Window Of Opportunity Research Articles

Organizational Formation for Priority Setting: Historical Perspectives and Thematic Analysis of India’s Health Technology Assessment Agency

ABSTRACT Countries pursuing universal health coverage must set priorities to determine which benefits to add to a national health program, but the roles that organizations play are less understood. This article investigates the case of the formation of an organization with a mandate for choice of technology for public health interventions and priorities, the Health Technology Assessment India. First, we narrate a chronology of agenda setting and adoption of national policy for organizational formation drawing on historical documentation, publicly available literature, and lived experiences from coauthors. Next, we conduct a thematic analysis that examines windows of opportunity, enabling factors, barriers and conditions, roles of stakeholders, messaging and framing, and specific administrative and bureaucratic tools that facilitated organization formation. This case study shows that organizational formation relied on the identification of multiple champions with sufficient seniority and political authority across a wide group of organizations, forming a coalition of broad base support, who were keen to advance health technology assessment policy development and organizational placement or formation. The champions in turn could use their roles for policy decisions that used private and public events to raise priority and commitment to the decisions, carefully considered organizational placement and formation, and developed the network of organizations for the generation of technical evidence and capacity building for health technology assessment, strengthened by international networks and organizations with financing, expertise, and policymaker relationships.

Genesis of Shaping a Concept of Environmental Safety in a Global Social and Political Thought and Political and Legal Practice

The article carries out a retrospective analysis of the genesis of shaping a concept of environmental security in world social and political thought and political and legal practice. The phenomenon of ecological security is considered as one of the most important issues of today’s reality, which reflects the influence of human activity in various fields on the natural environment is acute and is an urgent problem of our time, which actualizes the need for scientific understanding of phenomena and processes of both global environmental changes and direct human influence on the public environment in the context of public management and regulation processes of ensuring environmental security of national states and the whole world community It is emphasized that the global level of environmental security problems requires appropriate global response: understanding, conceptualization and development appropriate planetary strategy and public policy of environmental protection security and institutionalization of interstate, national and social structures necessary for the implementation of such a policy. It was concluded that the concept of environmental security, which originated on the border 18th–20th centuries, began to receive its scientific and social and political interpretation in the 20th century, but arose most acutely from the beginning of the third millennium, when humanity became aware of the threatening patterns of further increasing anthropogenic harmful impact on the environment. The issue of environmental safety were regularly considered at the highest level of the UN conference. However, the desired the result has not yet been achieved and the «window of opportunity» for humanity is getting narrow

Therapy of physical frailty

As an overarching geriatric syndrome, frailty describes a potentially reversible transitional stage between functional autonomy and irreversible disability. Thus, frailty addresses a "window of opportunity" in which functional limitations can be successfully treated. This article provides an overview of the therapeutic approaches and their scientific evidence.

Optimizing prevention strategies for PM2.5-related health risks in Nakhon Ratchasima

The detrimental effects of PM2.5 on the health of urban populations, especially in developing countries, are being carefully addressed by governments worldwide. To mitigate the adverse health effects of air pollution, this paper presents a case study and suggests a three-phase plan for implementing a prediction and control approach in the Thai metro region of Nakhon Ratchasima (NRM). A data-driven assessment of the region's air pollution situation is conducted in the initial phase, which is then followed by an analysis of the health risks related to PM2.5 concentrations. It is therefore imperative to determine which machine learning model has the best capabilities to estimate PM2.5 concentration. With the help of this advanced predictive capability, decision-makers will have an important window of opportunity to put preventive measures in place to safeguard the population from the adverse effects of air pollution. The study showed that there were respiratory diseases in the NRM area because of high concentrations of PM2.5 particles, primarily from vehicle exhaust, which far exceeded Thailand's threshold of 15 μg m−3. A total of 10,379 people, or 16.91% of the affected population, lived in zones with PM2.5 concentrations >38 μg m−3 in 2019. Another 741 people, or 1.21% of the population, lived in zones with PM2.5 values between 36 and 37 μg m−3. The study finds that Extra-Trees regression combined with AdaBoost has the best-predicting capacity for PM2.5 ambient concentration in the NRM area out of the 13 machine-learning regression models examined. This case study presents an additional tool for policymakers to employ in controlling adverse health effects in urban areas.

