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For over 2 decades, the mainstay of lymphedema treatment has been complete decongestive therapy, however, surgical options are available when conservative treatment is not successful in reducing lymphedema. Standardized pre-surgical and post-surgical guidelines for candidates are not readily available. As part of the 2023 Lymphedema Summit that was sponsored by the American Cancer Society, and the Lymphology Association of North America, an expert consensus workgroup was formed and developed an expert consensus which affirms the importance of pre-surgical guidelines for candidates with lymphedema. The workgroup recommended that guidelines should be tailored to four major end-user groups: (1) patients, (2) referring physicians, (3) allied health professionals, and (4) surgeons. [ABSTRACT FROM AUTHOR]

Background and AimsMethodsConclusionStudies investigating the relationship between initial electrophysiological thresholds and subsequent behavioural hearing thresholds have demonstrated uncertainty as to whether initial results can provide an accurate estimation of an infant’s functional hearing. This estimation must be accurate if a cochlear implant (CI) is to be considered before behavioural audiometry.This study aims to explore the variance between initial electrophysiological thresholds and subsequent behavioural hearing thresholds in infants to determine under which conditions electrophysiological results can be used to support a CI recommendation before behavioural audiology.This is a prospective cohort study of 63 infants with suspected severe to profound hearing loss, referred to the Cochlear Implant Clinic, Melbourne, before 12 months of age. The assessment protocol includes auditory brainstem response, auditory steady state response, tympanometry, and behavioural audiometry.For most infants undergoing CI candidacy evaluation, initial electrophysiological thresholds are an accurate reflection of their subsequent behavioural thresholds. An alternative CI candidacy pathway is recommended for infants who show profound sensorineural hearing loss on initial electrophysiological testing, in the absence of middle ear effusion, prematurity, or auditory neuropathy features, to provide CI recommendations before behavioural thresholds are obtained. This would lead to reduced delay to implantation and improved oral language outcomes. [ABSTRACT FROM AUTHOR]

Objectives: In order to develop a better understanding of students' access to mental health services, we explored the experiences of health care professionals interacting with university students with mental health problems. Methods: We interviewed 23 professionals working across university advice and counselling services, NHS general practice, crisis, and psychological services in North and East London between June 2022 and January 2023. Our approach drew on reflexive thematic analysis and the principles of abductive analysis. The notion of candidacy – that is, how different needs are deemed deserving of health service attention – was particularly helpful to our understanding of the ongoing phenomenon of interest in the data. Results: Each student's access to mental health support was highly contingent on the student's dynamic social context and the pressures and organisation of the local health system. Professionals described how different students viewed different needs as deserving of health service attention. Which students reached the professional's service depended on the resources and relationships a student could draw upon, and the service's relative permeability. Once there, what action professionals took was strongly influenced by the professional's service expertise, resource constraints, the relationships the professional's service had with other organisations, the students' wishes, and whether students regarded treatment offers as acceptable. Conclusions: Candidacy offers a useful lens to view university students' access to mental health support. Access appears to be an increasingly intricate task for students, given the fragmented service landscape, surging demand for mental health care and challenges of emerging adulthood. Our findings suggest that policy goals to increase use of mental health services are unlikely to improve outcomes for students without policy makers and health systems giving holistic consideration of inter-service relationships and available resources. [ABSTRACT FROM AUTHOR]

Background: Dominant conceptualisations of access to health care are limited, framed in terms of speed and supply. The Candidacy Framework offers a more comprehensive approach, identifying diverse influences on how access is accomplished. Aim: To characterise how the Candidacy Framework can explain access to general practice — an increasingly fraught area of public debate and policy. Design and setting: Qualitative review guided by the principles of critical interpretive synthesis. Method: We conducted a literature review using an author-led approach, involving iterative analytically guided searches. Articles were eligible for inclusion if they related to the context of general practice, without geographical or time limitations. Key themes relating to access to general practice were extracted and synthesised using the Candidacy Framework. Results: A total of 229 articles were included in the final synthesis. The seven features identified in the original Candidacy Framework are highly salient to general practice. Using the lens of candidacy demonstrates that access to general practice is subject to multiple influences that are highly dynamic, contingent, and subject to constant negotiation. These influences are socioeconomically and institutionally patterned, creating risks to access for some groups. This analysis enables understanding of the barriers to access that may exist, even though general practice in the UK is free at the point of care, but also demonstrates that a Candidacy Framework specific to this setting is needed. Conclusion: The Candidacy Framework has considerable value as a way of understanding access to general practice, offering new insights for policy and practice. The original framework would benefit from further customisation for the distinctive setting of general practice. [ABSTRACT FROM AUTHOR]

Use of venovenous extracorporeal membrane oxygenation (ECMO) is increasing, but candidacy selection processes are variable and subject to bias. What are the reasons behind venovenous ECMO candidacy decisions, and are decisions made consistently across patients? Prospective observational study of all patients, admitted or outside hospital referrals, considered for venovenous ECMO at a tertiary referral center. Relevant clinical data and reasons for candidacy determination were cross-referenced with other noncandidates and candidates and were assessed qualitatively. Eighty-one consultations resulted in 44 noncandidates (54%), 29 candidates (36%; nine of whom subsequently underwent cannulation), and eight deferred decisions (10%). Fifteen unique contraindications were identified, variably present across all patients. Five contraindications were invoked as the sole reason to deny ECMO to a patient. In patients with three or more contraindications, additional contraindications were cited even if the severity was relatively minor. All but four contraindications invoked to deny ECMO to a patient were nonprohibitive for at least one other candidate. Contraindications documented in noncandidates were present but not mentioned in 21 other noncandidates (47%). Twenty-six candidates (90%) had at least one contraindication that was prohibitive in a noncandidate, including a contraindication that was the sole reason to deny ECMO. Contraindications were proposed as informing three prognostic domains, through which patterns of inconsistency could be understood better: (1) irreversible underlying pulmonary process, (2) unsurvivable critical illness, and (3) clinical condition too compromised for meaningful recovery. ECMO candidacy decisions are inconsistent. We identified four patterns of inconsistency in our center and propose a three-domain model for understanding and categorizing contraindications, yielding five lessons that may improve candidacy decision processes until further research can guide practice more definitively. [Display omitted] [ABSTRACT FROM AUTHOR]

