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ContextTo facilitate the manufacturing of COVID-19 medical products, in October 2020 India and South Africa proposed a waiver of certain intellectual property (IP) provisions of a World Trade Organization (WTO) agreement. After nearly two years, a narrow waiver agreement that did little for vaccine access passed the ministerial despite the pandemic's impact on global trade, which the WTO is mandated to safeguard.MethodsThe authors conducted a content analysis of WTO legal texts, key-actor statements, media reporting, and the WTO's procedural framework to explore legal, institutional, and ideational explanations for the delay.FindingsIP waivers are neither legally complex nor unprecedented within WTO law, yet these waiver negotiations exceeded their mandated 90-day negotiation period by approximately 18 months. Waiver opponents and supporters engaged in escalating strategic framing that justified and eventually secured political attention at head-of-state level, sidelining other pandemic solutions. The frames deployed discouraged consensus on a meaningful waiver, which ultimately favored the status quo that opponents preferred. WTO institutional design encouraged drawn-out negotiation while limiting legitimate players in the debate to trade ministers, empowering narrow interest group politics.ConclusionsDespite global political attention, the WTO process contributed little to emergency vaccine production, suggesting a pressing need for reforms aimed at more efficient and equitable multilateral processes.

This study explores the methods used by micro-celebrity K-pop fanboys to negotiate their masculinity as male K-pop fans on Instagram. K-pop fanboy micro-celebrity is a term used to refer to K-pop fanboys who had transformed into micro-celebrities. The existence of K-pop fanboys wa often associated with non-hetrosexual streotypes and stigmas such as 'sissy' and 'faggot,' which placed them was in an unfair social order. Therefore, K-pop fanboys, especially those who had become micro-celebrities, it felt the necessaries to negotiate their masculinity as male K-pop fans. The netnography method was used by observing of this study the Instagram accounts of K-pop micro-celebrity fanboys to understand the ways and strategies they used in negotiating their masculinity. Based on the results of the study, it was found the finding that the negotiation of masculinity carried out by K-pop micro-celebrity fanboys was done by adjusting themselves to the existing hegemonic masculinity values. This study observation was done through the formation of an 'ideal' body, showing their heterosexual relationships, and displaying various preferred activities other than K-pop. By aligning themselves with the values of masculinity developed in society, K-pop fanboys tried to show that as male K-pop fans, they could express their enthusiasm without having to sacrifice their masculine image. [ABSTRACT FROM AUTHOR]

Professional identity and its development is a focus of research, education, and practice. But, there is a lack of how professional identity impacts changes in pharmacists' roles in practice, which are particularly prevalent in primary care teams. This research uses Goffmanian theory, micro-sociologic interactional theory, to describe the outcomes of role negotiation in integrated primary care teams. This is a multiple case study done per Yin, which used interviews and documents to collect data. Interviews used a storytelling format to gather information on the pharmacist's role and negotiation with their team. Four to six interviews were done in each case. Data was analyzed in an iterative manner using the Qualitative approach by Leuven including narrative reports being created for each case. Five cases were recruited but three cases were completed. In each case, the pharmacist was passive in role negotiation and allowed other actors to decide what tasks were of value. Likely this passivity was due to their professional identities: supportive and "not a physician". These identities led to a focus on the pharmacists' need to develop. This multi-case study demonstrated that pharmacists' professional identity led to passivity being valued and expected. Whether pharmacists self-limited, which has been previously seen, needs to be better defined. But unclear archetypes reduced tasks identified as unique to the pharmacist. Goffmanian theory highlighted a key success for future pharmacist role negotiation, a clear professional identity by both pharmacists and society, including team members. Until that occurs, there is a risk of underuse in primary care team settings. • Role negotiation suffers when pharmacists lack a clear professional identity. • Goffmanian theory supports improved outcomes when pharmacists actively negotiate roles. • Comparing pharmacists to physicians leads others to conclude pharmacists need to develop. • If pharmacists see themselves as supportive, passivity when collaborating is valued. [ABSTRACT FROM AUTHOR]

The current study followed the need for more research concerning the understanding of the relationship between simulation design and self-efficacy in negotiating development within role-play simulations of political decision-making. More specifically, the purpose of this study was to investigate the relationship of social persuasion as a source for self-efficacy in negotiating with simulation design elements. The research was conducted in a three-day simulation about the EU decision-making process. By means of daily diaries and semi-structured interviews, critical incidents about the emergence of social persuasion influencing self-efficacy development were defined. Data were analysed by applying thematic content analysis. Findings show that social persuasion was largely facilitated by the simulation design that offered possibilities for informal contact. [ABSTRACT FROM AUTHOR]

