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The 2022 United States Food and Drug Administration (US FDA) draft guidance on diversity plan (DP), which will be implemented through the Diversity Action Plans by December 2025, under the 21st Century Cures Act, marks a pivotal effort by the FDA to ensure that registrational studies adequately reflect the target patient populations based on diversity in demographics and baseline characteristics. This white paper represents the culminated efforts of the International Consortium of Quality and Innovation (IQ) Diversity and Inclusion (D&I) Working Group (WG) to assess the implementation of the draft FDA guidance by members of the IQ consortium in the discipline of clinical pharmacology (CP). This article describes current practices in the industry and emphasizes the tools and techniques of quantitative pharmacology that can be applied to support the inclusion of a diverse population during global drug development, to support diversity and inclusion of underrepresented patient populations, in multiregional clinical trials (MRCTs). It outlines strategic and technical recommendations to integrate demographics, including age, sex/gender, race/ethnicity, and comorbidities, in multiregional phase III registrational studies, through the application of quantitative pharmacology. Finally, this article discusses the challenges faced during global drug development, which may otherwise limit the enrollment of a broader, potentially diverse population in registrational trials. Based on the outcomes of the IQ survey that provided the current awareness of diversity planning, it is envisioned that in the future, industry efforts in the inclusion of previously underrepresented populations during global drug development will culminate in drug labels that apply to the intended patient populations at the time of new drug application or biologics license application rather than through post‐marketing requirements. [ABSTRACT FROM AUTHOR]

In 2020 Germany released its Indo‐Pacific guidelines in response to global shifts and escalating Sino‐US rivalries in the region. This article scrutinises Germany's ambitions and stance in the Indo‐Pacific, utilising the middle power concept as an analytical tool. It argues that Germany's Indo‐Pacific strategy is broadly in line with its wider foreign policy approach rather than marking a radical shift. Divided into three sections, the article explores middle power theories, Germany's foreign policy approach and Germany's Indo‐Pacific tilt. Assessing Germany's progress in the Indo‐Pacific, the paper employs a middle power framework based on capabilities, identity and engagement. We argue that Germany seems intent on positioning itself as a civilian middle power, evident in its deeply engrained norms determining identity and guiding engagement. The article uses a qualitative approach, drawing from primary material such as official statements of German policymakers and policy documents, supplemented by secondary sources covering the literature on middle power dynamics, the Indo‐Pacific region and Germany's foreign policy. Employing thematic documentary analysis, the paper identifies recurring patterns and trends in Germany's evolving role in the Indo‐Pacific. [ABSTRACT FROM AUTHOR]

How does India navigate contested regional multilateral frameworks in the Asia‐Pacific? This question has important implications for India's multilateral foreign policy and diplomacy that seeks to emerge from regional to global power. The authors argue that India's foreign policy involves seeking institutional balancing and avoiding rising power dilemmas. Based on the conceptual framework of institutional balancing and rising power dilemma, the paper examines how seeking institutional balancing helps India advance its diplomatic prowess vis‐à‐vis rising China while simultaneously leveraging its multi‐alignment strategy against the United States. Furthermore, the paper discusses India's key priorities for avoiding the rising power dilemma, thus exhibiting its reluctance to conform to the US hegemony and addressing its internal and external dilemma concerning China. The evaluation suggests that India's foreign policy rationality navigates between obtaining comprehensive security and economic gains in dealing with contested regional multilateralism. [ABSTRACT FROM AUTHOR]

Oman and its conflict management model are the focus of this paper. This model has crystalized out of the three stand‐alone but complementary systems of conflict resolution which evolved in an ad hoc fashion: the institute of tribal leaders; the reconciliation committees; and the formal judicial system. These systems offer a foundation for the current efforts of the local people to sustain a peaceful co‐existence among the vibrant and ethnically diverse Omani communities known for their turbulent past. The analyzed data obtained from interviews with Omani tribal leaders, reconciliation committee members, and lawyers shed light on both the strengths of the conflict management model and the modern challenges which the model faces. The findings confirm that this model represents a coherent entity run by an integrated constitutional‐tribal order. They also suggest that the model serves as a state mechanism for balancing power between the country's major players—the government and the institute of tribal leaders. The novel contribution of this paper lies in linking the origin and philosophy of each system with the "mediation identity" of Oman's foreign policy. [ABSTRACT FROM AUTHOR]