Abstract Background Although missed appointments in healthcare have been an area of concern for policy, practice and research, the primary focus has been on reducing single ‘situational’ missed appointments to the benefit of services. Little attention has been paid to the causes and consequences of more ‘enduring’ multiple missed appointments in primary care and the role this has in producing health inequalities. Methods We conducted a realist review of the literature on multiple missed appointments to identify the causes of ‘missingness.’ We searched multiple databases, carried out iterative citation-tracking on key papers on the topic of missed appointments and identified papers through searches of grey literature. We synthesised evidence from 197 papers, drawing on the theoretical frameworks of candidacy and fundamental causation. Results Missingness is caused by an overlapping set of complex factors, including patients not identifying a need for an appointment or feeling it is ‘for them’; appointments as sites of poor communication, power imbalance and relational threat; patients being exposed to competing demands, priorities and urgencies; issues of travel and mobility; and an absence of choice or flexibility in when, where and with whom appointments take place. Conclusions Interventions to address missingness at policy and practice levels should be theoretically informed, tailored to patients experiencing missingness and their identified needs and barriers; be cognisant of causal domains at multiple levels and address as many as practical; and be designed to increase safety for those seeking care.

The European accession policy has acquired a special and exceptional character since 2022 against the backdrop of the Russia-Ukraine war. The separation of the Association Trio countries (Ukraine, Moldova, Georgia) caused a non-uniform assessments in Georgia (giving candidacy to Ukraine and Moldova, and potential candidacy to Georgia). In the situation of extreme polarization and politicization of opinions, it is important to outline the legal and historical facts regarding the specifi cities of EU–Georgia relations and to evaluate scientifi cally Georgia’s geopolitical destiny (the possibility of joining the EU) in the light of global and regional processes. The article presents the various aspects of the difficulty and complexity of the EU enlargement towards Georgia, which actually go beyond the context of the full fulfi llment of the twelve conditions given to Georgia by the EU; synchronization of commitments issued by the European Commission for all Association Trio countries, making clear that the only distinguishing condition for Georgia in reality is the issue of depolarization; the possibility to fulfil the condition of depolarization in the current political situation in Georgia; the context of the historical dynamics of divergent approaches of the EU towards Ukraine, Moldova, and Georgia; the priority of saving the results of the 30-year struggle for freedom against the backdrop of Russia–Georgia wars, and the European future in Georgia and overcoming the ongoing distrust between Georgia and the EU (as the highest value) compared to the value of conditionality.

The public servant’s exercise of political rights is not absolutely like this, but rather a set of determinants derived from the legislation at times, and from the subjectivity of the public function at other times, and the determination of such determinants does not aim to ban political rights, but rather to place the exercise of these rights in its correct framework compatible with job duties, so it is Either they are fixed by legal texts, or they are derived from the nature of the public job, and these restrictions are imposed on all public officials, but in a relative manner according to the type of job, and the employee’s rank in the levels of the administrative ladder. And others, neglecting the duty of presidential obedience and not disclosing job secrets, so it was necessary to state who the employee is and then clarify the determinants imposed by legal texts

To analyse the mechanisms at play in the adjudications made by professionals and socially vulnerable patients with type 2 diabetes about their eligibility for care. The study included 14 patients and 10 health professionals in seven general practice surgeries in deprived areas in Greater Copenhagen. The study data consist of 17 semi-structured interviews with patients and 22 with health professionals immediately after observation of 23 consultations. Our analytical approach was inspired by Systematic Text Condensation and the concept of 'candidacy' for access to health care. Adjudications of patients not being candidates for services were common, but we also found that both patients and health professionals worked to align the services to the needs of the patients. This could include using services differently than was intended by the providers or by changing routines to make it easier for patients to use the services. We discuss these processes as 'tinkering'. This usually implies that the best individual solution for the patient is aimed for, and in this study, the best solution sometimes meant not focusing on diabetes. The study adds to existing knowledge about access to services for socially vulnerable patients by demonstrating that both patients and professionals in general practice engage in tinkering processes to make services work. Unequal use and benefits of health services play a significant role in relation to social inequality in health Flexibility in services and alternatives to school-like rehabilitation are needed to reduce inequality in access to health care Patients were sometimes judged as unsuitable for available routine services, but professionals 'tinkered' with services to make them fit Adaptation of services by professionals in general practice implies a longer time frame for obtaining goals [ABSTRACT FROM AUTHOR]

AbstractObjective To analyse the mechanisms at play in the adjudications made by professionals and socially vulnerable patients with type 2 diabetes about their eligibility for care.Design, setting and subjects The study included 14 patients and 10 health professionals in seven general practice surgeries in deprived areas in Greater Copenhagen. The study data consist of 17 semi-structured interviews with patients and 22 with health professionals immediately after observation of 23 consultations. Our analytical approach was inspired by Systematic Text Condensation and the concept of ‘candidacy’ for access to health care.Results Adjudications of patients not being candidates for services were common, but we also found that both patients and health professionals worked to align the services to the needs of the patients. This could include using services differently than was intended by the providers or by changing routines to make it easier for patients to use the services. We discuss these processes as ‘tinkering’. This usually implies that the best individual solution for the patient is aimed for, and in this study, the best solution sometimes meant not focusing on diabetes.Conclusion The study adds to existing knowledge about access to services for socially vulnerable patients by demonstrating that both patients and professionals in general practice engage in tinkering processes to make services work.