In Assam, India, the National Register of Citizens (NRC) population enumeration process excluded about two million people from the final list. The NRC dropouts referred to in this study as 'paused citizens' are locked in a condition that is legally and socially ambiguous, hovering between citizens and stateless. This essay seeks to highlight the experiences of 'paused citizens' who have been thrown into this opaque and paralysing situation as they attempt to manage their precarious status, illustrate the tangled web of citizenship regimes, and the binary distinctions between inclusion and exclusion that are mediated by documents. A closer examination also reveals how the systems of power and control operate and how people trapped in time alternate between feelings of purposeful waiting and senseless stasis. [ABSTRACT FROM AUTHOR]

BACKGROUND: Price variations in healthcare can be caused by quality or factors other than quality such as market share, negotiating power with insurers, or hospital ownership model. Efforts to improve care value (defined as the ratio between health outcomes and price) by making healthcare prices readily accessible to patients are driven by the assumption this can help patients more easily identify high-quality, low-price clinicians and health systems, thus reducing price variations. However, if price variations are driven by factors other than quality, then strategies that involve payments for higher-quality care are unlikely to reduce price variation and improve value. It is unknown whether prices for total joint arthroplasty (TJA) are correlated with the quality of care or whether factors other than quality are responsible for price variation. QUESTIONS/PURPOSES: (1) How do prices insurers negotiate for TJA paid to a single, large health system vary across payer types? (2) Are the mean prices insurers negotiate for TJA associated with hospital quality? METHODS: We analyzed publicly available data from 22 hospitals in a single, large regional health system, four of which were excluded owing to incomplete quality information. We chose to use data from this single health system to minimize the confounding effects of between-hospital reputation or branding and geographic differences in the cost of providing care. This health system consists of large and small hospitals serving urban and rural populations, providing care for more than 3 million individuals. For each hospital, negotiated prices for TJA were classified into five payer types: commercial in-network, commercial out-of-network, Medicare Advantage (plans to which private insurers contract to provide Medicare benefits), Medicaid, and discounted cash pay. Traditional Medicare plans were not included because the prices are set statutorily, not negotiated. We obtained hospital quality measures from the Centers for Medicare and Medicaid Services. Centers for Medicare and Medicaid Services quality measures included TJA-specific complication and readmission rates in addition to hospital-wide patient survey star rating (measure of patient care experience) and total performance scores (aggregate measure of clinical outcomes, safety, patient experience, process of care, and efficiency). We evaluated the association between the mean negotiated hospital prices and Centers for Medicare and Medicaid Services quality measures using Pearson correlation coefficients and Spearman rho across all payer types. Statistical significance was defined as p < 0.0025. RESULTS: The mean ± SD overall negotiated price for TJA was USD 54,500 ± 23,200. In the descriptive analysis, the lowest negotiated prices were associated with Medicare Advantage (USD 20,400 ± 1800) and Medicaid (USD 20,300 ± 8600) insurance plans, and the highest prices were associated with out-of-network care covered by commercial insurance plans (USD 78,800 ± 9200). There was no correlation between the mean negotiated price and TJA complication rate (discounted cash price: r = 0.27, p = 0.29; commercial out-of-network: r = 0.28, p = 0.26; commercial in-network: r = -0.07, p = 0.79; Medicare Advantage: r = 0.11, p = 0.65; Medicaid: r = 0.03, p = 0.92), readmission rate (discounted cash price: r = 0.19, p = 0.46; commercial out-of-network: r = 0.24, p = 0.33; commercial in-network: r = -0.13, p = 0.61; Medicare Advantage: r = -0.06, p = 0.81; Medicaid: r = 0.09, p = 0.74), patient survey star rating (discounted cash price: r = -0.55, p = 0.02; commercial out-of-network: r = -0.53, p = 0.02; commercial in-network: r = -0.37, p = 0.13; Medicare Advantage: r = -0.08, p = 0.75; Medicaid: r = -0.02, p = 0.95), or total hospital performance score (discounted cash price: r = -0.35, p = 0.15; commercial out-of-network: r = -0.55, p = 0.02; commercial in-network: r = -0.53, p = 0.02; Medicare Advantage: r = -0.28, p = 0.25; Medicaid: r = 0.11, p = 0.69) for any of the payer types evaluated. CONCLUSION: There is substantial price variation for TJA that is not accounted for by the quality of care, suggesting that a mismatch between price and quality exists. Efforts to improve care value in TJA are needed to directly link prices with the quality of care delivered, such as through matched quality and price reporting mechanisms. Future studies might investigate whether making price and quality data accessible to patients, such as through value dashboards that report easy-to-interpret quality data alongside price information, moves patients toward higher-value care decisions. CLINICAL RELEVANCE: Efforts to better match the quality of care with negotiated prices such as matched quality and price reporting mechanisms, which have been shown to increase the likelihood of choosing higher-value care in TJA, could improve the value of care.