The success of a state's coercive foreign policy depends on how much influence it has over a 'target' – a premise that assumes other factors do not obstruct the policy goal. In practice however, the nature of the international system complicates the potential for such a policy's success. This paper examines this idea using the 2018 US decision that aimed to dismantle the JCPOA by pulling out of the agreement and re‐sanctioning Iran. To do so, this paper engages with the general and region‐specific literature on coercive foreign policy, sets out a background of US‐Iranian ties and examines the consensus‐driven momentum that led to the JCPOA, along with the unilateral 2018 US decision to renege on the agreement. The findings demonstrate how the US and Iranian political environments made it difficult to realise the coercive foreign policy goal of dismantling the JCPOA. The reasons for this centre on the notion that the interconnected nature of the international system diminishes the effectiveness of this type of coercive foreign policy – even when considering the USA as a powerful implementer of this policy. Thus, I argue for the importance of capturing contextual factors when considering this type of international relations. [ABSTRACT FROM AUTHOR]

This intervention paper discusses the recent paper on the history of geoeconomics by Mallin and Sidaway. Some notes are made on the conceptual potential of critical geoeconomics vis‐à‐vis contemporary geopolitical scholarship. A particular focus is on the relationship between the concepts of geoeconomics and geopolitics. Conceptualising geopolitical and geoeconomic discourses as if they were distinct or even complementary geostrategic discourses – typical especially in mainstream strategic analysis and International Relations – risks reproducing the discursivism and noncritical outlook of state‐centric geostrategic arguments. In this paper, I discuss the conceptual potential of critical geoeconomics vis‐à‐vis contemporary geopolitical scholarship. This is arguably an important issue given that critical human geographers may be well positioned to reclaim the concept of geoeconomics. [ABSTRACT FROM AUTHOR]

Sister city relationships (SCRs) are a platform through which local governments (LGs) engage internationally. Increasingly, there is an expectation that such international engagement delivers economic opportunities and returns. Many LGs are therefore pursuing local economic development (LED) through their SCRs. Drawing on a national survey of Australian LGs (stage 1) and interviews with key council staff and stakeholders in five LG areas maintaining Australia–China SCRs (stage 2), this paper contributes to growing literature on LED by examining how LGs have developed their own capacities and supported local small‐ and medium‐sized enterprises (SMEs) to engage internationally. Our findings reveal insights into how Australian LGs have achieved international engagement through two strategies that leverage their SCRs, namely building government's capabilities and developing SMEs' capabilities. This paper contributes new insights into the evolving role of LGs in LED, including both current experimentation, challenges, and future opportunities. Points for practitioners: A growing number of Australian local governments pursue LED through their Chinese sister city relationships.Supporting the internationalisation of SMEs is an emerging component of local government pursuit of LED.International engagement of local governments has necessitated enhanced capacities in human, external, and financial resources.Findings highlight the unique and often overlooked role of local‐to‐local diplomatic and economic relations. [ABSTRACT FROM AUTHOR]

Objective: This paper aims to evaluate existing measurements and propose new ones for foreign policy similarity in international politics, emphasizing the importance of measurement in social science. The indicators designed must align with theoretical concepts and data characteristics to ensure consistency and validity. Methods: The paper meticulously examines the assumptions and calculation methods of existing indicators, such as the S‐score and tau‐b, to rigorously evaluate their alignment with theoretical concepts and data characteristics. It then proposes alternative measurements that can address these criteria. Results: The new indicators introduced in this paper address the limitations of the existing measurements. While producing values similar to existing measurements, they maintain conceptual consistency and operational interpretability. Additionally, the paper presents a tau‐like indicator weighted by national capability, an aspect not feasible with the previous tau‐b, leading to new meaningful conclusions. Conclusions: This paper emphasizes the importance of understanding measurements when creating or using them. A deep comprehension of similarity measures and the research topic facilitates more precise measurements, thereby enhancing research outcomes in international politics. [ABSTRACT FROM AUTHOR]