Background: Currently preoperative magnetic resonance imaging (MRI) brain and High-Resolution Computed Tomography (HRCT) scanning of temporal bones form part of routine Cochlear implantation (CI) assessment. Pre- operative imaging demonstrates anatomic details or anomalies if any, that prove essential in pre-surgical evaluation of patients. These form a road map for the surgeon to anticipate any difficulty during surgery, to aid in decision making to implant the most appropriate ear, plan surgical technique, or select electrode arrays. Methods: A descriptive observational pilot study was conducted at tertiary care hospital involving 51 paediatric patients worked-up for CI. Patients after detailed clinical evaluation and MRI Brain, a tentative surgical plan was formulated by a candidacy CI screening committee. Patients selected for surgery underwent HRCT temporal bones and surgical plan was modified after analysing the same. Percentage of cases in which surgical plan changed (in terms of laterality of surgery) after correlating with HRCT findings were determined and data analysed. Results: A total of 51 patients worked up for CI were included in the study. In 37.3% cases, there were unfavourable MRI findings. HRCT scan was used to aid the surgical road map in these patients, which based on MRI findings would have had suboptimal outcome. Conclusion: With this understanding, we recommend that, MRI with precise interpretation would be sufficient to furnish all necessary information in preoperative assessment of CI patients, and a HRCT temporal bones maybe indicated only in difficult cases or those with unfavourable MRI findings, may aid predict surgical events. [ABSTRACT FROM AUTHOR]

In a setting where substance use is rife, understanding contextual factors that influence an individual's perceived eligibility to seek rehabilitation is paramount. The study explores how situational factors influence an individual's perceived eligibility for healthcare uptake in people with substance use disorder (SUD). Using qualitative methods, the study draws on in-depth interviews with 20 substance users and 20 family members to unpack how individuals with SUD negotiate their eligibility for health services. Findings show that substance users are aware of their substance use habits and acknowledge their eligibility for health services with information on the navigation of health services is shared by peers and family members. Access and use of health services is hindered by individual determinants and the availability of health services for substance users, such as rehabilitation centers. The hunt for drugs and long waiting queues for health service acquisition overshadows substance users' claim to health services. Future research should prioritize understanding substance use and health seeking behavior at a context specific level in community settings so that, even in the absence of substance use health facilities, substance use is addressed at least from a harm reduction perspective which can improve health outcomes. [ABSTRACT FROM AUTHOR]

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The indications for cochlear implantation have expanded over time due to evidence demonstrating identification and implantation of appropriate cochlear implant (CI) candidates lead to significant improvements in speech recognition and quality of life (QoL). However, clinical practice is variable, with some providers using outdated criteria and others exceeding current labeled indications. As a results, only a fraction of those persons who could benefit from CI technology receive it. This document summarizes the current evidence for determining appropriate referrals for adults with bilateral hearing loss into CI centers for formal evaluation by stressing the importance of treating each ear individually and a "revised 60/60 rule". By mirroring contemporary clinical practice and available evidence, these recommendations will also provide a standardized testing protocol for CI candidates using a team‐based approach that prioritizes individualized patient care. This manuscript was developed by the Adult Cochlear Implantation Candidacy Task Force of the American Cochlear Implant Alliance using review of the existing literature and clinical consensus. Level of Evidence: N/A Laryngoscope, 134:S1–S14, 2024 [ABSTRACT FROM AUTHOR]

Objective: Cochlear implants (CIs) for single‐sided deafness (SSD) have only been approved for patients 5 years and older despite data supporting that younger children can also benefit from implantation. This study describes our institution's experience with CI for SSD in children 5 years and younger. Study Design: Case series with chart review. Setting: Tertiary referral center. Methods: A case series with chart review identified 19 patients up to age 5 years who underwent CI for SSD between 2014 and 2022. Baseline characteristics, perioperative complications, device usage, and speech outcomes were collected. Results: The median age at CI was 2.8 (range, 1.0‐5.4) years, with 15 (79%) patients being below age 5 at implantation. Etiologies of hearing loss were idiopathic (n = 8), cytomegalovirus (n = 4), enlarged vestibular aqueduct (n = 3), hypoplastic cochlear nerve (n = 3), and meningitis (n = 1). The median preoperative pure‐tone average was 90 (range, 75‐120) and 20 (range, 5‐35) dB eHL in the poor and better hearing ears, respectively. No patients had postoperative complications. Twelve patients achieved consistent device use (average, 9 h/d). Three of the seven who were not consistent users had hypoplastic cochlear nerves and/or developmental delays. The three patients with available preoperative and postoperative speech testing showed significant benefits, and five patients with available postoperative testing demonstrated speech recognition in the implanted ear when isolated from the better ear. Conclusion: CI can safely be performed in younger children with SSD. Patients and families accept early implantation, as evidenced by consistent device use, and derive notable benefits in speech recognition. Candidacy can be broadened to include SSD patients under age five years, particularly individuals without hypoplastic cochlear nerves or developmental delay. [ABSTRACT FROM AUTHOR]

Objective: We aimed to explore the experiences and perspectives of pregnant women, antenatal healthcare professionals, and system leaders to understand the impact of the implementation of remote provision of antenatal care during the COVID-19 pandemic and beyond. Methods: We conducted a qualitative study involving semi-structured interviews with 93 participants, including 45 individuals who had been pregnant during the study period, 34 health care professionals, and 14 managers and system-level stakeholders. Analysis was based on the constant comparative method and used the theoretical framework of candidacy. Results: We found that remote antenatal care had far-reaching effects on access when understood through the lens of candidacy. It altered women's own identification of themselves and their babies as eligible for antenatal care. Navigating services became more challenging, often requiring considerable digital literacy and sociocultural capital. Services became less permeable, meaning that they were more difficult to use and demanding of the personal and social resources of users. Remote consultations were seen as more transactional in character and were limited by lack of face-to-face contact and safe spaces, making it more difficult for women to make their needs – both clinical and social – known, and for professionals to assess them. Operational and institutional challenges, including problems in sharing of antenatal records, were consequential. There were suggestions that a shift to remote provision of antenatal care might increase risks of inequities in access to care in relation to every feature of candidacy we characterised. Conclusion: It is important to recognise the implications for access to antenatal care of a shift to remote delivery. It is not a simple swap: it restructures many aspects of candidacy for care in ways that pose risks of amplifying existing intersectional inequalities that lead to poorer outcomes. Addressing these challenges through policy and practice action is needed to tackle these risks. [ABSTRACT FROM AUTHOR]