Copyright of Revista Ciência & Saúde Coletiva is the property of Associacao Brasileira de Pos-Graduacao em Saude Coletiva and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Stakeholder advisory boards are recognized as an essential and useful part of patient-centered research. However, such engagement can involve exchanges of diverse individual experiences, multiple opinions, and strong feelings in the face of researchers limitations, deadlines, and agendas. Yet, little work examines how these potential tensions occur and are resolved in actual advisory board meetings. This perspective article describes and employs a communication framework for analyzing a patient advisory council (PAC) for a comparative effectiveness study on acupuncture and pain counseling for inpatients with cancer. The framework, Action-Implicative Discourse Analysis (AIDA), is an observational method that examines challenges through recorded and transcribed, naturally occurring interaction. Our analysis focused on two short excerpts from the first PAC meeting to demonstrate members navigation of advice-giving and advice-receiving-one in which advice was ultimately implemented by the study team and another in which it was deemed unfeasible. Although advice is inherent to the work of all PACs, it often emerges unannounced as negotiated moments, made up of seemingly minor conversation moves. As a recurring event, advice can and should be analyzed and discussed within PACs to improve communication and team dynamics.

This bibliometric review analyzes the trends in research related to networking and negotiating skills in the digital era. The study found that keywords like innovation, leadership, and network were interconnected, and networking and negotiating were popular topics in certain countries. The article emphasizes the importance of effective communication and negotiation skills in various contexts, such as business and career development. It also discusses the steps of the negotiation process and provides tips for improving negotiating skills. The document is a list of academic journal articles covering topics such as intra-firm trade, corporate price planning, and business network strategy in Islamic microfinance institutions, which may be useful for researchers in these areas. [Extracted from the article]

This commentary attempts to offer a practitioner's perspective on the use of hypothetical reported speech in business negotiations and how it might be explored in a Business English learning environment to help learners with English and negotiating skills. Some textbook materials on negotiations were reviewed for this purpose and some suggested activities are provided. • A functional focus on teaching negotiation skills. • A communicative approach to language learning. • Provision of some tasks in the classroom which reflect learner realities. • A practitioner's commentary on Koester's article (2014) on Hypothetical Reported Speech. • Revision of some textbook material for Hypothetical Reported Speech. [ABSTRACT FROM AUTHOR]

Obsessions and compulsions are central components of obsessive-compulsive disorder (OCD) and obsessive-compulsive related disorders such as body dysmorphic disorder (BDD). Compulsive behaviours may result from an imbalance of habitual and goal-directed decision-making strategies. The relationship between these symptoms and the neural circuitry underlying habitual and goal-directed decision-making, and the arbitration between these strategies, remains unknown. This study examined resting state effective connectivity between nodes of these systems in two cohorts with obsessions and compulsions, each compared with their own corresponding healthy controls: OCD (nOCD = 43; nhealthy = 24) and BDD (nBDD = 21; nhealthy = 16). In individuals with OCD, the left ventrolateral prefrontal cortex, a node of the arbitration system, exhibited more inhibitory causal influence over the left posterolateral putamen, a node of the habitual system, compared with controls. Inhibitory causal influence in this connection showed a trend for a similar pattern in individuals with BDD compared with controls. Those with stronger negative connectivity had lower obsession and compulsion severity in both those with OCD and those with BDD. These relationships were not evident within the habitual or goal-directed circuits, nor were they associated with depressive or anxious symptomatology. These results suggest that abnormalities in the arbitration system may represent a shared neural phenotype across these two related disorders that is specific to obsessive-compulsive symptoms. In addition to nosological implications, these results identify potential targets for novel, circuit-specific treatments.

CONTEXT: The literature on reproductive decision making often focuses on women and neglects the role of men and the importance of relationship context. Research with couples is vital to understanding joint decision making regarding having children at various stages of a couples relationship and an individuals life course. METHODS: In-depth, individual interviews were conducted with a socioeconomically, racially and ethnically diverse sample of 50 young heterosexual women and their male partners in northern California in 2015-2016. A dyadic, thematic analytic approach was used to examine whether and how prospective pregnancy intentions and current pregnancy desires are negotiated at the couple level, and how relationship dynamics influence any negotiation and decision-making processes. RESULTS: Twenty-three couples described engaging in joint pregnancy decision making, which required purposeful communication and, for some, compromise and acceptance. For nearly all of these couples, these processes led to aligned prospective pregnancy intentions, even when current pregnancy desires differed. The remaining 27 couples described individual pregnancy decision-making processes; many respondents reported intentions that aligned with their partners by happenstance, despite some respondents having avoided communicating their desires to their partner. Some of these couples faced relationship difficulties, including poor communication, leading some participants to misinterpret or be unaware of their partners pregnancy intentions and desires. CONCLUSIONS: The relationship context is important in the formulation of prospective pregnancy intentions among young people. Counseling protocols, interventions and policies that attend to the complex factors that influence young couples pregnancy decision making are needed to better help couples attain their reproductive goals.

