexivity are associated with better performance than models informed by hierarchy. The study contributes to scholarship on policy and OL, as well as providing a first, albeit limited and exploratory, empirical evaluation of a strategic public sector reform.

Decentralization of land development approval and economic impacts: A study on China's urban construction land reform

This paper explores how China's reform of the urban construction land approval system, which decentralized authority to provincial governments, affects enterprise total factor productivity (TFP) using a quasi-natural experiment approach. The reform streamlined processes, reduced legal ambiguities, and enhanced resource efficiency. Our findings indicate significant TFP gains primarily due to lower administrative costs and improved legal frameworks, emphasizing the pivotal role of regional governance and legal enforcement in economic outcomes. Additionally, the analysis highlights substantial TFP enhancements from reduced inefficient investments and financing constraints, with notable regional and enterprise-specific variations in the impact of legal reform.

Microscopic study on the memory effect of methane hydrate in the presence of silica nanoparticles: Ⅰ. Dissociation mechanism & guest supersaturated hypothesis

As a key issue emerged in the exploitation of combustible ice resources, the memory effect inducing hydrate reformation in sand-containing dissociated-water system is still ambiguous. Among them, methane hydrate dissociation kinetics and guest supersaturated hypothesis for methane hydrate reformation are the primary issues to be addressed. A molecular dynamics simulation system where methane hydrate interacts with surface-hydroxylated silica nanoparticles was established to simulate dissociation process, which is necessary to construct hydrate reformation systems for further microscopic study on hydrate memory effect. The transportation mechanism of methane during hydrate dissociation in sand-containing aqueous system was elucidated. Based on this, hydrate-dissociated systems with methane supersaturated were captured, and molecular dynamics simulations were carried out to further study hydrate reformation mechanism regarding the guest supersaturated hypothesis. By analyzing the distribution and transportation of methane, hydrate clusters, and silica nanoparticles, it can be concluded that the hydrate-like orderly arrangement of methane that are dissolved in the solution or on the surface of nanobubbles are necessary to trigger hydrate memory effect by inducing the reformation of hydrate clusters, while the silica nanoparticles can inhibit the reformation of hydrate clusters by disturbing the arrangement of methane molecules and water molecules. Thence, the microscopic analysis indicated that supersaturated guest molecules is vital to the occurrence of hydrate memory effect and its effect varies between the supersaturated states.

Civil Disputes and Civil Litigation: Analysis of Concepts, Characteristics and Resolution Mechanisms

This article discusses the basic concepts and characteristics of civil disputes and civil litigation and their resolution mechanisms, and analyzes the characteristics and resolution of different types of civil disputes, such as contract disputes and tort disputes. The article also describes in detail the civil litigation procedures, including the various aspects of prosecution and filing, trial procedures and enforcement procedures. It further discusses the background and motivation of the reform of the civil litigation system, as well as the content of the reform, such as the simplification of trial procedures, the application of electronic litigation and the improvement of the enforcement mechanism. Finally, the article looks forward to the development trend of the civil litigation system, including informationization and intelligence, the promotion of diversified dispute resolution mechanism and its institutional guarantee. Through these discussions, it aims to enhance judicial efficiency and fairness, and to meet the modern society's demand for fast and fair resolution of civil disputes.

The impact of China's residence permit system on the floating population's willingness to settle in cities

China's residence permit system is the focus of the nation's household registration system reform and a crucial aspect of promoting the new people-centered urbanization. Based on the China Migrants Dynamic Survey, this study uses the probit regression model to investigate the impact of the residence permit system on the floating population's willingness to settle in cities and examines the moderating effect of local government's financial resources. The results show that the residence permit system has a significant promoting effect on the migrants’ willingness to settle. And local government financial resources can strengthen the effect of the residence permit system on the willingness to settle. Additional exploration shows that the residence permit system can enhance the willingness of floating populations to settle in urban areas by increasing their income and consumption levels. Heterogeneity analysis shows that for non-agricultural household registration, high-education, high-income, and interprovincial migrating groups, the incentive effect of the residence permit system is more stronger. Based on the findings, while improving the residence permit system and expanding its coverage groups, transfer payments from the central government to local governments should be increased to effectively improve the value of residence permits, promote the floating population's settlement in cities, and advance China's new urbanization.