NATO's unified command structure affords the US Chairman of the Joint Chiefs of Staff influence in transatlantic foreign and security policy unparalleled with any other region. This, as Stephen Saideman has argued, is a function of the central role the Supreme Allied Commander Europe (SACEUR) plays in Alliance decision‐making. This paper explores the early development of this decision‐making structure. It is argued that the structures, norms, and rules that advantage US military advice in transatlantic security and foreign policy were a function of domestic US civil‐military and international bargaining in the early development of NATO institutions. In exchange for supporting new US commitments in Europe, uniformed Pentagon leadership insisted on German rearmament and a key set of provisions in the development of NATO military structures and institutions that ensured US military leadership, especially regards the duties and responsibilities of SACEUR. [ABSTRACT FROM AUTHOR]

This article examines the narratives surrounding Moscow's full‐scale invasion of Ukraine in 2022 and beyond. Since the start of the war, Western characterizations of Russia's foreign policy as revanchist and imperialist have been overshadowed by the more successful framing by Russia that its actions were driven by the need to push back on American unipolarity and Western imperialist tendencies. This article examines how the Kremlin's narrative on the war has been embraced by leaders in core BRICS countries, shaping their position vis‐à‐vis Russia and the war. Drawing on theories of strategic narratives, this article highlights how leaders in China, India, Brazil, and South Africa understand the war and create conditions in which Russia can prosecute its war against a neighbor with their support or acquiescence. The paper concludes with policy recommendations and a brief discussion of why theories of strategic narratives have been underappreciated relative to more standard power‐based and materialist explanations of the war's outbreak, scope, and trajectory by scholars of international relations. [ABSTRACT FROM AUTHOR]

This paper posits that, contrary to conventional wisdom, Sweden's decision to join the North Atlantic Treaty Organisation (NATO) and end its official policy of 'nonalignment' is neither very surprising nor radical in nature. Utilising the shelter theory framework, we examine the Swedish case to shed a new light on the economic, societal and political shelter‐seeking policy choices that led to Stockholm's NATO application in May of 2022. The analysis finds that Sweden's established strategy of seeking shelter from Western powers eventually induced and facilitated close military cooperation with NATO—ultimately leading to accession on 7 March 2024. The decision to join the Alliance should, therefore, be understood as a culmination, building on a historically flexible approach to neutrality and previously established shelter arrangements that were deemed in 2022, after Russia's full‐scale invasion of Ukraine and subsequent developments in Finland, to be no longer sufficient in deterring or responding to new threat dynamics. The case indicates that shelter theory accurately captures the foreign policy strategy of a small neutral and later nonaligned state. However, analysing Sweden's move towards NATO within the given framework also presents an opportunity for theory development; specifically, the theory ought to more meticulously examine three small‐state shelter‐seeking features, namely, how societal and economic shelter relations may precede and, therefore, affect political shelter strategies (or vice versa), the role of 'critical junctures' in the theory; and finally, how small states may be affected by each other's shelter‐seeking strategies. [ABSTRACT FROM AUTHOR]