ObjectiveAutoimmune conditions are associated with an increased risk of adverse pregnancy complications and outcomes, suggesting that pregnancy complications may mediate the excess risk. We performed a causal mediation analysis to quantify the mediated effects of autoimmune conditions on adverse pregnancy outcomes.MethodsWe queried a California birth cohort created from linked birth certificates and hospital discharge summaries. From 2,963,888 births, we identified women with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), psoriasis, and inflammatory bowel disease (IBD). Pregnancy complications included preeclampsia/hypertension, gestational diabetes mellitus, and infection in pregnancy. Adverse pregnancy outcomes were preterm birth, cesarean delivery, and small for gestational age. We performed a mediation analysis to estimate the total effects of each autoimmune condition and adverse pregnancy outcome and the indirect effects through pregnancy complications.ResultsAll 4 autoimmune conditions were associated with preterm birth and cesarean delivery, and RA, SLE, and IBD were associated with offspring that were small for gestational age. The strongest mediator of RA, SLE, and psoriasis was preeclampsia/hypertension, accounting for 20-33% of the excess risk of preterm births and 10-19% of excess cesarean deliveries. Gestational diabetes mellitus and infections generally mediated

Ponorogo Regency is included in the top 5 regencies/cities that send the largest number of migrant workers in Indonesia and ranks first in East Java Province with a total of 10,043 Indonesian migrant workers. The high number of Indonesian migrant workers in Ponorogo Regency encourages all actors to play a role in dealing with the impacts. It is listed in the Ponorogo Regency of Regional People's Representative Assembly Decree Number 188.4/01/2020 concerning the program for the establishment of the Ponorogo Regency Regional Regulation in 2020. This paper intends to analyze the usefulness of applying community research techniques to illuminate the nuanced requirements of immigrant com communities. Given the political interests of actors in the subsystem representing various stakeholders: Regent of Ponorogo Regency, DPRD of Ponorogo Regency, Religious Court of Ponorogo Regency, Manpower Office of Ponorogo Regency, LTSA of Ponorogo Regency, P4TKI, PPPMI, NGOs and PMI. This study aims to analyze the actors involved and the resources consisting of formal legal authorities to make decisions, public opinion, information, mobs, financial resources, and skilled leadership. This study uses a case study qualitative research method with data collection through interviews, observations, literature reviews, and data from public test results. The success of the actors in managing the trust of non-formal actors becomes the capital to convince the formal sector to be optimistic about meeting the needs of migrants. In Ponorogo social work, local community research may offer a more inclusive, community-based methodological strategy to migrant challenges. The context of policy belief and actor resource, determining success related to the ability to innovate, leadership, power, and determining the right steps are some of the recommendations from this research. [ABSTRACT FROM AUTHOR]

Many people recognize companion animals as their friends, partners, and family members, and an increasing number of them are observed traveling with companion animals. To enhance tourists' experience of traveling with companion animals, protect companion animals' welfare, and facilitate a healthy development of this niche market, it is worthy and necessary to understand the constraints in traveling with companion animals and how people negotiate them. This study did a Husserlian phenomenology inquiry based on data collected from a virtual community where users could raise and answer questions. This study reveals that most public transportation, hotels, and tourist attractions in China are very hostile to companion animals, and coping with these constraints is a primary experience of traveling with companion animals. Tourists negotiate constraints by driving personal cars, lying, hiding, and sneaking in, leaving companion animals alone, and being mindful and responsible. [ABSTRACT FROM AUTHOR]

In a complex healthcare system such as the NHS we are exposed to conflict every day. Conflict can arise from many different sources, and the pressures that our service currently faces will only serve to drive this further. We know that when managed poorly conflict has the potential to negatively affect the care of our patients and we will discuss some of the communication models that are available to help staff manage it when it arises. It is important looking forward that we minimize unnecessary conflict wherever possible, and therefore this article will also explore some of the current initiatives developed to raise awareness of the impact that conflict can have in the workplace, as well as the NHS' approach to conflict resolution training for its staff. [ABSTRACT FROM AUTHOR]

