FemTech: empowering reproductive rights or FEM-TRAP for surveillance?

The emergence of FemTech technologies promises to revolutionize women's health and reproductive rights but conceals an insidious trap of surveillance and control in the hands of private and state actors. This article examines the extent to which FemTech technologies, under the guise of empowerment, enable private actors to play a leading role in managing reproductive rights, replacing largely inactive States in this crucial function. The analysis shows how private FemTech companies are becoming critical players in implementing and defending these rights, often in response to the inaction or inadequacies of States. The article approaches the FemTech phenomenon from several angles, including the promises of empowerment, concerns about surveillance and control, and the ambivalent roles of private actors as implementers and defenders of reproductive rights. This structure makes it possible to offer a critical analysis of the legal, societal, and ethical implications of FemTech, highlighting the tensions between the promises of empowerment and the risks of surveillance and control.

Assessing the role of non-state actors in health service delivery and health system resilience in Myanmar.

BACKGROUND: Due to the weaknesses of the public health system and its low reach, especially in border areas, provision of health services by non-state actors (NSAs) has historically played an important role in Myanmar. NSAs include local and international NGOs and civil society organisations (CSOs), but also Ethnic Health Organisations (EHOs) in the border areas, as well as the private (for profit) sector. This study aims to understand the changing role of NSAs in the shifting political environment of Myanmar between 2010 and 2022, and to explore their contribution to health system resilience. METHODS: Our study includes three main components: a documentary review (n = 22), key informant interviews (KIIs) at central level (n = 14) and two township-level case studies (13 KIIs, 4 FGDs). Mostly qualitative data were collected in 2022 and synthesized, using a health system resilience framework to structure the analysis. RESULTS: During the transition period (2010-2014) and the new political era (2015-2020), while the country gradually transitioned to a democratic system, the government increasingly recognized NSAs. Initially, engagement with NSAs remained focused on disease-specific activities and government oversight was limited, but later it expanded to health system strengthening, including the start of a "convergence" with ethnic health systems. Progress was relatively slow, but defined by a clear vision and plans. The military coup of February 2021 brought a halt to this progress. Collaboration between government and NSAs was interrupted, and NSAs restored previous practices and parallel systems. Initially, most health service provision stopped, but with time coping strategies emerged, which showed the capacity of NSAs to absorb the shocks (focusing on basic services; using informal communication channels; maintaining buffer stocks of supplies) and adapt (changing modes of delivery and supply chains, and adjusting HRH training). CONCLUSIONS: The study highlights the role of NSAs during crises, and provides insights on how the resilience capacities built over time by NSAs to provide services in adverse circumstances have informed the response to the latest crisis. While strategies of absorption and adaptation are noted in the study, we did not identify any transformation strategy - which might indicate the difficulty of NSAs to introduce radical changes when subjected to multiple shocks and a hostile political environment.

'The company is using the credibility of our profession': exploring experiences and perspectives of registered dietitians from Canada about their interactions with commercial actors using semi-structured interviews.

OBJECTIVE: To gain insight into the experiences and perspectives of registered dietitians (RD) in Canada regarding their interactions with commercial actors and actions undertaken to manage these interactions. DESIGN: Qualitative study using semi-structured interviews combined with a document analysis. SETTING: Quebec, Canada. PARTICIPANTS: RD aged ≥ 18 years (n 18). RESULTS: All participants reported interacting with commercial actors during their careers, such as receiving continuing education provided or sponsored by food companies. RD in Quebec perceive these interactions as either trivial or acceptable, depending on the commercial actor or interaction type. Participants discussed how certain interactions could represent a threat to the credibility and public trust in dietitians, among other risks. They also discussed the benefits of these interactions, such as the possibility for professionals to improve the food supply and public health by sharing their knowledge and expertise. Participants reported ten mechanisms used to manage interactions with commercial actors, such as following a code of ethics (individual level) and policies such as partnerships policy (institutional level). Finally, RD also stressed the need for training and more explicit and specific tools for managing interactions with commercial actors. CONCLUSIONS: RD in Quebec, Canada, may engage with commercial actors in their profession and hold nuanced perspectives on this matter. While some measures are in place to regulate these interactions, they are neither standardised nor evaluated for their effectiveness. To maintain the public's trust in RD, promoting awareness and developing training on this issue is essential.