Technological catch-up in the Iranian steel industry: Integrating regime-based and complex product systems approaches

Researchers in the technological catch-up field have recently directed their attention toward a regime-based approach and Complex Product Systems (CoPs) streams. Within this context, studies on each stream demonstrate how industry-specific frameworks in developing countries influence technological catch-up dynamics. This study explores these dynamics by analyzing market and technological regimes within Iran's steel industry as semi-CoPs, comprehensively. The study utilizes historical and content analyses to delineate five capability-building waves and extract themes and dimensions from documents and expert interviews conducted within the steel industry. The findings show that Iran's steel industry catch-up strategy is based on a path-following in which synthesizing overseas technology transfer with indigenous technological developments occurs. That is, firms enrich their indigenous capabilities through reverse engineering of established technologies like MIDREX, progressing to re-engineering existing technologies in iron-making. The enhancement of capabilities, coupled with the employment of opportunity windows, has paved the way for the path-creation in minor technology that has ultimately resulted in the advent of PERED technology. Finally, the findings are further compared with other domestic industries and insights are sought from international counterparts for researchers and participators.

Effects of disease-modifying anti-rheumatic drugs on sacroiliac MRI score in axial spondyloarthritis: a systematic review and meta-analysis.

Sacroiliac bone marrow edema is an important factor in the diagnosis and management of axial spondyloarthritis (axSpA). The aim of this meta-analysis is to assess the effect of the different bDMARDs and tsDMARDs on the SPARCC score at 12-16 and 48-52 weeks. A systematic review, performed on PubMed (including Medline), Cochrane (CENTRAL) and DOAJ databases, included randomized controlled studies evaluating the sacroiliac joint (SIJ) SPARCC score at 12-16 or 48-52 weeks in patients with axSpA meeting the ASAS 2009 criteria or the modified New York criteria. We included studies evaluating the effects of the different treatments on the SPARCC score of SIJ in axial spondyloarthritis in comparison to a control group. Eighteen studies were included in the meta-analysis. Nine studies evaluated the effect of TNFα inhibitors (TNFi), three for IL-17 inhibitors, and four for JAK inhibitors. At 12 and 16 weeks, SIJ SPARCC score was significantly improved by TNFi (WMD: - 3.29 [95% CI - 4.25; - 2, 34]), by IL-17 inhibitors (WMD: - 4.66 [95% CI - 6.22; - 3.09]), and by JAK inhibitors (JAKi) (WMD: - 3.06 [95% CI - 3.24; - 2.89]). There was no difference between the molecule subgroups. At 48-52 weeks, TNFα inhibitors reduced more SIJ SPARCC, but not significantly (WMD: - 2.26 [95% CI - 4.94; 0.42]), than placebo groups who began a TNFi treatment with delay. Our meta-analysis shows a comparable improvement of the SIJ SPARCC score regarding TNFi, JAKi, and IL-17 inhibitors at three months and suggests the presence of an opportunity window. Key Points • Anti-TNF Ab, anti-IL17 Ab, and JAK inhibitor treatments reduce the sacroiliac joint SPARCC scores. • There is no difference between the different treatments in the reduction of the sacroiliac joint SPARCC score after 3 months in axial spondyloarthritis.

Early Life Nutrition during the First 1000 Days from a Malaysian Perspective

The first 1000 days of life, encompassing the period from conception to a child’s second birthday, represents a pivotal phase in human development. This review paper highlighted the importance of this critical window with a comprehensive analysis exploring the multifaceted impact of nutrition during the three distinct phases: the pregnancy-intrauterine period, early infancy-breastfeeding period, and early childhood-complementary feeding period. Within the pregnancy-intrauterine period, the maternal body mass index emerges as a crucial factor, directly affecting the well-being of both mother and child. Optimal nutrition, including essential micronutrients such as folic acid, iron, iodine, and vitamin D, are imperative to mitigate the risk of neural tube defects and related disorders, which remain a concern in Malaysia. Exclusive breastfeeding during the initial six months of life is identified as a cornerstone of infant development, nurturing both the child’s cognitive abilities and immune system. Timely introduction of complementary foods is equally vital, acting as a safeguard against childhood obesity and undernutrition. This review paper provided an in-depth examination of the importance and critical role of nutrition in the first 1000 days of life. It further outlined the current status, recommended strategies and interventions to improve child nutrition during this crucial phase in the Malaysian context.