Background: Person‐centred services are inherently related to patients/caregivers' needs. However, the extent to which dysphagia services within Singapore meet consumer needs is largely unknown. Involving patients/caregivers in service evaluation/redesign deepens the understanding of consumer needs. This process also increases the success of implementing service enhancements through relevant and meaningful change. Aim: This study aimed to identify aspects of dysphagia services, within acute and subacute settings in Singapore, perceived as highly important and easy to change by patients/caregivers. Methods & Procedures: Using concept mapping methodology, 5 patients and 11 caregivers reflected on their experiences of receiving dysphagia care and proposed 59 unique suggestions to improve dysphagia services within Singapore. Then, each individual sorted the suggestions into groups based on similarity and rated each statement for its perceived importance and changeability for service enhancement. Data were analysed using multidimensional scaling, hierarchical cluster analysis, and bivariate analysis to generate clusters of conceptually similar suggestions and a prioritised list of suggestions for service enhancement. Results: Twelve clusters were identified, with most rated as more important than changeable for service improvement. Participants prioritised 23 (39%) of the suggestions as highly important and easy to change, and these focused on ensuring effective communication among consumers and healthcare team, enhancing patients and carers' access to support at home, increasing patients and carers' access to educational resources, and improving service quality and access through technology. Conclusion: These findings provide future directions on how to develop and implement dysphagia services in Singapore to better meet the needs of patients/caregivers. WHAT THIS PAPER ADDS: What is already known on this subject: Little is known about patients and caregivers' experiences and expectations of receiving dysphagia services in Singapore. Consulting them in service review and improvement deepens understanding of their needs and increases the success of implementing meaningful service enhancements. What this study adds to existing knowledge: This study shows that patients and caregivers in Singapore identified a wide range of dysphagia service issues and prioritised a list of suggestions for service improvement. They prioritised four key areas for service optimisation: ensuring effective communication among consumers and healthcare team, enhancing patients and carers' access to support at home, increasing patients and carers' access to educational resources, and improving service quality and access through technology. What are the clinical implications of this work?: This research highlights the importance of considering the consumers' perspectives in service review and redesign. Patients and caregivers in Singapore identified four prioritised areas for service enhancements. These findings provide future directions on how to develop and implement dysphagia services in Singapore to better meet the needs of patients and caregivers. [ABSTRACT FROM AUTHOR]

The idea of the Greater Eurasian Partnership (GEP) has gained increasing currency in Russian foreign policy. The Russia–China partnership has been presented as its bedrock through a partnership between the Eurasian Economic Union and the Belt and Road Initiative, further expanding to include other regional powers from across East Asia, South Asia, Central Asia, and Middle East as well as nonwestern multilateral groupings (SCO, ASEAN). Given the centrality of Asia‐Pacific to this expansive concept, GEP has to deal with the challenges posed by the evolving regional geopolitics of the East and the rise of the Indo‐Pacific amidst heightened US–China rivalry. The paper seeks to conduct a policy review of GEP and its proposed development format in light of ongoing changes in the East to determine the likely future of the concept in a contested region that also remains at the center of this expansive Russian vision. [ABSTRACT FROM AUTHOR]

Although literature on energy cooperation highlights that cooperation is more successful at the regional level, it largely fails to understand and conceptualize energy cooperation as part of the wider phenomenon of regionalism. Energy cooperation tends to be analyzed through prisms of security and geopolitics, thus, downplaying other important regional integration processes. The present paper addresses this lacuna, defining energy regionalism and conceptualizing its various dimensions, logics, motivations, and interests. We apply a comparative perspective, examining two regions which exhibit extensive energy cooperation yet differ in several ways: North America and the European Energy Community. Our findings suggest various trajectories and models, and indicate that formal institutionalization is neither a necessary condition for nor a guarantee of strong energy regionalism. We discern that regional anchor is key in North American and European energy regionalism. [ABSTRACT FROM AUTHOR]

This paper evaluates the effects of sanctions on Russia between 2014 and 2019 and the resulting countersanctions. We estimate their impact on trade in a gravity framework, allowing for treatment heterogeneity among pairs and sectors, and use the estimated elasticities in a general equilibrium analysis. We find that the sanctions decreased trade with Russia in key sectors, translating to a loss in real income in Russia by 0.3%. Full decoupling of the EU and its allies from Russia would increase this effect to over 4%. Our results emphasize the role of deep sanctions as a foreign policy instrument and international cooperation. [ABSTRACT FROM AUTHOR]