The Dutch Citizen's Understanding and Perception of the Actors Involved in the Netherlands' COVID-19 Pandemic Response: A Focus Group Study During the First Pandemic Wave.

INTRODUCTION: The COVID-19 pandemic was a public health emergency (PHE) of unprecedented magnitude and impact. It provided the possibility to investigate the Dutch citizens' understanding and perception of the actors involved in the Dutch pandemic response as a PHE unfolded. METHODS: Three focus groups (FGs) were held with 16 Dutch citizens in June 2020. Citizens were recruited using the Dutch Health Care Consumer Panel. During the FGs, participants were asked to fill in a table with actors they thought were involved in the management of the COVID-19 pandemic. They also received information on actors involved in Dutch outbreak responses. Then, the actors named and omitted by the participants were discussed. RESULTS: An analysis of the FGs suggests that the Dutch citizens participating in the study were not fully aware of the scope of actors involved in the Dutch COVID-19 pandemic response. Some participants would have appreciated more information on the actors involved. This would help them have an informed opinion of the actors involved in the decision-making process, and accept non-pharmaceutical interventions implemented. Lastly, most participants recognised that they played a role in limiting the spread of the COVID-19 pandemic. Yet, very few spontaneously mentioned themselves as actors within the COVID-19 pandemic response. CONCLUSION: This study suggests that early in the COVID-19 pandemic, the Dutch citizens participating in this study's FG did not have a complete understanding of the scope of actors involved in the Dutch COVID-19 pandemic response, or the potential role of the citizen. Future research can build on these results to explore the citizen's perception of their role during PHEs of another origin, as well as other geographical and historical contexts. PATIENT OR PUBLIC CONTRIBUTION: The public participated in the focus groups and received a non-expert report summarising the outcomes of the focus groups.

A Preliminary Report of Developing Performer-Centered Vocal Injury Rehabilitation: An Interprofessional Collaborative Practice for Graduate Students in Speech-Language Pathology and Acting.

OBJECTIVES: Acting voice coaches (AVCs) and speech-language pathologists (SLPs) use dynamic teaching methods and intervene using motor learning principles. Both display instructional flexibility based on the actor/client's needs. With these criteria, we developed a virtual 3-hour professional voice lab to promote team-based learning between SLP graduate students and Master of Fine Arts (MFA) student actors. METHODS: The lab contained three phases: prebrief (50 minutes), case-study simulation (1.5 hours), and debrief (30 minutes). The students completed pre and postevaluation surveys to reflect on their learning experience. During the prebrief, the roles of AVCs and SLPs in actor's voice habilitation and rehabilitation, respectively, were discussed along with the special vocal needs of stage actors. The learners completed a comprehensive voice evaluation on "Maria Horseman," a 23-year-old professional actor with a voice disorder, in small interprofessional groups. The provided template offered a holistic approach to explore speaking-singing-acting vocal activities, vocal behaviors, physical demands/cardiorespiratory load, training/practice regimen, lifestyle changes including medication effect, and voice ergonomics. A customized client-centered voice intervention plan was developed by considering Maria's best interests and stimulability. RESULTS: Two different surveys, 15 items in Performance Voice Diagnostics for SLP students and Voice-Related Self-Perception for MFA students, and 20 items in modified Casey-Fink Readiness to Practice, were used to compare differences in self-confidence levels intervening professional voice disorders. Comparison of pre and postevaluation data revealed a statistically significant difference in learner self-confidence and readiness levels. CONCLUSIONS: A team-based, interprofessional learning approach on voice rehabilitation would help SLPs to consider special vocal demands of professional voice users in their evaluation methods. This may also lead to preventive early intervention by increasing vocal awareness and knowledge on phonatory function in professional actors from the beginning of their careers.