Hickey et al.'s scoping of infant mental health (IMH) services and the challenges faced in ensuring that vulnerable infants can access them highlights important issues and suggests some solutions (Hickey et al., Child and Adolescent Mental Health, 2023). Their synthesis of useful research in the field is limited only by its focus on more affluent English‐speaking countries, which is acknowledged. Writing from an Australian perspective, they highlight the need for culturally sensitive service delivery. This commentary draws attention to the concept of candidacy as a helpful way of thinking about patents' journeys into services. It can support a deeper understanding of the barriers to referral for infants most in need. One key issue is the knowledge and understanding of both professionals and the public about the importance of the early years for later well‐being. Infants cannot advocate for themselves and depend on those around them to exercise their right to services. Good relationships between professionals and between family members and clinicians are essential for IMH service development and delivery. [ABSTRACT FROM AUTHOR]

The development of infant mental health (IMH) services globally is still in its early stages. This qualitative study aims to understand the challenges of setting up IMH services and explores the views and experiences of 14 multi‐disciplinary stakeholders who are part of the IMH implementation group in a large Scottish health board. Six major themes were identified through thematic analysis. This paper examines the most prominent theme "Systems" alongside the theme "Gaps in Current Service". The theoretical framework of "candidacy" is found to be a valuable way to conceptualize the complex systemic layers of micro, meso, and macro factors that contribute to the challenges of setting up services. At the micro level, key themes included the view that services must be accessible, individualized, and involve families. At the meso level, in line with the aims of the service, multiagency integration, aspects of early intervention, and clear operating conditions were all seen as important. Finally, at the macro level, perhaps the biggest challenge perceived by stakeholders is delivering a service that is entirely infant‐focused. These findings will help inform policy makers about factors considered by professionals to be vital in the establishment of IMH services in Scotland and across the globe. [ABSTRACT FROM AUTHOR]

Along with the eligibility conditions, the one who exercises the position of President of Romania is also subject to some incompatibilities. The eligibility conditions are required to be fulfilled on the date of submission of the candidacy, and the states of incompatibility must cease after the elections, until the beginning of the exercise of the mandate. [ABSTRACT FROM AUTHOR]

The press and politics have different patterns of relations, and involve certain actors in them. This study aims to find out and analyze the relationship between the press and politics from Margiono, former Chairman of the Indonesian Journalists Association (PWI) and the influence of this relationship on Margiono's candidacy process as a candidate for Regent of Tulungagung Regency in 2018. This research uses qualitative methods with interviews as primary data collection method with the theoretical framework of candidate selection Reuven Hazan and Gideon Rahat is used to analyze the candidacy process. This research found that Margiono's candidacy process was carried out exclusively and centralized so that personal affinity, leadership and persona of Margiono could become his capital in the candidacy process. [ABSTRACT FROM AUTHOR]

In order to make progress towards Sustainable Development Goal 2 – Zero Hunger - we must acquire a better understanding of what continues to hamper achieving food security, particularly in contexts where progress has been achieved, but has then faltered. This article investigates access to nutrition and food services in three of the Indian state of Odisha's traditionally poorer districts, where a large number of the state's most marginalised populations live. Semi-structured interviews were carried out in 11 villages. The Dixon-Woods Candidacy Model was employed to provide greater insight into the experiences of access to health and nutrition services, from both the supply and the demand sides. We found that there are many points along the journey that hamper access. We identified two levels of gatekeepers that can create (or remove) barriers, the first as front-line service providers and the second as high-level officials. The candidacy model shows that marginalisation caused by identity, poverty and education disparities hampers progress throughout this journey. This article aims to provide a view to improve our understanding of access to health, food and nutrition services, to improve food security, and to show the value of the candidacy model applied to an LMIC health setting. [ABSTRACT FROM AUTHOR]

Since Georgia's inclusion in the European Neighborhood Policy program in 2006, Georgia-EU relations have been in a stable and gradual development process, taking into account the geopolitical balances in the region. During this process, the European Union provided Georgia with a political framework for integration, both at the institutional and legislative levels. Georgia, on the other hand, concluded this process positively, which resulted in the Association Agreement, and succeeded in taking its relations with the EU to the next level. This rapid reform process, which brought Georgia closer to the EU acquis, has also made the European Union the most important and influential external actor in the country. In this context, as opposed to Moldova and Ukraine, the EU's unwillingness to grant a candidate status to Georgia has created a great disappointment in Georgia. The primary goal of this article is to assess the effects of the EU Commission's decision to link Georgia's EU candidacy status to the reform conditions, following Georgia’s application in 2022. Using qualitative research methods and utilizing a variety of primary and secondary sources, this study examines the problems encountered in the implementation of reforms on political polarization, oligarchization, and the protection of vulnerable minorities, which we consider will be the most difficult to resolve. The conclusions of the study are important in terms of the steps that Georgia should take to fulfill the EU candidacy status requirements, the technical assistance that the EU can provide to Georgia in this regard, and the possible implications of this process on Georgia’s politics.

Nonattendance for cervical cancer screening is often understood in terms of a lack of 'appropriate' or 'correct' knowledge about the risks and prevention of the disease. Few studies have explored how lay persons—the users themselves—interpret and contextualise scientific knowledge about cervical cancer. In this study, we address the following research question: How is the epidemiology of cervical cancer and its prevention discussed among women who are late for cervical cancer screening in Norway? We completed nine focus group interviews (FGIs) with 41 women who had postponed cervical screening. The analyses were both inductive and explorative, aiming to unpack the complexity of lay understandings of cervical cancer. Interactive associations expressed in the FGIs reflected multiple understandings of aetiology and risk factors, screening, and interpretations of responsibility for acquiring cervical cancer. The term 'candidacy' was employed to provide an enhanced understanding of lay reasoning about the explanations and predictions of cervical cancer, as reflected in the FGIs. Both interpretations of biomedical concepts and cultural values were used to negotiate acceptable and nuanced interpretations of candidacy for cervical cancer. Uncertainties about risk factors for acquiring cervical cancer was an important aspect of such negotiations. The study's findings provide an in-depth understanding of the contexts in which screening may be rendered less relevant or significant for maintaining health. Lay epidemiology should not be considered inappropriate knowledge but rather as a productive component when understanding health behaviours, such as screening attendance. [ABSTRACT FROM AUTHOR]