Biological invasions represent one of the major threats to the world's biodiversity. National and international efforts are taken to address the complexity and dynamic of invasions in legislation. However, based on the Polish experience of implementing the European Union's regulation on invasive alien species (IAS), we suggest that an unclear and disorganized process of law implementation results in the regulations being counterproductive. We describe how a well‐planned policy can become a burden impeding effective research and, consequently, scientific feedback to improve the policy. The results of our study suggest that there is a large scale of scientists' noncompliance with new legal requirements. For many researchers, the implementation of the new IAS regulation was changing the rules in the middle of the game. Researchers strictly following the new regulations must wait for the relevant permits and may risk the successful completion of their projects. Conversely, researchers who prioritize project completion may be forced to continue their research violating the law. We argue that this example of implementing the new IAS regulation illustrates the need to include some intermediate solutions providing more flexibility and time for researchers to adjust to policy change, thus minimizing the negative impacts of the new legislature on scientific progress. [ABSTRACT FROM AUTHOR]

Aim: Internationalization at Home (IaH) strategies play an important role in nursing curricula to enhance nursing students' cultural awareness in the globalized world. The Community of Inquiry (CoI) is a theoretical framework for the optimal design of online learning environments to support critical inquiry and discourse among students and teachers. To optimise nursing students' online cultural awareness learning experiences, it was timely to develop online IaH strategies based on a sound theoretical model. This study aimed to examine the effectiveness of CoI‐guided online IaH strategies on enhancing the cultural awareness of nursing undergraduates who enrolled in a community nursing course. Design: This was an interventional pre‐test post‐test study. Method: One hundred and six nursing undergraduates who enrolled in the course participated in the study. The online IaH strategies were developed focusing on the interactions of teaching presence, cognitive presence and social presence of CoI framework and they were integrated into the course. A previously validated Cultural Awareness Scale was adopted for pre‐post evaluation. Higher scores indicate greater cultural awareness. Results: The results showed that there was a significantly higher total score of cultural awareness of participating students at post‐online IaH strategies. To be effective, aligning CoI‐guided online IaH strategies with course content, pedagogy and assessment was shown to be significant. The inclusion of technological elements in related strategies was also critical to engage student learning. The positive change on the total score of cultural awareness suggested the effectiveness of the deployed strategies. In this ever‐changing educational landscape, it may provide insights to educators regarding considering online IaH strategies with theoretical underpinning for curriculum planning and design. [ABSTRACT FROM AUTHOR]

Background: Cocreation has the potential to engage people with lived and living experiences in the design and evaluation of health and social services. However, guidance is needed to better include people from equity‐deserving groups (EDGs), who are more likely to face barriers to participation, experience ongoing or historical harm, and benefit from accessible methods of engagement. Objective: The aim of this international forum (CoPro2022) was to advance a collective vision for equity‐based cocreation. Design: A participatory process of engagement in experiential colearning and arts‐based creative and reflective dialogue. Visual prototypes were created and synthesised to generate a collective vision for inclusive equity‐based cocreation. Setting and Participants: The Forum was held at the Gathering Place by the Grand River in Ohsweken, Ontario, Canada. A total of 48 participants attended the forum. They were purposely invited and have intersecting positionalities (21 academic experts, six experience experts, 10 trainees, and 11 members of EDGs) from nine countries (Bangladesh, Botswana, Canada, England, Italy, Norway, Scotland, Singapore, Sweden). CoPro2022 Activities: CoPro2022 was an immersive experience hosted on Indigenous land that encouraged continuous participant reflection on their own worldviews and those of others as participants openly discussed the challenges and opportunities with engaging EDGs in cocreation activities. Visual prototypes and descriptions created in small groups were informed by participants' reflections on the panel presentations at the Forum and their own experiences with equity‐based cocreation. Following the event, the authorship team inductively coded themes from the prototype descriptions and met to discuss the cross‐cutting themes. These informed the design of an illustrated collective vision for Equity Based Co‐Creation (EqCC). Results: Six prototypes were cocreated by each small group to illustrate their vision for EqCC. Within these, four cross‐cutting themes were identified: (i) go to where people are, (ii) nurture relationships and creativity, (iii) reflect, replenish and grow, (iv) and promote thriving and transformation. These four themes are captured in the Collective EqCC Vision to guide a new era of inclusive excellence in cocreation activities. Patient or Public Contribution: Service users, caregivers, and people with lived experience were involved in leading the design of the CoPro2022 and co‐led the event. This included activities at the event such as presenting, facilitating small and large group discussion, leading art‐based activities, and reflecting with the team on the lessons learned. People with lived experience were involved in the analysis and knowledge sharing from this event. Several members of the research team (students and researchers) also identified as members of EDGs and were invited to draw from their personal and academic knowledge. [ABSTRACT FROM AUTHOR]