We examine how a simple handshake-a gesture that often occurs at the outset of social interactions-can influence deal-making. Because handshakes are social rituals, they are imbued with meaning beyond their physical features. We propose that during mixed-motive interactions, a handshake is viewed as a signal of cooperative intent, increasing people's cooperative behavior and affecting deal-making outcomes. In Studies 1a and 1b, pairs who chose to shake hands at the onset of integrative negotiations obtained better joint outcomes. Study 2 demonstrates the causal impact of handshaking using experimental methodology. Study 3 suggests a driver of the cooperative consequence of handshaking: negotiators expected partners who shook hands to behave more cooperatively than partners who avoided shaking hands or partners whose nonverbal behavior was unknown; these expectations of cooperative intent increased negotiators' own cooperation. Study 4 uses an economic game to demonstrate that handshaking increased cooperation even when handshakes were uninstructed (vs. instructed). Further demonstrating the primacy of signaling cooperative intent, handshaking actually reduced cooperation when the action signaled ill intent (e.g., when the hand-shaker was sick; Study 5). Finally, in Study 6, executives assigned to shake hands before a more antagonistic, distributive negotiation were less likely to lie about self-benefiting information, increasing cooperation even to their own detriment. Together, these studies provide evidence that handshakes, ritualistic behaviors imbued with meaning beyond mere physical contact, signal cooperative intent and promote deal-making. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Negotiation skills are critical to career success, yet many physicians feel ill-equipped to negotiate for professional opportunities. Enhancing competencies in this arena may be especially critical for women and underrepresented minorities to reduce disparities in compensation and resources that begin upon entry into the workforce as junior faculty. This perspective offers a comprehensive overview of negotiation strategies and the job search process for individuals finishing medical training and seeking first-time employment. First, we extrapolate lessons from clinical medicine to provide a negotiation roadmap for residents and fellows. We use both a clinical and an employment scenario to illustrate the concept of principled negotiation in which negotiating partners elicit each other's values and interests and identify options for mutual gain. We then describe approaches to seeking and negotiating job opportunities and discuss typical timelines for these activities. We supply a list of professional needs to consider before a negotiation begins and introduce the concept of a best alternative to negotiated agreement to help ensure essential requirements are met in a final employment offer. Finally, we explore the utility of third-party assistance and published benchmarks and offer best practices for negotiating.

The act of politeness (or impoliteness) being an important aspect in any kind of interaction, this study aims to explore how politeness is achieved in intercultural communication. This aim is achieved by analysing the naturally occurring conversation between Pakistani and Polish participants: the two very different cultures. Pakistani and Polish cultures, being Asian and European or Eastern and Western cultures respectively, with former representing collectivistic and the latter, individualistic society, are very different from one another and serves as an appropriate choice for this study. The data has been analysed using conversational analysis (CA) to study how turn-taking is organised in everyday interaction. However, Lakoff's rules of politeness have been adapted as the basic framework for the analysis of politeness. Conclusions and implications have been drawn based on the study's findings. [ABSTRACT FROM AUTHOR]

Copyright of Rolling Stock (1002-7602) is the property of Rolling Stock Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Up to two-thirds of new cases of HIV transmission between gay, bisexual and other men who have sex with men in the USA are attributed to primary relationships. Understanding the relationship dynamics and sexual agreements of male-male couples can provide insight into HIV transmission patterns and prevention needs in this population. The daily use of antiretroviral pre-exposure prophylaxis (PrEP) is highly effective in preventing HIV, but its negotiation and use within social and intimate relationship contexts remain understudied. We conducted semi-structured qualitative interviews with 20 male couples (n = 40 men) in which at least one partner was either using or in the process of initiating PrEP. Congruent with a theoretical focus on social theories of relationships and negotiated risk, couples were interviewed about relationship dynamics, trust, communication and sexual health practices, including their perception and use of PrEP. Overall, we found that couples showed heightened trust and communication when establishing open, sexual agreements and demonstrated high awareness of sexual risks and health practices in the context of PrEP use. This study demonstrates how understanding relationship dynamics can better inform HIV prevention and sexual health promotion efforts for male couples at risk of HIV.

Obtaining maximum antiretroviral therapy (ART) adherence is critical for maintaining a high CD4 count and strong immune function in PLWHA. Key factors for achieving optimum adherence include good medication self-efficacy, decreased medication-taking difficulties, and positive patient-healthcare provider (HCP) relationships. Limited studies have analyzed the correlation of these factors and ART adherence in Chinese population. In this paper, structural equation modeling was performed to assess the proposed model of relations between patient-HCP relationships and adherence. Audio Computer-Assisted Self-Interview (ACASI) software was used to collect data on ART adherence and patient variables among 227 PLWHA in Shanghai and Taipei. Participants completed a one-time 60-minute ACASI survey that consisted of standardized measures to assess demographics, recent CD4 counts, self-efficacy, patient-HCP relationship, adherence, and medication-taking difficulties. The data shown the relationship between patient-HCP relationships and adherence was significantly consistent with mediation by medication self-efficacy. However, patient-HCP interaction did not directly influence medication-taking difficulties, and medication-taking difficulties did not significantly affect CD4 counts. Furthermore, patient-HCP interactions did not directly impact CD4 counts; rather, the relation was consistent with mediation (by either better medication self-efficacy or better adherence) or by improved adherence alone. Future interventions should be designed to enhance self-management and provide better patient-HCP communication. This improved communication will enhance medication self-efficacy and decrease medication-taking difficulties. This in turn will improve medication adherence and immune function among PLWHA.