Potential Impact of Current Agricultural Practices on Mycotoxin Occurrence and Mycotoxin Knowledge Along the Cassava Value Chain in Uganda.

Cassava is the second most important staple food crop for Uganda and is prone to contamination with mycotoxins. This study aimed at understanding the current agricultural practices, their potential influence on mycotoxin occurrence, as well as assessing mycotoxin knowledge among key cassava value chain actors, including farmers, wholesalers, and processors. Data were collected through individual interviews (210), key informant interviews (34), and 4 focus group discussions. The findings revealed that 51% of farmers peeled cassava directly on bare ground, resulting in direct contact with soil that potentially harbors mycotoxin-producing fungi, such as Aspergillus section Flavi. During postharvest handling, 51.6% of farmers dried cassava chips directly on bare ground. Nearly, all (95.2%) of wholesalers packed cassava chips in local gunny bags and placed them on ground instead of pallets. In the processing of cassava chips into flour, only one of the 14 processing machines was certified by the Uganda National Bureau of Standards. Additionally, there was only one processing machine available for every 180 (1:180) consumers bringing their cassava for processing. 50.8% of cassava consumers interviewed admitted to consuming cassava flour regardless of quality, while 73% blended cassava flour with flour from mycotoxin-susceptible crops mainly maize, millet, and sorghum. Most (96.2%) of the people along the cassava value chain did not understand what the term mycotoxins meant. However, 56% of interviewed respondents were familiar with the term aflatoxins. Of the cassava value chain actors aware of mycotoxins, 82.9% knew of methods for reducing aflatoxin contamination, but only 40.9% were putting such methods into practice. More farmers (47.9%) managed aflatoxins compared to wholesalers (33.3%) and processors (21.4%). Knowledge on aflatoxins was significantly associated with value chain actor (P = 0.026), head of household (P = 0.004), region (P = 0.033), age (P = 0.001), and experience (P = 0.001). This study highlights the critical areas of mycotoxin contamination within the cassava value chain in Uganda and underscores the need to improve the knowledge among value chain actors especially farmers.

Transforming the residential built environment: Land-use policies and the influence of the growth machine across the United States.

What effects do growth machine actors have on transformation of the built environment in terms of localities' enacted land-use policies and actual development? To the best of our knowledge, this study is among the first to answer this question for communities across the United States. We draw on the growth machine theory and speak to some of its proponents' puzzling findings that policies designed to limit growth often facilitate it. Our analysis is grounded in the urban-quantitative tradition of large-sample studies of U.S. localities. We find that involvement of growth machine business actors in local government is related to transformation of the built environment as indicated by the issuance of new residential building permits. Intriguingly, involvement of local growth actors is also associated with greater use of land-use control policies, which, in turn, have positive rather than negative effects on issuance of new residential building permits. Thus, it seems growth machine actors support policies that outwardly appear to stymie growth, although they in practice do not. These findings suggest land-use policies are often designed with enough leeway for continued growth. Supporting such policies allows growth machine actors to publicly signal support for managed growth and environmental protection, although the reality on the ground remains business as usual.

Dose-response effects of physical exercise standardized volume on peripheral biomarkers, clinical response, and brain connectivity in Parkinson's disease: a prospective, observational, cohort study.