Aim: Human immunodeficiency virus (HIV) nursing has become more prominent with the increase in chronic HIV infections. This study examined articles related to HIV nursing to determine how the profession has developed and its future direction. Design: A bibliometric analysis was conducted. Methods: HIV nursing‐related articles published in the Web of Science core collection between 1999 and 2022 were searched. VOSviewer was used to identify the contributions of countries, institutions and authors in HIV‐related care. Collaborative maps, hot topics and keywords trends were analysed using VOSviewer and CiteSpace. Results: A total of 1513 publications were extracted. An increase in articles published between 1999 and 2012 was observed. After 2012, the increase in the number of publications was relatively stable. Since 2016, a downward trend in the number of publications has occurred. The USA, South Africa and the UK were the leading contributors to publications related to HIV nursing. The focus of the HIV nursing research has gradually shifted from "HIV infection", "risk factors", and "transmission routes" to "social support", "depression", and "public health". The result shows that increased collaboration among countries/regions can improve the development of HIV nursing and effectively reduce the global HIV infection rate. The mental health of patients has become a research centre in the field of HIV nursing. This study provides direction in clinical practice and future research areas in this field. [ABSTRACT FROM AUTHOR]

Introduction: There is a growing role for patients, family members and caregivers as consultants, collaborators and partners in health system settings in Canada. However, compensation for this role is not systematized. When offered, it varies in both type (e.g., one‐time honorarium, salary) and amount. Further, broad‐based views of patient partners on compensation are still unknown. We aimed to describe the types and frequency of compensation patient partners have been offered and their attitudes towards compensation. Methods: This study uses data from the Canadian Patient Partner Study (CPPS) survey. The survey gathered the experiences and perspectives of those who self‐identified as patient partners working across the Canadian health system. Three questions were about compensation, asking what types of compensation participants had been offered, if they had ever refused compensation, and whether they felt adequately compensated. The latter two questions included open‐text comments in addition to menu‐based and scaled response options. Basic frequencies were performed for all questions and open‐text comments were analyzed through inductive qualitative content analysis. Results: A total of 603 individuals participated in the CPPS survey. Most respondents were never or rarely offered salary (81%), honorarium (64%), gift cards (80%) or material gifts (93%) while half were offered conference registration and expenses at least sometimes. A total of 129 (26%) of 499 respondents reported refusing compensation. Of 511 respondents, half felt adequately compensated always or often, and half only sometimes, rarely or never. Open‐text comments revealed positive, ambivalent and negative attitudes towards compensation. Attitudes were framed by perceptions about their role, sentiments of giving back to the health system, feelings of acknowledgement, practical considerations, values of fairness and equity and accountability relationships. Conclusions: Our findings confirm that compensation is not standardized in Canada. Half of survey respondents routinely feel inadequately compensated. Patient partners have diverse views of what constitutes adequate compensation inclusive of personal considerations such as a preference for volunteering, and broader concerns such as promoting equity in patient partnership. Organizations should attempt to ensure that compensation practices are clear, transparent and attentive to patient partners' unique contexts. Patient Contribution: Two patient partners are members of the CPPS research team and have been fully engaged in all study phases from project conception to knowledge translation. They are co‐authors of this manuscript. The survey was co‐designed and pilot tested with patient partners and survey participants were patient partners. [ABSTRACT FROM AUTHOR]