Latecomers’ technological catch-up dynamics in natural resource-based industries: Evidence from Iran’s oil & gas sector

This study sheds light on the catch-up dynamics in natural resource-based industries (NRBI) of developing countries considering learning modes, technological capability dimensions, catch-up strategies, and windows of opportunity. It provides a framework for examining the technological catch-up of latecomer Exploration & Production companies while emphasizing the nature of the industry and characteristics of lagging behind and under-sanction countries like Iran. The analytical framework has been examined by studying two Iranian oil companies. Findings show that latecomer E&P companies can take two distinct paths for technological catch-up, including increasing the depth of operational capability and upgrading the level of advanced capability.

Trogocytosis of CAR molecule regulates CAR-T cell dysfunction and tumor antigen escape

Chimeric antigen receptor (CAR) T-cell therapy has demonstrated clinical response in treating both hematologic malignancies and solid tumors. Although instances of rapid tumor remissions have been observed in animal models and clinical trials, tumor relapses occur with multiple therapeutic resistance mechanisms. Furthermore, while the mechanisms underlying the long-term therapeutic resistance are well-known, short-term adaptation remains less understood. However, more views shed light on short-term adaptation and hold that it provides an opportunity window for long-term resistance. In this study, we explore a previously unreported mechanism in which tumor cells employ trogocytosis to acquire CAR molecules from CAR-T cells, a reversal of previously documented processes. This mechanism results in the depletion of CAR molecules and subsequent CAR-T cell dysfunction, also leading to short-term antigen loss and antigen masking. Such type of intercellular communication is independent of CAR downstream signaling, CAR-T cell condition, target antigen, and tumor cell type. However, it is mainly dependent on antigen density and CAR sensitivity, and is associated with tumor cell cholesterol metabolism. Partial mitigation of this trogocytosis-induced CAR molecule transfer can be achieved by adaptively administering CAR-T cells with antigen density-individualized CAR sensitivities. Together, our study reveals a dynamic process of CAR molecule transfer and refining the framework of clinical CAR-T therapy for solid tumors.

The scholarship of teaching and learning in public administration: An agenda for future research

ABSTRACT Two essential questions for those leading the field of public administration are: What do we teach our students, and how do we train them? As scholars, we pay significant attention to our research, often to the detriment of recognizing the potential for merging our research with teaching through the Scholarship of Teaching and Learning (SoTL). However, given our students’ leadership positions, SoTL-related work is vital to their success. In this article, we have come together to reflect on the state of SoTL’s work in public administration. Through this reflection, we explore the windows of opportunity for research that we see emerging. Included among these opportunities is the need for research on how we can best serve students in and out of the classroom, as well as research the most effective way of managing our programs. We also see the need for research into faculty development, instructional design, and the return on investment for a public administration degree. Lastly, we argue for improved recognition of the value and contribution of SoTL-related work in tenure and promotion standards.

Rusų nacionalistai prieš Kauno gubernatorių: kitataučIų švietimo draugijos kaip pavojus imperijai 1907–1910 m.

The article explains why, in 1909, there appeared instigations in Russian public discourse calling for closure of the Lithuanian Catholic educational society ‘Saulė’ (The Sun), and at the same time criticism was directed at the governor of Kaunas, who supposedly was the patron of this association. This action of Russian nationalist is interpreted as a reflection of the empirewide struggle against non-Russian public organisations. It was Russian public figures and civil servants promoting a nationalistic nationality policy who wanted to close the ‘Saulė’.

Induced Endothelial Cell Cycle Arrest Prevents Arteriovenous Malformations in Hereditary Hemorrhagic Telangiectasia.