Background: Exercise has been proposed as the "Universal Prescription for Parkinson's Disease"; however, the specificity of exercise dose in terms of frequency, intensity, duration, and type to be prescribed remains to be elucidated. The 2018 US updated guidelines and WHO Guidelines on Physical Activity and Sedentary Behavior recommend older adults (> 65+ years) to achieve weekly minimal activity levels, indicating the intensity of aerobic exercise as the metabolic equivalent of task and duration as minutes/week (150-300 min/week at a moderate intensity of 3-5.9 MET- or 75-150 min/week of a vigorous intensity of ≥6 MET). Translating these recommendations to PD patients, the study aimed to assess the dose-response effects of standardized volume of structured exercise, measured as METs-minutes/week (weekly energy expenditure) of two different rehabilitation settings to quantify the change in neurotrophic factors. The exercise-induced benefits between the two rehabilitation settings will be evaluated based on motor and non-motor symptoms, kinematic parameters of gait, cognitive function, quality of life, and cortical activity and brain connectivity. Methods: METEX-PD is a pilot, prospective, observational, cohort study. The study will enroll consecutively thirty (N = 30) participants with mild-to-moderate Parkinson's disease diagnosis to be assigned to a non-intensive or intensive rehabilitation group. The non-intensive rehabilitation group will achieve a range of 180-270 METs-min/week (90 min/week of low-intensity aerobic exercise, 2-3 METs), while the intensive rehabilitation group will exercise at 1350-1980 METs-min/week (225 min/week of high-intensity aerobic exercise, 6-8.8 METs). The METEX-PD trial will last 12 weeks, including 4 weeks of aerobic training program and two follow-ups. Assessments will be performed at baseline (T0), at the end of the exercise program (T1-end of the program), and 4- and 8 weeks after the end of the training program (FU-1 and FU-2). The primary outcome is the change from baseline in peripheral blood BDNF levels. Secondary outcomes are differences in peripheral biomarkers, functional-motor assessments, clinical-functional evaluations, and brain imaging. Conclusion: METEX-PD trial will enable us to estimate the change in BDNF levels and other peripheral biomarkers under precise exercise-induced energy expenditure. The primary results of the METEX-PD study will allow the development of a larger multicenter randomized controlled trial to investigate the molecular pathways inducing the change in selected neurotrophic factors, such as BDNF, IGF-1, or irisin, and the downstream mechanisms of neuroplasticity in PD patients.

Voice actors show enhanced neural tracking of pitch, prosody perception, and music perception.

Experiences with sound that make strong demands on the precision of perception, such as musical training and experience speaking a tone language, can enhance auditory neural encoding. Are high demands on the precision of perception necessary for training to drive auditory neural plasticity? Voice actors are an ideal subject population for answering this question. Voice acting requires exaggerating prosodic cues to convey emotion, character, and linguistic structure, drawing upon attention to sound, memory for sound features, and accurate sound production, but not fine perceptual precision. Here we assessed neural encoding of pitch using the frequency-following response (FFR), as well as prosody, music, and sound perception, in voice actors and a matched group of non-actors. We find that the consistency of neural sound encoding, prosody perception, and musical phrase perception are all enhanced in voice actors, suggesting that a range of neural and behavioural auditory processing enhancements can result from training which lacks fine perceptual precision. However, fine discrimination was not enhanced in voice actors but was linked to degree of musical experience, suggesting that low-level auditory processing can only be enhanced by demanding perceptual training. These findings suggest that training which taxes attention, memory, and production but is not perceptually taxing may be a way to boost neural encoding of sound and auditory pattern detection in individuals with poor auditory skills.

Is There a Relationship between Psychotic Disorders and the Radicalization Process? A Systematic Review.