Research suggests that altered emotion processing may be one important pathway linking social risk factors and depressive symptoms. We examined the extent to which neural response to negatively valenced social information might help to account for the relationship between social risk and depressive symptoms in youth. Forty-nine youth were scanned while identifying the emotional valence of words that connoted social status. They also completed questionnaires assessing self-reported social risk factors and depressive symptoms. Mediation analysis revealed that reduced dorsolateral prefrontal cortex activity in response to negative social status words explained the positive association between social risk and depressive symptoms. These findings suggest that social risk factors present during adolescence may contribute to depressive symptoms by influencing the neural substrates of emotion processing.

Copyright of Enfermagem Brasil is the property of Atlantica Editora and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Windermere is a complex and contested freshwater site which encounters fluctuating social and environmental pressures. Swimmers at Windermere regularly practice across all four seasons while negotiating social concerns such as access, conflicting user groups, public health communications, and swim safety, alongside environmental complications including extreme weather, wastewater, run-off, plastic pollution, algal blooms, biosecurity, and climate change. Simultaneously, these entangled pressures generate ongoing adaptation, ambivalence, and avoidance within the swim communities. Furthermore, they disrupt individualised and inwardly focused understandings of 'healthy' outdoor swimming practices. In contribution to the special issue (on outdoor swimming), this article reflects on how outdoor swimming researchers may methodologically attend to these social and environmental complexities within contested lacustrine environments through an immersive 12-month wet ethnographic approach, combining 'lake-hangouts' and 'swim-along interviews' with different swimmers at Windermere. The article discusses how these relational in-situ approaches can continue to broaden inwardly focused understandings of 'healthy' outdoor swimming practices towards the wider social and environmental relations for both the participants and researcher. The article also highlights senses of ambivalence and ethical tension while negotiating conflicting concerns of ill-health, in and out of Windermere's fragile waters., (Crown Copyright © 2024. Published by Elsevier Ltd. All rights reserved.)

Introduction: Global workforce shortages in medical specialties strain healthcare systems, jeopardising patient outcomes. Enhancing recruitment strategies by supporting professional identity (PI) development may be one way to address this workforce gap-yet little research has explored this topic. The goal of the current study was to explore specialty-specific recruitment through considering PI. As proposed causes of workforce shortages in anatomical pathology (AP) bear similarities to many other specialties, this study uses the field of AP as a model for specialist PI development and asks: (1) why, how and when do doctors choose to pursue AP training and (2) what can be learned from this for recruitment to AP and other specialties?, Methods: A qualitative research approach was undertaken using narrative inquiry. Interviews with junior doctors interested in AP, AP registrars and AP consultants from Australia and New Zealand were interpreted as stories via 're-storying'. Narrative synthesis of participants' collective stories identified chronological key events (i.e. 'turning points') in choosing AP., Results: Narrative synthesis resulted in identification of three portraits entering medical specialist training: (1) die-hards, deciding upon initial exposure; (2) negotiators, choosing after comparing specialties; and (3) migrants, seeking to move away from non-pathology specialties. The negotiators and migrants cemented their decision to pursue AP as a postgraduate doctor, whereas the die-hards made this decision during medical school., Conclusions: Given the similarities in portrait traits between AP and other specialties across the literature, our results suggest ways to support specialty recruitment using PI development. We propose a medical specialist recruitment framework to support the PI development of doctors with die-hard, negotiator and migrant traits. Use of this framework could enhance current specialty-specific recruitment approaches, particularly in fields challenged by workforce shortages., (© 2024 The Authors. Medical Education published by Association for the Study of Medical Education and John Wiley & Sons Ltd.)

Dr. Jeremy Safran had a unique talent to seamlessly weave together clinical work with his broad knowledge of philosophy, history, and theology. Alongside his commitment to researching the minutest clinical interactions, he was conscious of the broad values of the nature of the good life that underpinned his analytic approach. This paper will explore the concepts of the enchanted unconscious, clinical impasses, negotiation, and surrender, suggesting that these concepts together provide insight into Safran's larger philosophy of life. It will then provide the approach to these concepts of the Rebbes of Ishbitz/Radzin, a school of Polish Hasidic thought. It will conclude with an exploration of how both Safran's psychoanalytic approach and the Ishbitz/Radzin Rebbes' Hasidic approach to the Torah provide distinct insights and applications of these concepts, which can be mutually enriching for both disciplines., (© 2024. Association for the Advancement of Psychoanalysis.)