Distinct endothelial cell cycle states (early G1 versus late G1) provide different "windows of opportunity" to enable the differential expression of genes that regulate venous versus arterial specification, respectively. Endothelial cell cycle control and arteriovenous identities are disrupted in vascular malformations including arteriovenous shunts, the hallmark of hereditary hemorrhagic telangiectasia (HHT). To date, the mechanistic link between endothelial cell cycle regulation and the development of arteriovenous malformations (AVMs) in HHT is not known. We used BMP (bone morphogenetic protein) 9/10 blocking antibodies and endothelial-specific deletion of activin A receptor like type 1 (Alk1) to induce HHT in Fucci (fluorescent ubiquitination-based cell cycle indicator) 2 mice to assess endothelial cell cycle states in AVMs. We also assessed the therapeutic potential of inducing endothelial cell cycle G1 state in HHT to prevent AVMs by repurposing the Food and Drug Administration-approved CDK (cyclin-dependent kinase) 4/6 inhibitor (CDK4/6i) palbociclib. We found that endothelial cell cycle state and associated gene expressions are dysregulated during the pathogenesis of vascular malformations in HHT. We also showed that palbociclib treatment prevented AVM development induced by BMP9/10 inhibition and Alk1 genetic deletion. Mechanistically, endothelial cell late G1 state induced by palbociclib modulates the expression of genes regulating arteriovenous identity, endothelial cell migration, metabolism, and VEGF-A (vascular endothelial growth factor A) and BMP9 signaling that collectively contribute to the prevention of vascular malformations. This study provides new insights into molecular mechanisms leading to HHT by defining how endothelial cell cycle is dysregulated in AVMs because of BMP9/10 and Alk1 signaling deficiencies, and how restoration of endothelial cell cycle control may be used to treat AVMs in patients with HHT.

THE NATIONAL MINORITIES EMIGRATION FROM THE UkSSR DURING THE NEP PERIOD (ON THE EXAMPLE OF THE VOLHYNIA PASSENGER AGENCY "RUSCAPA")

Abstract
 The purpose of the article is to study the main problems and factors of the ethnic minorities emigration, in particular, Germans and Jews, from Volhynia-Zhytomyr region in the 1920s; to reveal the peculiarities of the activities of the Russian-Canadian-American Passenger Agency (RUSCAPA) that helped USSR citizens to emigrate legally during the NEP period. Methodology of the study was general scientific methods (analysis of the available archival documents, synthesis of other sources that allowed to recreate the picture of the organization of migration flows), historical research methods (historical-comparative: parallels were drawn with previous periods and the causes of various migration waves), methods of classification and typology (to study the categories of citizens who could obtain permission to leave and enter another country). Scientific novelty. New documents from the archival fund «The Volhynia passenger agency «RUSCAPA»», stored in the State Archives of Zhytomyr region, are introduced into scientific circulation for the first time. The conditions of emigration during the NEP period and the methods of its regulation by the Soviet authorities are systematized.
 Conclusions. The second wave of emigration among the representatives of national minorities (primarily Jews and Germans) was an indicative form of protest against the conditions of economic, religious life, and other restrictions imposed by the Soviet political system. The former Volhynia province, with its center in Zhytomyr, was a region with a compact population of German and Jewish communities, whose representatives made up the highest percentage of those who took advantage of the short «window of opportunity» to travel abroad that existed in the USSR during the NEP period. That was a reason for the presence in Zhytomyr a representative office of a private company that organized emigration. However, it was not easy to leave the USSR, nor was it easy to get to the country of immigration, due to significant bureaucratic obstacles and arguments for the expediency of permits/prohibitions for the departure/entry of representatives of different social categories and national groups. Restrictions were created by the Soviet government that sought to prove to the world the advantages of the young «proletarian» state and by the immigration policy of «overseas» states that were interested in attracting physically, socially and financially prosperous citizens to their countries. RUSCAPA helped to bypass the restrictions, and its liquidation was a consequence of the collapse of the NEP and the transformation of the USSR into a totalitarian system closed by the Iron Curtain.

BIOLOGICAL AGE AND COGNITIVE PERFORMANCE AMONG LATE MID-LIFE WOMEN

Abstract Older biologic age, indicated by accelerated epigenetic aging, may place women at risk for poorer cognitive performance as they age. However, findings are inconsistent and based upon limited neuropsychological batteries. Studies of midlife women are few, yet women comprise two thirds of those with Alzheimer’s disease, and midlife is a critical transition and potential window for early intervention. We tested whether greater epigenetic age would be associated with poorer cognitive performance among late midlife women. 224 MsBrain study participants (average age=59 years, 82% White, 14% Black, 4% other ethnicities) underwent phlebotomy, including epigenetic aging clock estimates (GrimAge, DunedinPACE, PCPhenoAGE), and a neuropsychological battery assessing global cognitive function (Montreal Cognitive Assessment), verbal learning and memory (California Verbal Learning Test), working memory and attention (Letter Number Sequencing), letter fluency (P, R, W); semantic fluency (animal task), spatial ability (Card Rotations), processing speed (Symbol Digit Modalities Test), and perceptual speed (Finding A’s). In linear regression models controlling for age, race, and education, older PCPhenoAge was associated with poorer global cognitive performance [B(SE)=-.07(.03), p=.01], verbal memory [B(SE)=-.09(.03), p=.006], working memory [B(SE)=-.12(.03), p=.0001], attention [B(SE)=-.10(.04), p=.02], spatial ability [B(SE)=-.77(.34), p=.02], processing speed [B(SE)=-.24(.09), p=.007], and somewhat lower letter fluency [B(SE)=-.23(.13), p=.07]. GrimAge and DunedinPACE showed similar yet less consistent patterns. Interactions by race (p’s<.05) indicate that associations between older biologic age and poorer cognitive performance (verbal learning, verbal memory, processing speed) was particularly pronounced among Black women in the sample. Older biologic age is associated with poorer cognitive performance across multiple domains among late midlife women, particularly for Black women. Biologic age may serve as an early indicator of risk that could help identify women warranting early intervention to help maintain cognitive function. Supported by NIH RF1AG053504, R01AG053504, K24HL123565