Background and Objectives: Radicalization, a complex and multifaceted phenomenon, has been a subject of increasing concern in recent years, particularly due to its potential connection to acts of mass violence and terrorism. This systematic review examines the intricate link between radicalization and psychotic disorders, utilizing various sources such as observational studies, case reports, and series. It aims to highlight the prevalence of schizophrenia spectrum and other psychotic disorders among radicalized individuals and to define the role of mental health professionals in dealing with this issue, contributing to the development of prevention and treatment strategies. Materials and Methods: The methodology involved an extensive literature search across PubMed, Scopus, and APA PsycINFO up to 1 February 2024, adhering to PRISMA guidelines. The study focused on radicalization and psychotic disorders as defined by DSM-5 criteria, excluding other mental disorders. A population sample of 41 radicalized individuals diagnosed with psychotic disorders was selected, among which schizophrenia was identified as the predominant condition. Results: It was observed that 24% of these individuals passed away soon after committing their crimes, leading the researchers to rely on retrospective data for their diagnoses. The use of diverse assessment tools for psychiatric diagnosis and the lack of a standardized method for diagnosing or assessing involvement in the radicalization process were also noted. Despite limitations like reliance on observational studies and case reports, which result in low evidence quality and varied methodologies, our work provides a valuable contribution to clarifying the relationship between radicalization and psychotic disorders. However, further clinical studies are needed to delve deeper into these aspects. Conclusions: In conclusion, our review points out that individuals with psychotic disorders do not have a higher crime rate than the general population and warns against associating crimes with mental illness due to the stigma it creates. The lack of uniform psychiatric diagnostic tools and radicalization assessment highlights the need for more standardized risk assessment tools and validated scales in psychiatric diagnosis to better understand the relationship between radicalization and psychotic disorders and to develop integrated protocols.

Collaborations and Networks Within Communities for Improved Utilization of Primary Healthcare Centers: On the Road to Universal Health Coverage.

Objectives: Community involvement depends on the level of linked and targeted activities for health by community members. This study examines the collaborations employed within communities to ensure sustainable access and improved use of healthcare in the community. Methods: This study was conducted in rural and urban local government areas in Anambra, Kano, and Akwa-Ibom, Nigeria. About 90 in-depth interviews and 12 focus group discussions were conducted with community stakeholders and service users. The findings were transcribed and coded via thematic analysis, guided by the Expanded Health Systems framework. Results: Various horizontal collaborations in communities foster increased use of PHC services; promoting community health. Major horizontal collaborations in these communities were community-led, primary health facility-led, and Individual-led collaborations. Their actions revolved around advocacy, building and renovating PHC centers, equipping facilities, and sensitization to educate community members on the need to utilize services at PHC centers. Conclusion: Strategic involvements and collaborations of local actors within communities give rise to improvements in the utilization of primary healthcare centres, reportedly resulting in improved access to PHC healthcare services for community members.

'My Advocacy is Not About Me, My Advocacy is About Canadians': A Qualitative Study of how Caregivers and Patients Influence Regulation of Medical Assistance in Dying in Canada.

Medical assistance in dying (MAiD) was legalised federally in Canada after the Supreme Court decision in Carter v Canada (Attorney General) [2015] 1 SCR 331. The federal legislative framework for MAiD was established via Bill C-14 in 2016. Caregivers and patients were central to Carter and subsequent litigation and advocacy, which resulted in amendments to the law via Bill C-7 in 2021. Research has primarily focused on the impacts of regulation on caregivers and patients. This qualitative study investigates how caregivers and patients influence law reform and the operation of MAiD practice in Canada (ie, behave as 'regulatory actors'), using Black's definition of regulation. We found that caregivers and patients performed sustained, focused, and intentional actions that influenced law reform and the operation of MAiD in practice. Caregivers and patients are not passive objects of Canadian MAiD regulation, and their role in influencing regulation (eg, law reform and MAiD practice) should be supported where this is desired by the person. However, recognising the burdens of engaging in regulatory action to address barriers to accessing MAiD or to quality care, and MAiD system gaps, other regulatory actors (eg, governments) should minimise this burden, particularly where a person engages in regulatory action reluctantly.

Hidden figures: how legal experts influence the design of international institutions.