Recently, psychoanalysts have begun to write about the ways in which trauma and loss in their lives have affected their work. However, there has been nothing published about that subject in the life of a psychoanalytic candidate. This article is an exploration of the ways in which a family tragedy that occurred during my candidacy affected my psyche, my training, and my work. It was particularly poignant that my trauma reignited issues of trauma and loss in my two analytic cases, both of whom had a history of trauma and loss. The structure and guidance provided by my analysis and supervision during this time were comforting and healing, and enabled me to continue to work confidently with patients. [ABSTRACT FROM AUTHOR]

This analysis of people's accounts of establishing their need and experiences of healthcare for long Covid (LC) symptoms draws on interview data from five countries (UK, US, Netherlands, Canada, Australia) during the first ∼18 months of the Covid-19 pandemic when LC was an emerging, sometimes contested, condition with scant scientific or lay knowledge to guide patients and professionals in their sense-making of often bewildering constellations of symptoms. We extend the construct of candidacy to explore positive and (more often) negative experiences that patients reported in their quest to understand their symptoms and seek appropriate care. Candidacy usually considers how individuals negotiate healthcare access. We argue a crucial step preceding individual claims to candidacy is recognition of their condition through generation of collective candidacy. “Vanguard patients” collectively identified, named and fought for recognition of long Covid in the context of limited scientific knowledge and no established treatment pathways. This process was technologically accelerated via social media use. Patients commonly experienced “rejected” candidacy (feeling disbelieved, discounted/uncounted and abandoned, and that their suffering was invisible to the medical gaze and society). Patients who felt their candidacy was “validated” had more positive experiences; they appreciated being believed and recognition of their changed lives/bodies and uncertain futures. More positive healthcare encounters were described as a process of “co-experting” through which patient and healthcare professional collaborated in a joint quest towards a pathway to recovery. The findings underpin the importance of believing and learning from patient experience, particularly vanguard patients with new and emerging illnesses.

Abstract Background The UK’s “Getting It Right First Time” programme recommends that management of people with fibromyalgia should centre on primary care. However, it remains unclear as to how best to organise health systems to deliver services to optimise patient outcomes. Aim To profile UK healthcare services for people with fibromyalgia: provision of National Health Services (NHS) and use of non-NHS services by people with fibromyalgia. Methods Two online open surveys (A and B) incorporating questions about diagnosis, treatment and management of fibromyalgia and gaps in healthcare services were conducted between 11th September 2019 and 3rd February 2020. These were targeted to NHS healthcare professionals consulting with people with fibromyalgia (Survey A) and people ≥16 years diagnosed with fibromyalgia using non-NHS services to manage their condition (Survey B). Descriptive statistics were used to report quantitative data. Thematic analysis was undertaken for qualitative data. Results Survey A received 1701 responses from NHS healthcare professionals across the UK. Survey B received 549 responses from people with fibromyalgia. The results show that NHS services for people with fibromyalgia are highly disparate, with few professionals reporting care pathways in their localities. Diagnosing fibromyalgia is variable among NHS healthcare professionals and education and pharmacotherapy are mainstays of NHS treatment and management. The greatest perceived unmet need in healthcare for people with fibromyalgia is a lack of available services. From the pooled qualitative data, three themes were developed: ‘a troublesome label’, ‘a heavy burden’ and ‘a low priority’. Through the concept of candidacy, these themes provide insight into limited access to healthcare for people with fibromyalgia in the UK. Conclusion This study highlights problems across the NHS in service provision and access for people with fibromyalgia, including several issues less commonly discussed; potential bias towards people with self-diagnosed fibromyalgia, challenges facing general practitioners seeking involvement of secondary care services for people with fibromyalgia, and a lack of mental health and multidisciplinary holistic services to support those affected. The need for new models of primary and community care that offer timely diagnosis, interventions to support self-management with access to specialist services if needed, is paramount.

Abstract Objectives Cochlear implants (CI) are reliable implantable devices that are highly cost‐effective in reducing the burden of hearing loss at an individual and societal scale. However, only 10% of CI candidates are aware of their candidacy and receive a CI. A web‐based screening tool to assess CI candidacy may make many more individuals aware of their candidacy for cochlear implantation. The objective of this study was to validate and optimize the online Cochlear Implant Candidacy Calculator against in‐clinic audiometric testing. Methods Audiogram data and word discrimination scores for 132 patients who underwent initial CI consultation at the Johns Hopkins Cochlear Implant Center in 2020 were inputted into the calculator. Candidacy results from the calculator were compared against formal clinical diagnoses provided by the audiologist at the time of visit. Receiver Operating Characteristic (ROC) and Area Under the Curve (AUC) analyses were performed to identify optimal diagnostic thresholds. Results Of the resulting 132 patients, 54 presented with single‐sided deafness (SSD), and 114 were clinically determined to be CI candidates. ROC AUC analyses identified optimal thresholds of high‐frequency PTA ≥65 dB and word discrimination score ≤ 50%. To maximize sensitivity at the expense of specificity, diagnostic thresholds of high‐frequency PTA ≥ 65 dB and word discrimination score ≤ 70% were chosen, which yielded accuracy, sensitivity, specificity, and ROC AUC of 0.90, 0.94, 0.82, and 0.88, respectively. Conclusion The novel online CI Candidacy Calculator exhibits high sensitivity and accuracy, and moderate specificity. The calculator may thereby be useful in increasing awareness of potential CI candidacy, increasing prevalence of CIs, and decreasing the burden of hearing loss.