THE IMPORTANCE OF ROMANTIC PARTNERS FOR HEALTH—SHARED TIME, DAILY ACTIVITIES, AND COUPLE DYNAMICS

Abstract Research has shown that social relationships, particularly with a spouse or romantic partner, affect health, for better or worse. More work is needed to better understand relational dynamics within couples and their cascade effects on health throughout the life course. This symposium brings together four empirical studies that examine the importance of romantic relationships for multiple aspects of health, from biological markers (i.e., inflammation) to mental health and social connection, using diverse methodologies, from macro (long-term) and micro (short-term) longitudinal assessments to dyadic analysis. First, Dr. Stokes and colleagues examine marital status in the Health and Retirement Study and find that transitions, such as becoming widowed (as compared to remaining married), heighten inflammation and potentially harm health. Second, Dr. Karakose and colleagues examine perceptions of time spent together within married couples and find that time together is protective against stress for both partners, and against depressive symptoms for wives. Third, Dr. Luchetti and colleagues examine momentary, phone-based assessments of loneliness within romantic couples and find loneliness in males to affect subsequent loneliness in their female partners. Finally, Dr. Nikitin and colleagues examine possible sources of loneliness within couples and find an association between low-quality daily activities with partners and momentary/daily loneliness. These studies focus on adults across the lifespan, including middle adulthood, which is a critical yet under studied period of life and regarded as a window of opportunity for interventions to improve health. Results highlight the importance of couple dynamics for the health and well-being of aging adults.

Early Famine Exposure Results in Left Ventricular Remodeled, Diastolic Dysfunction and Systolic Function Preserved in Adults

Introduction: Malnutrition during a critical window of development in a fetus or infant can result in abnormal cardiac remodeling and function. It is uncertain whether the contribution of these effects continues to impact the cardiac remodeling and function of adults over the course of several decades of growth. Our study examined the impact of early Chinese famine exposure on cardiac remodeling, left ventricular (LV) diastolic function, and LV systolic function in adults. Methods: Participants at high risk of cardiovascular disease from the China Patient-Centered Evaluative Assessment of Cardiac Events Million Persons Project (PEACE MPP) were enrolled. The famine in China lasted from 1959 to 1962. A total of three groups were formed based on the participants’ birth dates: pre-famine group, famine exposure group, and post-famine group. Logistic regression and linear mixed models were used to explore the association between famine exposure and cardiac remodeling, LV diastolic function and LV systolic function in adults. Results: The study included 2,758 participants, the mean age was 57.05 years, 62.8% were female, 26.4% had LV hypertrophy (LVH), 59.6% had LV diastolic dysfunction (LVDD), and 10.5% had reduced global longitudinal strain (GLS). Compared to post-famine exposure, participants had independently increased risk of LVH in the famine exposure group (OR: 2.02, 95% CI: 1.60–2.56) and pre-famine exposure (OR: 1.36, 95% CI: 1.06–1.76). Compared to post-famine exposure, the risk of LVDD remarkably increased in the famine exposure group (OR: 3.04, 95% CI: 2.49–3.71) and pre-famine exposure group (OR: 1.87, 95% CI: 1.52–2.31). Famine exposure had no significant impact on GLS but was associated with a significant increase in LV ejection fraction (LVEF) and LV end-diastolic diameter (LVEDD). Significant interactions were observed between the effects of famine exposure and other clinical/sociodemographic variables (gender, systolic blood pressure [SBP] ≥140 mm Hg or not, high school or above or not, and annual income <50,000 RMB or not) on these outcomes. Conclusion: Exposure to famine, particularly during fetal and infant stages, increases the risk of LVH and LVDD in adults. However, the LV systolic function remains preserved. These impacts are more pronounced in females, individuals with SBP ≥140 mm Hg, those with low income, or those with high educational status.