Whose preferences influence the design of international institutions? Scholarship on the legalization of international politics and creation of international legal institutions largely adopts a state-centric perspective. Existing accounts, however, fail to recognize how states often delegate authority over institutional design tasks to independent legal experts whose preferences may diverge from those of states. We develop a principal-agent (PA) framework for theorizing relations between states (collective principals) and legal actors (agents) in the design process, and for explaining how legal actors influence the design of international institutions. The legal dimensions of the PA relationship increase the likelihood of preference divergence between the collective principal and the agent, but also create conditions that enable the agent to opportunistically advance its own design preferences. We argue that the more information on states' preferences the agent has, the more effectively it can exploit its legal expertise to strategically select and justify design choices that maximize its own preferences and the likelihood of states' acceptance. Our analysis of two cases of delegated institutional design concerning international criminal law at the United Nations and the African Union supports our theoretical expectations. Extensive archival and interview data elucidate how agents' variable information on states' preferences affects their ability to effectively advance their design preferences. Our theory reveals how independent legal experts with delegated authority over design tasks influence institutional design processes and outcomes, which has practical and normative implications for the legalization of international politics.

"God, I hope it doesn't fade out": Team Member Perspectives on the Future of Veterans Treatment Courts.

Despite their rapid spread over the last 15 years, little research has explored the perceptions of Veterans Treatment Courts (VTCs) team members regarding the viability and longevity of VTCs. The present qualitative study explores the perceptions of 145 VTC team members from 20 VTCs around the United States regarding the future of their own VTC and VTCs in general. Our analysis revealed four overarching themes about team members' expectations and hopes for VTCs in the future: the need for continued funding and increased resources; desires to expand participation in VTCs; hope and uncertainty about the future of VTCs; and depending on specific people to ensure the future of VTCs. While interviewees in general felt quite hopeful and optimistic that VTCs would continue to exist and may even expand, there was unease about exactly how this would occur. These concerns included securing stable funding sources, maintaining 'buy in' from key individuals, and resource needs for expanding the participation and eligibility criteria of VTCs. Given the important role that VTCs can play in effectively supporting justice-involved veterans, and offering more benefits compared to a traditional justice-system response, it seems vital to ensure that VTCs are able to continue operating in the future.

Social and behavior change communication competency among front-line healthcare system actors in Ethiopia: a cross-sectional study.

INTRODUCTION: Social and Behavior Change Communication (SBCC) plays a critical role in improving behavior and health outcomes across the continuum of healthcare. Failing to implement tailored SBCC strategies continues to pose a risk of ill health, increase disease burden, and impact the quality life of people. In Ethiopia, front-line healthcare system actors' knowledge and skills about SBCC have not been rigorously assessed. Thus, the current study aimed to assess healthcare system actors' competencies in designing, implementing, monitoring, and evaluating SBCC interventions in Ethiopia. METHODS: A cross-sectional study was conducted between 01 August and 31 October, 2020. Five hundred twenty-eight frontline healthcare system actors in SBCC in Ethiopia were included using simple random sampling technique. Data was collected using a self-administered structured questionnaire adopted from Communication for Change; SBCC capacity assessment tool. Descriptive analysis frequencies, percentages, mean, median, standard deviation (SD), interquartile range (IQR) were employed. Besides correlations and linear regression with robust standard errors were carried out. A 95% confidence interval and a p-value of less than 0.05 were used to declare significant statistical association. RESULTS: A total of 488 frontline workers participated in the study, with a response rate of 92.4%. The mean SBCC knowledge score was 13.2 ± standard deviation (SD) 3.99 and 59.2% scored below 60% of the expected maximum score. The standard mean score of overall skill in SBCC intervention was 2.36 (SD ± 0.98) and 52.6% of them scored below mean score. The SBCC knowledge was significantly predicted by the service year and the regional variation. On the other hand, SBCC skills was significantly predicted by sex, service year, profession, regional variation, and SBCC knowledge. The regional variation was the main predictor of both knowledge and skill on SBCC. The regression models explained 23.1% and 50.2% of the variance in knowledge and skill of SBCC, respectively. CONCLUSION: Front-line healthcare system actors in Ethiopia has low knowledge and skills in SBCC. Variations in SBCC knowledge and skill were observed based on demographic and professionals experience related characteristics. Hence, continuous capacity building activities need to be given to frontline healthcare system actors to enhance their knowledge and skill on SBCC program and achieve the intended health results.