Implementation of Respect for Autonomy in Hospital Services Within the Indonesia National Health Insurance System

The principle of patient autonomy forms the foundation of medical ethics. However, its exploration within the context of national health insurance systems in developing countries remains under-researched. This study aimed to evaluate respect for patient autonomy within Indonesia's National Health Insurance (NHI/JKN) system. The study using a qualitative research interview analyzed thematically. Conducted in Depok, West Java, the study involved in-depth semi-structured interviews with 18 participants, encompassing patients from first-level health facilities (FLHF), general practitioners at FLHF, specialist doctors, and management of referral hospital (RH) officers, and staff members of the JKN. The data were transcribed and analyzed using a thematic approach. The study revealed substantial underutilization of respecting patient autonomy within medical contexts under the JKN. Five themes emerged: challenges in the referral system, knowledge and information dissemination, decision-making and autonomy, quality of healthcare services, and systemic constraints and impact. These themes highlight the lack of patient awareness, restricted medical choices, the dominant role of paternalism (a system in which the government or a person in a position of authority makes decisions for other people) in healthcare decisions, and improper informed consent process. The findings suggest that the principles of beneficence and paternalism often overshadow respect for patient autonomy in the JKN system. This raises concerns about the ethical aspect of patient treatment, particularly the need for greater focus on patient autonomy and shared decision-making to align more closely with global medical ethics practices. This study contributes to understanding autonomy in national health insurance systems in developing countries. It highlights the need for systemic reforms to enhance healthcare efficiency and effectiveness while respecting patient autonomy.

Characteristics of financial capital flow circulation and the risk transmission effect in China

Financial capital is an important force driving China's economic modernisation. Examining the characteristics of financial capital flow circulation across sectors and risk transmission laws is crucial in guiding financial market operations and deepening financial system reforms. This study establishes a 2011–2020 China matrix that includes capital fund flow statements for non-financial corporations, financial institutions, the general government, households, and foreign sources and examines changes in capital flow circulation by developing a financial flow multiplier system model to measure the direct and indirect transmission effects of capital flows between sectors from the perspective of liabilities. Results show that China's overall scale of financial capital flows has increased, but fluctuations have emerged in the last decade. The sectors' financing structure has changed significantly, with financial institutions remaining the primary capital inflow and outflow sectors of the financial market; however, the proportion of liability and investment in the household sector has increased, resulting in increased risk transmission. Moreover, the sectoral fund surpluses and shortages are highly volatile and uncertain, with non-financial enterprises serving as the primary drivers of real-economy investment. The capital flow from financial services to the real economy shows a fluctuating growth trend, primarily flowing to non-financial corporations; however, the proportion exhibits a downwards trend. Finally, we find that the flow transmission relationship between different sectors and financial transactions in the financial market is complex, with both direct and indirect risk transmission effects between sectors. Changes of financial institutions' liabilities significantly affect the liabilities and investments of other sectors.

Increasing access to justice for families through preventive legal advocacy

AbstractWhat is the role of preventive legal advocacy in promoting justice for families and redefining child welfare to focus on family and community‐based systems which prioritize community‐based support and to forego government oversight, regulation and punishment? Given the timeline for systemic reforms and the necessity of providing access to justice for families presently struggling to protect their family autonomy, preventive legal advocacy is a critical piece of reform efforts and scholarly attention. This article advocates for the expansion of existing preventive legal advocacy models and legislation codifying early access to counsel with the goal of disrupting the traditional pathways into the child welfare and family regulation system, enforcing the rights of parents and children to their family autonomy and meaningfully supporting families to thrive.

Global perspectives of the formation of the environmental rights of children and youth to health and life