The inclusion of body mass index (BMI) as a criterion for determining kidney transplant candidacy in children raises clinical and ethical challenges. Childhood obesity is on the rise and common among children with kidney failure. In addition, obesity is reported as an independent risk factor for the development of CKD and kidney failure. Resultantly, more children with obesity are anticipated to need kidney transplants. Most transplant centers around the world use high BMI as a relative or absolute contraindication for kidney transplant. However, use of obesity as a relative or absolute contraindication for pediatric kidney transplant is controversial. Empirical data demonstrating poorer outcomes following kidney transplant in obese pediatric patients are limited. In addition, pediatric obesity is distributed inequitably among groups. Unlike adults, most children lack independent agency to choose their food sources and exercise opportunities; they are dependent on their families for these choices. In this paper, we define childhood obesity and review (1) the association and impact of obesity on kidney disease and kidney transplant, (2) existing adult guidelines and rationale for using high BMI as a criterion for kidney transplant, (3) the prevalence of childhood obesity among children with kidney failure, and (4) the existing literature on obesity and pediatric kidney transplant outcomes. We then discuss ethical considerations related to the use of obesity as a criterion for kidney transplant. [ABSTRACT FROM AUTHOR]

People living with young onset dementia and their families have significant support needs, but experience difficulties accessing services. This study explored the process of accessing community-based services drawing on semi-structured interviews with people living with dementia, family members and providers in Winnipeg, Canada. Data analysis involved a combination of inductive coding and theoretical analysis using the candidacy framework as a conceptual lens. Forced to navigate services that do not recognize people with young onset dementia as a user group, participants experienced ongoing barriers that generated continuous work and stress for families. Access was constrained by information resources geared towards older adults and restrictive eligibility criteria that constructed people with young onset dementia as "not impaired enough" or "too impaired". At the organizational level, fragmentation and underrepresentation of young onset dementia diminished access. Our findings underscore the need for continuous, coordinated supports alongside broader representation of young onset dementia within research, policy, and practice. We conclude with a discussion of how the candidacy theory could be extended to account for the social and political status of user groups. [ABSTRACT FROM AUTHOR]

Since Georgia's inclusion in the European Neighborhood Policy program in 2006, Georgia-EU relations have been in a stable and gradual development process, taking into account the geopolitical balances in the region. During this process, the European Union provided Georgia with a political framework for integration, both at the institutional and legislative levels. Georgia, on the other hand, concluded this process positively, which resulted in the Association Agreement, and succeeded in taking its relations with the EU to the next level. This rapid reform process, which brought Georgia closer to the EU acquis, has also made the European Union the most important and influential external actor in the country. In this context, as opposed to Moldova and Ukraine, the EU's unwillingness to grant a candidate status to Georgia has created a great disappointment in Georgia. The primary goal of this article is to assess the effects of the EU Commission's decision to link Georgia's EU candidacy status to the reform conditions, following Georgia’s application in 2022. Using qualitative research methods and utilizing a variety of primary and secondary sources, this study examines the problems encountered in the implementation of reforms on political polarization, oligarchization, and the protection of vulnerable minorities, which we consider will be the most difficult to resolve. The conclusions of the study are important in terms of the steps that Georgia should take to fulfill the EU candidacy status requirements, the technical assistance that the EU can provide to Georgia in this regard, and the possible implications of this process on Georgia’s politics. [ABSTRACT FROM AUTHOR]

Actively involving people in self-monitoring and management during their pregnancy is an emerging clinical and social practice. Self-monitoring of blood pressure and self-testing for proteinuria, key diagnostic tests for pre-eclampsia, are becoming commonplace in hypertensive pregnancies. While evidence exists on the acceptability and feasibility of self-monitoring blood pressure, evidence for self-testing for proteinuria in pregnancy is thin, with little knowledge of how it might affect the traditional structures of maternity care. As part of a diagnostic accuracy study on self-testing for proteinuria, pregnant people and healthcare professionals were recruited to a qualitative study to understand their experiences of, and attitudes to, self-testing. Multiple qualitative methods were used, including interviews, focus groups, and free text postcards. A discourse analysis was conducted to understand how self-testing might inform and reshape routine antenatal care. Analysis revealed a tension between the empowering concept of participatory surveillance, which pregnant people and healthcare professionals were broadly positive about, and the adjudications made by healthcare professionals about the candidacy, or suitability, of certain pregnant people to self-test. Candidacy is a framework for understanding what influences access to healthcare for socially disadvantaged groups, including professional judgments that impact access to interventions. While participatory surveillance was felt to have the potential to empower pregnant people in antenatal care, the loss of the traditional clinical gaze was disquieting for some, and pregnant people and healthcare professionals were reluctant to cede professional responsibility. [ABSTRACT FROM AUTHOR]

This study aims to describe the candidacy process and challenges of female candidates in the 2020 regional elections in Tanah Datar Regency as well as campaign issues promoted by female candidates based on gender perspective. This research is a qualitative research using candidacy theory. The findings of this study that the challenge faced by Betty Shadiq Pasadigue in the contestation of the 2020 Regional Elections of Tanah Datar Regency is the emergence of gender stereotypes and negative views of women's leadership as regional leader, although the LKAAM of Tanah Datar Regency has affirmed that women's leadership in the political field is permitted.

The Republic of Indonesia‟s Law no. 7 of 2017 requires presidential and vice-presidential candidates to be proposed by political parties that meet the requirements, namely obtaining at least 20% of the total Legislative House seats or nationally obtaining 25% of valid votes in the previous Legislative House election. This is not recognized in Article 6A paragraph (2) of the 1945 Constitution, the constitutional basis for nominating a president. This paper aims to provide a philosophical analysis on the presidential and vice-presidential electoral threshold. Results show that from a philosophical perspective, this threshold provisions eliminate the constitutional rights of the people and minor political parties to nominate presidential and vice-presidential candidates. There can only be a maximum of three political parties and the oligarch and large political parties will make sure that the candidates will only come from their parties. This threshold undermines the logic of the presidential system. In conclusion, philosophically the threshold limits the freedom of alternative candidates to nominate themselves in the presidential election. It will only give an opportunity for candidates from major political parties. Thus, the government and various parties must reconsider this law to protect the rights of the people as mandated by the constitution. [ABSTRACT FROM AUTHOR]

As cochlear implant (CI) candidacy expands to consider children with more residual hearing, the use of a CI and a hearing aid (HA) at the non-implanted ear (bimodal devices) is increasing. This case study examines the contributions of acoustic and electric input to speech perception performance for a pediatric bimodal device user (S1) who is a borderline bilateral cochlear implant candidate. S1 completed a battery of perceptual tests in CI-only, HA-only and bimodal conditions. Since CIs and HAs differ in their ability to transmit cues related to segmental and suprasegmental perception, both types of perception were tested. Performance in all three device conditions were generally similar across tests, showing no clear device-condition benefit. Further, S1's spoken language performance was compared to those of a large group of children with prelingual severe-profound hearing loss who used two devices from a young age, at least one of which was a CI. S1's speech perception and language scores were average or above-average compared to these other pediatric CI recipients. Both segmental and suprasegmental speech perception, and spoken language skills should be examined to determine the broad-scale performance level of bimodal recipients, especially when deciding whether to move from bimodal devices to bilateral CIs. [ABSTRACT FROM AUTHOR]