The future of radiology and radiologists: AI is pivotal but not the only change afoot.

Uncertainty regarding the future of radiologists is largely driven by the emergence of artificial intelligence (AI). If AI succeeds, will radiologists continue to monopolize imaging services? As AI accuracy progresses with alacrity, radiology reads will be excellent. Some articles show that AI can make non-radiologists experts. However, eminent figures within AI development have expressed concerns over its possible adverse uses. Bad actors, not bad AI, may account for a future in which AI is not as successful as we might hope and, as some fear, even pernicious. More relevant to current predictions over the course of AI in medicine, and radiology in particular, is how the evolution of AI is often seen in a vacuum. We cannot predict the future with certainty. But as we contemplate the potential impact of AI in radiology, we should remember that radiology does not exist in a vacuum; while AI is changing, so is everything else. The medical system, not to mention the world's population, has been severely impacted by the global COVID-19 pandemic and numerous experts expect future worldwide pandemics. We cannot predict the condition of the healthcare system in two decades but may assume that radiology will likely remain critical in any future medical practice. For now, we should responsibly use all tools at our disposal (including AI) to make ourselves as indispensable as possible. Our best chances of remaining relevant and instrumental to patient care will likely hinge on our ability to lead the changes rather than be passively impacted by them.

The confluence of legacy, corporate social responsibility, and public health: The case of Migros and alcohol-free retailing in Switzerland.

BACKGROUND: Alcohol policy studies have traditionally focused on formal policymaking processes. Retail cooperatives, however, have rarely been studied as sites of public health interventions. Migros, a cooperatively owned chain of supermarkets in Switzerland, has long forbidden alcohol sales in its supermarkets. Focusing on processes of framing, this study explores a recent unsuccessful attempt to reverse the long-standing ban via membership vote in 2022. METHODS: The study draws on a range of data sources, including company documents, a televised debate, and the results of a large online survey among the general population conducted ahead of the referendum. Using thematic analysis, it investigates various campaign-related arguments, including those made by Migros management, NGOs, and other key campaign participants. RESULTS: Proponents and opponents used a combination of public health, economic/market-oriented, and corporate social responsibility (CSR) frames. Migros's longstanding dedication to CSR, its participatory governance structure, and the regional political dynamics in the Swiss context are essential in understanding the nature and impact of framing. CONCLUSIONS: Alcohol-related harm arises from a complex interaction between different social, political, and economic factors. Reducing harm requires approaches that consider the range of contexts and measures that can shape alcohol availability.

Amazon deforestation: A dangerous future indicated by patterns and trajectories in a hotspot of forest destruction in Brazil.

In recent years, the loss of forest in the Brazilian Amazon has taken on alarming proportions, with 2021 recording the largest increase in 13 years, particularly in the Abunã-Madeira Sustainable Development Reserve (SDR). This has significant environmental, social, and economic repercussions globally and for the local communities reliant on the forest. Analyzing deforestation patterns and trends aids in comprehending the dynamics of occupation and deforestation within a critical Amazon region, enabling the inference of potential occupation pathways. This understanding is crucial for identifying deforestation expansion zones and shaping public policies to curb deforestation. Decisions by the Brazilian government regarding landscape management will have profound environmental implications. We conducted an analysis of deforestation patterns and trends up to 2021 in the municipality (county) of Lábrea, located in the southern portion of Amazonas state. Deforestation processes in this area are likely to spread to the adjacent "Trans-Purus" region in western Amazonas, where Amazonia's largest block of remaining rainforest is at risk from planned highways. Annual deforestation polygons from 2008 to 2021 were categorized based on occupation typologies linked to various actors and processes defined for the region (e.g., diffuse, linear, fishbone, geometric, multidirectional, and consolidated). These patterns were represented through 10 × 10 km grid cells. The findings revealed that Lábrea's territory is predominantly characterized by the diffuse pattern (initial occupation stage), mainly concentrated in protected areas. Advanced occupation patterns (multidirectional and consolidated) were the primary contributors to deforestation during this period. Observed change trajectories included consolidation (30.8%) and expansion (19.6%) in the southern portion of the municipality, particularly along the Boi and Jequitibá secondary roads, providing access to large illegal landholdings. Additionally, non-change trajectories (67%) featured initial occupation patterns near rivers and in protected areas, likely linked to riverine and extractive communities. Tailoring measures to control deforestation based on actor types and considering stages of occupation is crucial. The techniques developed in this study provide a comprehensive approach for Amazonia and other tropical regions.