The article presents an analysis of the reform of the legal system which is an urgent problem, which is the study of environmental rights of children and young people in the system of constitutional rights and freedoms of the individual and the citizen. The analysis of the legislative and psychological aspects of young people's environmental rights, the impact of these rights on the realization of the interests of environmental law subjects. These are the principles of a clean environment, the interdependence of peace and a clean environment, the credibility of environmental information, the participation of young people in environmental management, access to every young person, the responsibility of states and governments for environmental disasters, the overall responsibility of protecting and preserving ecosystems, deepening and developing international environmental law, sustainable development of societies, combined with environmental protection. The purpose of the article is to investigate and substantiate the global perspectives of the establishment of environmental rights of children and youth to their own health.The assigned research tasks were implemented by means of the application of general scientific and special methods of cognition. The most significant role in the study was played by the method of comparative legal analysis, since its application allowed for the comparison of legal norms in different fields of law. The system-functional method was used to review the process of legal culture management, and the logical-semantic method contributed to the generalization and classification of epistemological units to make sound proposals for improving the legal regulation of the legal culture management process of youth. Targeted samples were used to recruit participants to maximize age, experience and demographic differences. Common invitation emails were systematically sent during February-April 2020 to registered Facebook members, which included the range: 10 - 13, 14 - 19, 20 - 24, 25 - 29, 30 - 34, 25 - 40, 41 - 50, 51 years and older. After receiving an email in the form of a motivational commentary to the questionnaire, along with the questionnaire, the participants completed the online form by choosing from three options: yes, no, partially. The consent to this short online survey was from adults 18 and older in the form of a positive attitude to participating in the survey, which was expressed in filling out the questionnaire, as well as positive comments about it, to which the words “Well done”, “It important”, “We wish you success”, “Thank you”, etc., as well as signs: +, +++, V and others. Surveys of children and young people under the age of 18 were conducted with the consent of their parents or their substitute. The study of the problem of environmental rights of young people covers the interests of every nation and every person in the modern world, because saving the life of posterity – children and young people – is one of the basic ideas of all living beings on our planet about justice in the self-realization of the meaning of one's own life. The field of environmental law is now in the process of development and formation, which is to define its own subject field, categories, principles and its own methodology. This process is aimed at enhancing the environmental rights of those generations who inherit the planet Earth and who by their later birth than predatory environmental use by previous generations have not been able to influence the prevention of environmental damage and maintain living conditions acceptable to living organism’s life. In this way, the universally recognized right to life is embodied in the definition and justification of the special and special right of newborns to a safe and environmentally friendly life. An understanding of environmental law acquired at the present level requires consolidation in international and national law as a set of non-property human rights that determine its relationship with the environment and ensure its physical existence.

Innovative research of comprehensive practice classroom teaching of Chinese reading

The innovative research of comprehensive practical classroom teaching of Chinese reading shows that teachers should pay attention to cultivating students 'interest in reading in the teaching process, improve their information screening and integration ability, and introduce diversified teaching strategies to stimulate students' learning initiative and creative thinking. Through the continuous innovation of teaching methods, we can enrich the reading practice activities, and provide students with a broader space for exploration and thinking. Classroom teaching is an important link in the field of education, and it has a key influence on students' learning effect and development. With the rapid change of society and the reform of education system, the traditional classroom teaching model faces many challenges. Therefore, it is of great theoretical and practical significance to study the innovation of comprehensive practical classroom teaching of Chinese reading and improve the teaching effect. First of all, the innovation of the comprehensive practical classroom teaching can promote the improvement of the quality of Chinese education. Through the exploration and application of the comprehensive practice innovation strategy of different Chinese reading, it can better meet students' learning needs, stimulate their interest and initiative in learning Chinese, and improve the effect and quality of Chinese learning. Secondly, the innovation of comprehensive practical classroom teaching of Chinese reading can promote the professional development of Chinese teachers. Teachers are the main implementers and organizers of classroom teaching, and their teaching ability and level are directly related to the quality and effect of classroom teaching. Studying the practical innovation of classroom teaching can help teachers to continuously improve their teaching ideas, teaching methods and teaching skills, and improve their professional quality and teaching level. In addition, the innovation of studying the comprehensive practical classroom teaching of Chinese reading can also promote the in-depth progress of educational reform. Education reform needs to learn from and introduce new educational ideas, teaching methods and teaching means, and all of these need to be verified and implemented through practical innovation. By studying the innovation of comprehensive practical classroom teaching of Chinese reading, it can provide practical experience and theoretical support for the promotion of educational reform.

1461년의 호구제 개혁과 호의 변화

1461년의 호구제 개혁과 호의 변화

Проблемы трансформации госорганов, участвующих в кадастровых отношениях и пути их решения

The article examines the process of transformation of state bodies involved in cadastral relations in Russia. The main problems arising during this transformation are analyzed and ways to solve them are proposed. Special attention is paid to the issues of improving the efficiency of cadastral authorities in the context of the regional economy. Measures are proposed to improve the organizational structure and functionality of these bodies. The prospects for the introduction of innovative technologies in the field of cadastral registration and registration of real estate rights are considered. The necessity of an integrated approach to the reform of the public administration system in the field of land and property relations is substantiated.