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In this article we explore how people who experienced a stroke, transient ischaemic attack, or heart attack sought health care during the COVID-19 lockdown periods. Semi-structured interviews were conducted with 27 patients admitted to hospital between March 2020 and May 2021, and one carer who was recruited from cardiac and stroke rehabilitation services in two large acute NHS trusts in England. Drawing on concepts of candidacy, illness and moral work, we discuss how people's sense-making about their symptoms fundamentally shaped both their decisions about seeking help and the impact of COVID-19 on help seeking. Risk perception and interactional ritual chain theory allow further exploration of constructing symbols of national identity in times of crises, managing risk and levels of acceptable risk and critique of ambiguous national messaging over accessing health-care services for people with emergency health-care needs. Our findings have wider implications for supporting access into health care for those with life-threatening conditions under highly publicised strain on the health system, including winter pressure and staff strikes, as well as policymaking and public messaging., (© 2024 The Author(s). Sociology of Health & Illness published by John Wiley & Sons Ltd on behalf of Foundation for the Sociology of Health & Illness.)

Patterned hair loss which includes both male pattern hair loss (MPHL) or androgenic alopecia (AGA) and female pattern hair loss (FPHL) is the most common indication for hair transplant surgery. However, not all such patients are candidates for hair transplants. There are eight conditions that cause patients to not be appropriate candidates. These are: diffuse unpatterned alopecia (DUPA), cicatricial alopecia (CA), patients with unstable hair loss, patients with insufficient hair loss, very young patients, patients with unrealistic expectations, patients with psychologic disorders such as body dysmorphic disorder (BDD) and trichotillomania, and patients who are medically unfit. In addition, there are patients who are poor candidates and who should undergo hair transplantation only if they understand and accept limited results. The key to identifying these patients involves performing careful and detailed history and examination at the time of consultation.

Background: The UK's "Getting It Right First Time" programme recommends that management of people with fibromyalgia should centre on primary care. However, it remains unclear as to how best to organise health systems to deliver services to optimise patient outcomes.Aim: To profile UK healthcare services for people with fibromyalgia: provision of National Health Services (NHS) and use of non-NHS services by people with fibromyalgia.Methods: Two online open surveys (A and B) incorporating questions about diagnosis, treatment and management of fibromyalgia and gaps in healthcare services were conducted between 11th September 2019 and 3rd February 2020. These were targeted to NHS healthcare professionals consulting with people with fibromyalgia (Survey A) and people ≥16 years diagnosed with fibromyalgia using non-NHS services to manage their condition (Survey B). Descriptive statistics were used to report quantitative data. Thematic analysis was undertaken for qualitative data.Results: Survey A received 1701 responses from NHS healthcare professionals across the UK. Survey B received 549 responses from people with fibromyalgia. The results show that NHS services for people with fibromyalgia are highly disparate, with few professionals reporting care pathways in their localities. Diagnosing fibromyalgia is variable among NHS healthcare professionals and education and pharmacotherapy are mainstays of NHS treatment and management. The greatest perceived unmet need in healthcare for people with fibromyalgia is a lack of available services. From the pooled qualitative data, three themes were developed: 'a troublesome label', 'a heavy burden' and 'a low priority'. Through the concept of candidacy, these themes provide insight into limited access to healthcare for people with fibromyalgia in the UK.Conclusion: This study highlights problems across the NHS in service provision and access for people with fibromyalgia, including several issues less commonly discussed; potential bias towards people with self-diagnosed fibromyalgia, challenges facing general practitioners seeking involvement of secondary care services for people with fibromyalgia, and a lack of mental health and multidisciplinary holistic services to support those affected. The need for new models of primary and community care that offer timely diagnosis, interventions to support self-management with access to specialist services if needed, is paramount. [ABSTRACT FROM AUTHOR]

Cancer is a disease that is imbued with notions of risk, with individuals expected to avoid 'risky' behaviours and act swiftly when symptoms indicating a risk of cancer emerge. Cancer symptoms, however, are often ambiguous and indicative of a number of other conditions, making it difficult for people to assess when symptoms may, or may not, be the result of cancer. Here, we discuss interview data from a study examining the symptom appraisal and help-seeking experiences of patients referred for assessment of symptoms suspicious of a lung or colorectal cancer in the North-East of England. We explore how individuals draw upon ideas about cancer risks to assess whether cancer may be a possible explanation for their symptoms and to inform their decisions about help-seeking. In our analysis, we applied the concept of candidacy to the data, to highlight how lay epidemiology shapes people's perceptions of cancer risk, and their subsequent responses to it. We found that participants appraised their symptoms, and the likelihood that they may have cancer, in light of relevant information on risk. These sources of information related to lifestyle factors, family history of cancer, environmental factors, and importantly, the symptomatic experience itself, including the absence of symptoms that participants associated with cancer. The importance of experienced, and absent, symptoms was a core element of participants' everyday constructions of the 'cancer candidate', which informed symptom appraisal and subsequent help-seeking decision-making. [ABSTRACT FROM AUTHOR]