The introduction of mental health collaborative care (MHCC) is one of the strategies to scale up access to mental health care in primary health care in Brazil. This article investigates an experience of mental health collaborative care in the city of Rio de Janeiro, Brazil. It is a qualitative study involving interviews with physicians and mental health professionals working in primary health care units located in the northern part of the city of Rio de Janeiro, Brazil. The aim is to examine the various strategies and negotiations that primary health care professionals deploy to identify mental distress and plan health care interventions. We discuss the results within the economy of attention framework. We argue that divergences in diagnostic design and therapeutic planning carried out by professionals and users or observed in MHCC meetings illustrate the health-disease-care seeking phenomenon as a negotiated process, entangled in complex interactions. Our results evince that those interactions are not always evident and configure 'what is at stake' in mental suffering. The incorporation of cultural and structural determinants in collaborative care may enable the expansion of mental health initiatives sensitive to local needs and realities., (© 2024. The Author(s).)

Rules help guide our behavior-particularly in complex social contexts. But rules sometimes give us the "wrong" answer. How do we know when it is okay to break the rules? In this paper, we argue that we sometimes use contractualist (agreement-based) mechanisms to determine when a rule can be broken. Our model draws on a theory of social interactions - "virtual bargaining" - that assumes that actors engage in a simulated bargaining process when navigating the social world. We present experimental data which suggests that rule-breaking decisions are sometimes driven by virtual bargaining and show that these data cannot be explained by more traditional rule-based or outcome-based approaches., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

In the short and longer terms, the Medicare Drug Price Negotiation Program should be evaluated based on four categories of outcomes: beneficiary access, prices and spending, promotion of value, and effects on innovation.

Introduction: Despite legislation mandating accommodation policies in postsecondary education, support for students with disabilities is often not implemented within health and human services (HHS) education programs, particularly in fieldwork settings. As part of a Canada-wide study exploring the experiences of disabled students in 10 HHS programs, we examined how HHS students described their experiences accessing accommodations in fieldwork to understand how conceptions of disability relate to students' fieldwork experiences. Using a critical disability studies framework, we explored how HHS fieldwork education understands disability, accommodations and professional competence and what those understandings reveal about the discrepancy between mandated accommodations and what happens in practice., Methods: Thirty-five students requiring accommodations in HHS fieldwork education participated in interviews. Through a critical interpretive analysis of interview data, we developed first-person composite narratives to show the richness and complexity of the students' diverse, yet similar, subjective experiences with fieldwork accommodations., Findings: Two composite narratives demonstrate how conceptions of disability incommensurate with professional competence expectations influenced student experiences with disclosing disability and obtaining accommodations in fieldwork. Fear of stigma and having one's competence questioned, or having accommodation requests denied for being misaligned with professional expectations, demonstrate how HHS fieldwork education and practice are upheld by ableist systemic structures., Discussion: The dominant medical model of disability in HHS education creates institutional barriers that require students to constantly (re)construct their 'professional' identity in relation to their 'patient' identity. This patient-professional identity construction relates to HHS professional competency standards and assumptions about what makes a 'good' professional. Suggestions include reworking competency standards and implementing critical pedagogical approaches to teach future and current HHS professionals to question both personal and practice assumptions. With institutional backing, such changes may support diversity within HHS and a culture shift toward more equitable education and health care., (© 2024 The Authors. Medical Education published by Association for the Study of Medical Education and John Wiley & Sons Ltd.)

Background: Nested within a growing body of evidence of a gender pay gap in medicine are more alarming recent findings from family medicine: a gender pay gap of 16% can be detected at a very early career stage. This article explores qualitative evidence of women's experiences negotiating for their first job out of residency to ascertain women's engagement with and approach to the negotiation process., Methods: We recruited family physicians who graduated residency in 2019 and responded to the American Board of Family Medicine 2022 graduate survey. We developed a semistructured interview guide following a modified life history approach to uncover women's experiences through the transitory stages from residency to workforce. A qualitative researcher used Zoom to interview 19 geographically and racially diverse early career women physicians. Interviews were transcribed verbatim and analyzed using NVivo software following an Inductive Content Analysis approach., Results: Three main themes emerged from the data. First, salary was found to be nonnegotiable, exemplified by participants' inability to change initial salary offers. Second, the role of peer support throughout residency and early career was crucial to uncovering and rectifying salary inequity. Third, a pay expectation gap was identified among women from minority and low-income households., Conclusion: To rectify the gender pay gap in medicine, a systems-level approach is required. This can be achieved through various levels of interventions: societally expanding the use of and removing the stigma around parental leave, recognizing the importance of contributions not currently valued by productivity-based payment models, examining assumptions about leadership; and institutionally moving away from fee-for-service systems, encouraging flexible schedules, increasing salary transparency, and improving advancement transparency., Competing Interests: Conflict of interest: Annie Koempel and Madeline Byrd are employees of the American Board of Family Medicine; Melissa K. Filippi, Anam Siddiqi, and Yalda Jabbarpour are employees of the Robert Graham Center for Policy Studies in Family Medicine and Primary Care., (© Copyright 2024 by the American Board of Family Medicine.)