Medicaid Accountable Care Organizations and Disparities in Pediatric Asthma Care.

Nearly 6 million children in the US have asthma, and over one-third of US children are insured by Medicaid. Although 23 state Medicaid programs have experimented with accountable care organizations (ACOs), little is known about ACOs' effects on longstanding insurance-based disparities in pediatric asthma care and outcomes. To determine associations between Massachusetts Medicaid ACO implementation in March 2018 and changes in care quality and use for children with asthma. Using data from the Massachusetts All Payer Claims Database from January 1, 2014, to December 31, 2020, we determined child-years with asthma and used difference-in-differences (DiD) estimates to compare asthma quality of care and emergency department (ED) or hospital use for child-years with Medicaid vs private insurance for 3 year periods before and after ACO implementation for children aged 2 to 17 years. Regression models accounted for demographic and community characteristics and health status. Data analysis was conducted between January 2022 and June 2024. Massachusetts Medicaid ACO implementation. Primary outcomes were binary measures in a calendar year of (1) any routine outpatient asthma visit, (2) asthma medication ratio (AMR) greater than 0.5, and (3) any ED or hospital use with asthma. To determine the statistical significance of differences in descriptive statistics between groups, χ2 and t tests were used. Among 376 509 child-year observations, 268 338 (71.27%) were insured by Medicaid and 73 633 (19.56%) had persistent asthma. There was no significant change in rates of routine asthma visits for Medicaid-insured child-years vs privately insured child-years post-ACO implementation (DiD, -0.4 percentage points [pp]; 95% CI, -1.4 to 0.6 pp). There was an increase in the proportion with AMR greater than 0.5 for Medicaid-insured child-years vs privately insured in the postimplementation period (DiD, 3.7 pp; 95% CI, 2.0-5.4 pp), with absolute declines in both groups postimplementation. There was an increase in any ED or hospital use for Medicaid-insured child-years vs privately insured postimplementation (DiD, 2.1 pp; 95% CI, 1.2-3.0 pp), an 8% increase from the preperiod Medicaid use rate. Introduction of Massachusetts Medicaid ACOs was associated with persistent insurance-based disparities in routine asthma visit rates; a narrowing in disparities in appropriate AMR rates due to reductions in appropriate rates among those with private insurance; and worsening disparities in any ED or hospital use for Medicaid-insured children with asthma compared to children with private insurance. Continued study of changes in pediatric asthma care delivery is warranted in relation to major Medicaid financing and delivery system reforms.

Does younger children's social health insurance alleviate household impoverishment due to illness?

The ambitious expansion of social health insurance in China has played a crucial role in preventing and alleviating poverty caused by illness. However, there is no government-sponsored health insurance program specifically for younger children and inequities are more pronounced in healthcare utilization, medical expenditure, and satisfaction in some households with severely ill children. This study assessed the effectiveness of child health insurance in terms of alleviating poverty caused by illness. Data were collected from two rounds of follow-up surveys using the China Family Panel Studies 2016 and 2018 child questionnaires to investigate the relationship between child health insurance and household medical impoverishment (MI). Impoverishing health expenditure (IHE) and catastrophic health expenditure (CHE) were measured to quantify "poverty due to illness" in terms of absolute and relative poverty, respectively. Propensity score matching with the difference-in-differences (PSM-DID) method, robustness tests, and heterogeneity analysis were conducted to address endogeneity issues. Social health insurance for children significantly reduced household impoverishment due to illness. Under the shock of illness, the incidences of IHE and CHE were significantly lower in households with insured children. The poverty alleviation mechanism transmitted by children enrolled in social health insurance was primarily driven by hospitalization reimbursements and the proportion of out-of-pocket medical payments among the total medical expenditure for children. Children's possession of social health insurance significantly reduced the likelihood of household poverty due to illness. The poverty-reducing effect of social medical insurance is most significant in rural areas, low-income families, no-left-behind children, and infants. Targeted poverty alleviation strategies for marginalized groups and areas would ensure the equity and efficiency of health system reforms, contributing to the goal of universal health insurance coverage in China.