Catalyzing India's Progress: Integrating Youth Empowerment, Skill-Based Education, and Economic Development Initiatives

India, home to the world's largest youth population, recognizes its youth demographic as a pivotal 'window of opportunity' for national growth and development. The challenge lies in proactively addressing the multifaceted needs of this demographic to harness its potential effectively. This paper explores the intersection of youth, skill-based education, and national development, emphasizing the critical role of skill-based education in equipping the youth for a dynamic job market and fostering comprehensive socio-economic development. The National Education Policy 2020 serves as a transformative milestone, envisioning a holistic education system aligned with 21st-century goals. Key features include universal access to schooling, vocational integration, and targeted literacy goals, reflecting a commitment to nurturing a skilled and enlightened youth. The Micro, Small, and Medium Enterprises (MSME) sector emerges as a crucial player in inclusive industrial development, providing substantial employment opportunities and contributing significantly to the nation's economic fabric. The state of Odisha aligns with the national vision, undertaking initiatives contributing to the overarching goal of youth development and community engagement..The impact of these endeavors not only contributes to economic growth but also lays the groundwork for a socially conscious and globally competitive nation.

Generation of adult hippocampal neural stem cells occurs in the early postnatal dentate gyrus and depends on cyclin D2.

Lifelong hippocampal neurogenesis is maintained by a pool of multipotent adult neural stem cells (aNSCs) residing in the subgranular zone of the dentate gyrus (DG). The mechanisms guiding transition of NSCs from the developmental to the adult state remain unclear. We show here, by using nestin-based reporter mice deficient for cyclin D2, that the aNSC pool is established through cyclin D2-dependent proliferation during the first two weeks of life. The absence of cyclin D2 does not affect normal development of the dentate gyrus until birth but prevents postnatal formation of radial glia-like aNSCs. Furthermore, retroviral fate mapping reveals that aNSCs are born on-site from precursors located in the dentate gyrus shortly after birth. Taken together, our data identify the critical time window and the spatial location of the precursor divisions that generate the persistent population of aNSCs and demonstrate the central role of cyclin D2 in this process.

Key trends of rural development in the world and their projection on Russia

This article is the first attempt by the authors to formulate key trends in the field of rural development. The main tool is a bibliometric analysis based on the Scopus database. In 2021, the priority areas of scientific research are rural tourism, environmental problems in rural areas, the creation of engineering infrastructure, sustainable rural communities as well as climate change and its impact on rural areas. In the course of the study, the authors found that the interest in rural development is growing rapidly: tenfold from 2000 to 2021. We proposed to divide the directions of scientific research into two groups: lower and upper levels. Developed countries are focused on leading research areas, less developed — on the lowest. These include problems of rural poverty, infrastructure, rural population outflow and depopulation. The authors also conducted a desk study to identify key trends in rural development. The projection of these trends onto Russian rural areas opens up new windows of opportunity for them. These are the diversification of the rural economy through rural tourism and the development of alternative types of employment, the establishment of eco-settlements, the production of environmentally friendly farm products, and the creation of new rural settlements in areas that will become climatically favorable as a result of the projected climate change.

Participation of Religious Brothers in the Exercise of Authority in Clerical Religious Institutes

The paper has been inspired by the rescript of Pope Francis issued as a motu proprio on the appointment of superiors in clerical institutes. According to the binding ecclesiastical legislation, such practices used to be prohibited, although the Holy See would grant permissions on a case-by-case basis. The article discusses the idea of exercising authority in religious institutes according to the traditional rules of religious life, referring to St Benedict and St Francis. A serious obstacle to regulating this issue is the exercise of power. Another reason indicated in the rescript is the personnel situation in religious institutes, which makes it impossible for some members of the clergy to serve as superiors due to age and health status. This fact caused requests to the Holy See seeking permission for non-clerics to exercise the office of superiors. A significant attempt to respond to this need is the rescript announced by Pope Francis. It takes account of the existing legal solutions, as well as opening up a certain window of opportunity as regards changes to the structure of power in clerical institutes.