Objectives: Cochlear implants (CI) are reliable implantable devices that are highly cost‐effective in reducing the burden of hearing loss at an individual and societal scale. However, only 10% of CI candidates are aware of their candidacy and receive a CI. A web‐based screening tool to assess CI candidacy may make many more individuals aware of their candidacy for cochlear implantation. The objective of this study was to validate and optimize the online Cochlear Implant Candidacy Calculator against in‐clinic audiometric testing. Methods: Audiogram data and word discrimination scores for 132 patients who underwent initial CI consultation at the Johns Hopkins Cochlear Implant Center in 2020 were inputted into the calculator. Candidacy results from the calculator were compared against formal clinical diagnoses provided by the audiologist at the time of visit. Receiver Operating Characteristic (ROC) and Area Under the Curve (AUC) analyses were performed to identify optimal diagnostic thresholds. Results: Of the resulting 132 patients, 54 presented with single‐sided deafness (SSD), and 114 were clinically determined to be CI candidates. ROC AUC analyses identified optimal thresholds of high‐frequency PTA ≥65 dB and word discrimination score ≤ 50%. To maximize sensitivity at the expense of specificity, diagnostic thresholds of high‐frequency PTA ≥ 65 dB and word discrimination score ≤ 70% were chosen, which yielded accuracy, sensitivity, specificity, and ROC AUC of 0.90, 0.94, 0.82, and 0.88, respectively. Conclusion: The novel online CI Candidacy Calculator exhibits high sensitivity and accuracy, and moderate specificity. The calculator may thereby be useful in increasing awareness of potential CI candidacy, increasing prevalence of CIs, and decreasing the burden of hearing loss. [ABSTRACT FROM AUTHOR]

Using a genealogical and Ijtehādi method, the present study explores the ethics of candidacy -Tarshih- and its decency or indecency impact on the elections as a whole. The main purpose of raising this idea is to give awareness to some candidates who are obsessed with the illusion of deontology about the indecency of their candidacy in the election process. The results of the study shows that candidacy as a part of the election process in the religious ideology is not free from jurisprudential and ethical norms so every person who has an indecent motivation is not permitted to be nominated for a position. There are many traditions that forbid a human from seeking governance and it is interpreted as greed and acquisitiveness for this world. On the other hand, some other traditions that confirm this request are so cautious about the degradation of ethical values. Reflection on the arguments for Tarshih can make those candidates participating in the election process due to worldly incentives or lack of qualification withdraw and thereby prevent the presence of disqualified people in this civil issue.

• Investigates relational enactments of gendered alcohol consumption during the pandemic, contrasted with special attention on women as a 'priority population' for alcohol-related harm reduction. • Adopts a gendered approach to understanding the alcohol-harm paradox, the breast cancer paradox, and the risk-pleasure paradox in women's health policies. • Synthesises evidence to construct a burden of proof that problematising women's consumption at an individual level alone has potential to worsen inequities in gendered alcohol-related harms and broader health outcomes. • Showcases how gender-responsive alcohol policy needs to be cross-sectoral and address upstream factors to protect women from alcohol harm. Drinking alcohol facilitates pleasure for women while also elevating disease risk. Symbolic expectations of what alcohol 'does in' life per lay insight (relax, identity-work, connect) sit in tension with scientific realities about what alcohol 'does to' women's bodies (elevate chronic disease risks such as breast cancer). Policy must work amidst – and despite – these paradoxes to reduce harm(s) to women by attending to the gendered and emergent configurations of both realities. This paper applies a logic of candidacy to explore women's alcohol consumption and pleasure through candidacies of wellness in addition to risk through candidacies of disease (e.g. breast cancer). Using qualitative data collected via 56 interviews with Australian women (n = 48) during early pandemic countermeasures, we explore how risk perceptions attached to alcohol (like breast cancer) co-exist with use-values of alcohol in daily life and elucidate alcohol's paradoxical role in women's heuristics of good/poor health behaviours. Women were aged 25–64 years, experienced varying life circumstances (per a multidimensional measure of social class including economic, social and cultural capital) and living conditions (i.e. partnered/single, un/employed, children/no children). We collated coding structures from data within both projects; used deductive inferences to understand alcohol's paradoxical role in candidacies of wellness and disease; abductively explored women's prioritisation of co-existing candidacies during the pandemic; and retroductively theorised prioritisations per evolving pandemic-inflected constructions of alcohol-related gendered risk/s and pleasure/s. Our analysis illuminates the ways alcohol was configured as a pleasure and form of wellness in relation to stress, productivity and respectability. It also demonstrates how gender was relationally enacted amidst the priorities, discourses and materialities enfolding women's lives during the pandemic. We consider the impact of policy regulation of aggressive alcohol marketing and banal availability of alcohol in pandemic environments and outline gender-responsive, multi-level policy options to reduce alcohol harms to women. [ABSTRACT FROM AUTHOR]

The implantable cardioverter defibrillator(ICD) has revolutionized the management of patients with hypertrophic cardiomyopathy (HCM) at risk of sudden cardiac death (SCD). However, the identification of ideal candidates remains challenging. We aimed to describe the long-term impact of the ICD for primary prevention in patients with HCM based on stringent (high SCD risk) vs lenient indications (need for pacing/personal choice). Data from two Italian HCM Cardiomyopathy Units were retrospectively analyzed. Only patients >1 follow-up visits were divided into two groups according to ICD candidacy:stringent (high SCD risk) and lenient (need for pacing, patients' choice, physician advice despite lack of high SCD risk). Major cardiac events (composite of appropriate shock/intervention and SCD) was the primary endpoint. A safety endpoint was defined as a composite of inappropriate shocks and device-related complications. Of 2009 patients, 252(12.5%) received an ICD, including 27(1.3%) in secondary prevention and 225(11.2%) in primary prevention (age at implantation 49 ± 16 years; men 65.3%). Among those in primary prevention, 167(74.2%) had stringent, while 58(25.8%) had lenient indications. At 5 ± 4 years, only stringent ICD patients experienced major cardiac events (2.84%/year, 5-year cumulative incidence: 8.1%, 95%CI [3.5–14.1%]). ICD-related complications were similar across stringent and lenient subgroups. However, patients implanted >60 years had a significantly higher risk of adverse events. One third of ICD recipients with HCM in primary prevention received a lenient implantation and had no appropriate intervention. ICD implantation due to systematic upgrade in patients requiring pacing and increased risk perception may offer little advantage and increase complication rates. • What is the impact of the ICD for primary prevention in HCM based on stringent (high SCD risk) vs lenient indications (need for pacing/personal choice)? • Only stringent ICD patients experienced major cardiac events.No major arrhythmic event was recorded in the lenient group. • ICD implantation due to upgrade in patients requiring pacing or increased risk perception offers little advantage and increases complications [ABSTRACT FROM AUTHOR]