Dialog Hukum Adat dan Islam: Kritik Syeikh Ahmad Khatib Al-Minangkabawi Terhadap Sistem Waris di Minangkabau

This research discusses the two main forces influencing Minangkabau society, namely custom and religion. The matrilineal system practiced in Minangkabau has significant differences compared to the Islamic kinship system, particularly in terms of inheritance distribution. These differences often become a source of conflict and academic interest, especially among scholars of Islamic law. One figure who firmly opposes the customary inheritance system in Minangkabau is Sheikh Ahmad Khatib al-Minangkabawi, a prominent scholar who served as Imam, Khatib, and teacher in Mecca. This study employs a library research approach with a descriptive analytical method to explore Sheikh Ahmad Khatib's critiques of the prevailing inheritance system. Sheikh Ahmad Khatib argues that customary practices that divert inheritance to nephews rather than biological children contradict Islamic principles. He even equates this action with consuming the wealth of orphans, a deed prohibited in Islam. During his time, there was ambiguity regarding the ownership status of property in Minangkabau society whether it belonged to a father or was property of the clan managed by the niniak mamak. When a father passed away, the inheritance that should rightfully go to biological children often ended up with nephews, leading to injustice. Sheikh Ahmad Khatib's sharp criticism emphasizes the need for reform in the customary inheritance system to align it with Islamic law and protect the rights of children, thereby reducing conflict and injustice in Minangkabau society in the future.

Shortcomings of the Bharatiya Nyaya Sanhita, 2023: An Analytical Perspective

The Bharatiya Nyaya Sanhita, 2023 was enacted on December 25, 2023, to supplant the Indian Penal Code of 1860, marking a significant reform in India's criminal justice system. This legislation, along with the Bharatiya Nagarik Suraksha Sanhita as well as Bharatiya Sakshya Adhiniyam, took impact on 1st July 2024. The changes signify a departure from colonial legal frameworks, aiming for a system aligned with contemporary rights and inclusivity. While the Chief Justice of India and various legal experts have praised the BNS as a transformative step, it still exhibits notable shortcomings. For instance, it fails to address necrophilia, leaving serious offences unregulated. Moreover, Section 69's treatment of "deceitful means" in sexual relations raises issues regarding consent, particularly in contexts involving job offers or promotions. Section 152, which deals with threats to national sovereignty, could lead to overly broad interpretations that impede free expression. Additionally, Sections 84 and 88 reveal gender biases and outdated perspectives on marital rights and women's reproductive decisions. These challenges highlight the urgent need for further review and reform to ensure BNS fulfils its goal of creating a just and equitable legal system.

A new EUtopia – Understanding Common European Asylum System (CEAS) and the criminalisation of migration in Europe

The aim of this paper is to expound and critically analyse the proposed reform of the Common European Asylum System (CEAS) in December 2023. Drawing on insights from migration science and political philosophy, it argues that political agreement on the controversial reform can best be understood through a Foucauldian lens, conceptualising the European border regime as a biopolitical space in which migrant lives are contested. Against the background of the ever-expanding criminalisation and securitisation of migration, analyses of disciplinary and biopower offer unique insights into modern-day European asylum and border politics. The article criticises the bifurcation of European rights discourses in light of this trend, and calls for differentiated engagement with developments in European asylum politics.

An Exploration of the Legal Aid System in Colleges and Universities in the New Era from the Perspective of Realist Legal Education

The construction of university legal aid is an important part of China’s legal aid system, and also an important reform task in deepening the reform of the judicial system proposed by the 18th National Congress of the Communist Party of China. However, as China’s legal education mode is still dominated by traditional theoretical teaching and case teaching methods, teachers’ pure compulsory guidance, as the main body of legal aid organizations in colleges and universities, will inevitably increase their research pressure. Students’ voluntary participation takes up a lot of time and increases their academic pressure, and the development of legal aid organizations in colleges and universities also falls into a dilemma. From the perspective of realistic legal education, this paper deeply studies the development model of legal aid center, pursues the rationality of the legal aid system in colleges and universities, and proposes to formulate the grading standard of legal aid in colleges and universities from the construction and ontology dimension of legal aid system in colleges and universities. The legal aid system of colleges and universities should be improved from four aspects: party building, social union, student organization, and network operation. This puts forward the university legal aid “1+4” solution measures. Through exploring the common measures of legal aid construction in universities, the legal aid of universities has become an important force in the development of public legal service causes in the country.