Communication and swallowing training of stroke-specialized health professionals using transdisciplinary knowledge in a patient-actor scenario: A case report.

BACKGROUND: Most people with stroke exhibit a variety of impairments that need to be addressed by a multidisciplinary team. Communication and swallowing disorders are common and should be screened very early. To guarantee a patient-centred approach, all patients, even those with speech and language disorders, must be actively engaged in the healthcare process. Effective communication is essential to success in many of the needed interventions. However, healthcare professionals often do not receive formal training in communicating with these patients, thus increasing the risk of preventable adverse events. AIMS: To describe the design, implementation and evaluation of a post-acute stroke multidisciplinary team training using patient actors in a simulation approach. METHODS & PROCEDURES: A 2-day course focused on the transdisciplinary knowledge related to communication and swallowing that all members of the multidisciplinary stroke team should acquire was implemented. A case-based learning methodology used simulation and resorting to patients' actors. Learning outcomes were evaluated by comparing the results obtained in two knowledge tests, one for each topic, which participants performed before and after each day course. Reaction to the training was gathered concerning the content, teacher quality and course organization. The follow-up was performed 6 months later to assess training skills transfer to the workplace environment. OUTCOMES & RESULTS: All the participants considered that the programme objectives were relevant or truly relevant and revealed that the programme's dynamic, rhythm and scenarios set were excellent. After the end of the programme, both communication and swallowing knowledge increased. Most participants had the opportunity to employ the acquired training skills in their work environment. The main barriers identified to implementing these skills were the 'need for additional training', the 'lack of time' or 'the lack of opportunities'. CONCLUSIONS & IMPLICATIONS: Simulation is a central method to increase and improve health professionals' skills when intervening with stroke patients. Using simulation with patient actors allows flexibility and diversification of clinical situations under analysis, which can provide a multiplier effect of reflection and learning. The implemented training achieved its objectives. WHAT THIS PAPER ADDS: What is already known on this subject Simulation in the training of health professionals is increasingly used as a good practice, allowing the recreation of scenarios identical to those in the context of professional practice. This strategy is used not only in initial training but also for the development of advanced skills. What this study adds to the existing knowledge This study reports the use of simulation using actor patients for the development of transdisciplinary skills in the topics of communication and swallowing in people with stroke What are the clinical and practical implications of this work? The study demonstrates that in a short period of training, the use of simulation with actor patients favours the development of transdisciplinary skills in the topics of communication and swallowing in people with stroke. At the same time, the skills developed are transferable to professional practice.

Opening up New Geographical Ontologies around Adapting to Climate Change.

Opening up regional ontologies for climate action is a necessary and underexplored dimension of climate change policymaking. This commentary explores how a regional lens might be integrated into the complex mosaic of climate governance, particularly in the context of resilient regions. I argue regional ontologies for climate policymaking could have greater analytical power if integrated into a theoretical framing of action that goes beyond the nation-state, beyond formal policy processes and beyond a strict binary between science and policy. Applying this lens to resilient regions, I argue there are particular opportunities at the regional scale for highlighting diverse perspectives or adaptation issues obscured through a national ontology, using existing transnational data infrastructure and community-led data systems to support the regional ontology and reframing the scale of collective future visions for a climate-adapted world.