Competing Interests: Competing interests: None declared.

Health controversies involve complex exchanges of disagreements over health and medicine. They unfold differently in different parts of the world, and they often extend over long periods of time. In contemporary argumentation theory, proposals have recently been emerging for "disagreement management at large scale" and for an explicit focus on design of disagreement management methods. Lewiński and Aakhus characterize large-scale disagreement as polylogic: formed of complex networks of players holding contrasting positions that are attacked and defended in multiple places . Large-scale disagreements such as health controversies are important sites for emergence of new disagreement management methods, including new ways of arriving at conclusions about questions of fact (affecting positions) and new formats for coming to decisions about questions of policy (affecting places). The controversy over myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), spanning a period of very rapid change in reasoning about health, has been deeply entangled with the design of new institutional places for managing disagreements about health. It serves well to illustrate both the large, multi-scale structure of health controversies and the importance of long-term disagreement management strategies.

This article analyses the use of mediation to resolve mental capacity law disputes, including those that arise in the healthcare context. It draws on original empirical data, including interviews with lawyers and mediators, and analysis of a mediation scheme, to argue that mediation has the potential to be an effective method of resolution in mental capacity law. It highlights the relationship benefits of mediation while acknowledging the challenges of securing P's participation and best interests. The final section of the article considers how mediation can operate in one of the most challenging healthcare environments, the Intensive Care Unit. The article emphasizes that the challenges we see in mediation are not unique and exist across the spectrum of Court of Protection practice. Therefore, the article concludes that mediation may be used effectively but the jurisdiction would also benefit from a clearer regulatory framework in which it can operate., (© The Author(s) 2024. Published by Oxford University Press.)

Humans cooperate in groups in which mutual monitoring is common, and this provides the possibility of third-party arbitration. Third-party arbitration stabilizes reciprocity in at least two ways: first, when it is accurate, it reduces the frequency of misunderstandings resulting from perception errors, and second, even when it is inaccurate, it provides a public signal that allows pairs to align their expectations about how to behave after errors occur. Here, we describe experiments that test for these two effects. We find that in an iterated, sequential Prisoner's Dilemma game with errors, players with the highest average payoffs are those who make use of third-party arbitration and who also employ forgiving strategies. The combination of these two behaviours reduces the detrimental effects of errors on reciprocity, resulting in more cooperation.

The aim of the present research is to investigate the phenomenon of the negotiation of the central core elements of a social representation under the effect of the confirmation of another, in relation to their intra core hierarchy, to understand the socio cognitive conditions in which this negotiation takes place and the role of conditionality in this. Also, in the effects it has on the perceptual and evaluative activity of the subjects. Two experimental procedures it was conducted. Based on our results: • when there was no condition, the simultaneous questioning of a primary central element, which founds the meaning of a representation (PCE) is not compensated by the confirmation of an adjunctive central element, which only specifies it (ACE) and subjects do not accept the representation, • while in the conditionality: the questioning of a primary central element (PCE) is compensated by the confirmation of an adjunctive central element (ACE) and leads instead to the acceptance of the representation. We conclude that our research findings, allow us to make it possible to understand further the internal functioning of the central system of a social representation, and the term of negotiability of a central element, which depends on the position and role of this element at the socio-cognitive level in the structure of the representation., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author. Published by Elsevier B.V. All rights reserved.)

Academics and policymakers have suggested making flexible work arrangements (FWAs) the default in workplaces to promote a family-friendly workplace culture conducive to having and raising children. However, systematic research investigating how FWAs, as a long-term approach to negotiating work-family spheres, are related to fertility among dual-earner heterosexual couples is limited. Drawing on the linked-lives perspective, we theorize the relationship between FWAs and fertility among couples and potential variation depending on the interplay of both spouses' work and family characteristics. We test our hypotheses using longitudinal couple-level dyadic data in the United Kingdom (2010-2022). We find that although FWA availability alone is unrelated to fertility, wives' (not husbands') FWA use is significantly associated with a higher probability of experiencing a first birth. Moreover, the effect of wives' FWA use is particularly pronounced when both spouses work in professional and managerial occupations and when husbands contribute a larger proportion of income and at least equal housework. This study reveals a gendered effect of FWAs on fertility across work-family arrangements, deepening our understanding of couple-level dynamics in the fertility process., (Copyright © 2024 The Authors.)