Strategic Alliances in Global Health: Innovative Perspectives in the Era of Sustainable Development.

This article discusses current challenges in the field of global health and the World Health Organization's (WHO) strategies to address them. It highlights the importance of measuring the health impacts of global recession and globalization and the need for human-centered approaches to sustainable development. Emphasis is placed on commitment to health equity and the use of strategic partnerships for health at global, national, and local levels. Improving the health and well-being of populations, as well as public health equity, are core principles of the 2030 Agenda for the Sustainable Development Goals (SDGs). These principles are expressed in SDG 3, which promotes universal access to health services and systems and recognizes global health as a basic human right. It highlights the importance of strategic partnerships to combat emerging health crises, improve public health indices, and address the burden of chronic disease. These partnerships are contemplated in SDG 17 and are manifested in different modalities, such as network governance, cross-sector collaboration, public-private partnership, and social participation. This diversity of alliances has played an important role in scaling up and strengthening universal health systems around the world, including in Latin America and the Caribbean. The text concludes by presenting the essential characteristics of these inter-organizational and inter-institutional alliances in the field of global health.

How Gender-Sexuality Alliances cultivate a sense of school belonging from week to week for LGBTQ+ youth.

School belonging can facilitate positive youth development and educational outcomes. Given that LGBTQ+ youth face marginalization in schools, there is a need to identify school supports that could still promote their sense of school belonging. We considered Gender-Sexuality Alliances (GSAs) as LGBTQ+ affirming school clubs. Among 92 LGBTQ+ student members of GSAs in nine states who completed weekly diary surveys over an 8-week period (Mage = 15.83 years, SD = 1.29; 50% youth of color; 51% trans or non-binary), we considered whether a youth's GSA experiences from meeting to meeting predicted their relative levels of school belonging in days following these meetings. There was significant within-individual (37%) and between-individual (63%) variability in youth's sense of school belonging during this time. Youth reported relatively higher school belonging on days following GSA meetings where they perceived greater group support (p = .04) and took on more leadership (p = .01). Furthermore, youth who, on average, reported greater advisor responsiveness (p = .01) and leadership (p = .01) in GSA meetings over the 8-week period reported greater school belonging than others. Findings showcase the dynamic variability in LGBTQ+ youth's sense of school belonging from week to week and carry implications for how schools and GSAs can support LGBTQ+ youth and sustain their ties to school.

In pop pursuit: social bond strength predicts vocal synchrony during cooperative mate guarding in bottlenose dolphins.

Vocal communication is an emblematic feature of group-living animals, used to share information and strengthen social bonds. Vocalizations are also used to coordinate group-level behaviours in many taxa, but little is known of the factors that may influence vocal behaviour during cooperative acts. Allied male Indo-Pacific bottlenose dolphins (Tursiops aduncus) use the 'pop' vocalization as a coercive signal when working together to herd single oestrous females. Using long-term association and acoustic data, we examined the influence of social and non-social factors on pop use by allied male dolphins in this context. Neither pop rate nor pop bout duration were influenced by any of the factors examined. However, allied males with stronger social bonds engaged in higher rates of vocal synchrony; whereby they actively matched the timing of their pop production. Hence, social bond strength influenced pop use in a cooperative context, suggesting dual functions of pop use: to induce the female to remain close, and to promote social bond maintenance and cooperation among males. This article is part of the theme issue 'The power of sound: unravelling how acoustic communication shapes group dynamics'.

Comparison of the market share of public and private hospitals under different Medical Alliances: an interrupted time-series analysis in rural China.

BACKGROUND: China initiated the Medical Alliances (MAs) reform to enhance resource allocation efficiency and ensure equitable healthcare. In response to challenges posed by the predominance of public hospitals, the reform explores public-private partnerships within the MAs. Notably, private hospitals can now participate as either leading or member institutions. This study aims to evaluate the dynamic shifts in market share between public and private hospitals across diverse MAs models. METHODS: Data spanning April 2017 to March 2019 for Dangyang County's MA and January 2018 to December 2019 for Qianjiang County's MA were analyzed. Interrupted periods occurred in April 2018 and January 2019. Using independent sample t-tests, chi-square tests, and interrupted time series analysis (ITSA), we compared the proportion of hospital revenue, the proportion of visits for treatment, and the average hospitalization days of discharged patients between leading public hospitals and leading private hospitals, as well as between member public hospitals and member private hospitals before and after the reform. RESULTS: After the MAs reform, the revenue proportion decreased for leading public and private hospitals, while member hospitals saw an increase. However, ITSA revealed a notable rise trend in revenue proportion for leading private hospitals (p < 0.001), with a slope of 0.279% per month. Member public and private hospitals experienced decreasing revenue proportions, with outpatient visits proportions declining in member public hospitals by 0.089% per month (p < 0.05) and inpatient admissions proportions dropping in member private hospitals by 0.752% per month (p < 0.001). The average length of stay in member private hospitals increased by 0.321 days per month after the reform (p < 0.01). CONCLUSIONS: This study underscores the imperative to reinforce oversight and constraints on leading hospitals, especially private leading hospitals, to curb the trend of diverting patients from member hospitals. At the same time, for private hospitals that are at a disadvantage in competition and may lead to unreasonable prolongation of hospital stay, this kind of behavior can be avoided by strengthening supervision or granting leadership.

Sexual Minorities and Loneliness: Exploring Sexuality through Social Media and Gender-Sexuality Alliance (GSA) Supports.

We examined online and offline social supports for sexual minority adolescents, underscoring the understudied developmental period of early adolescence and the mental outcome of loneliness. Stemming from a larger study in the northeast U.S., 967 youth participants were 26% sexual minority, 53% female, 45% male, and 2% other/nonbinary (mean age = 13.1, SD = 1.52). LGBTQ+ youth reported significantly higher levels of loneliness compared to their heterosexual counterparts. To understand potential sources of social support while exploring their sexual identities, we compared the experiences of LGBTQ+ youth at both ends of the loneliness spectrum. Gaining knowledge about their sexual orientation from LGBTQ+ organization websites, participating in gender-sexuality alliances, and using TikTok or Instagram were associated with lower levels of loneliness. Providing social support to online friends was associated with lower loneliness; however, receiving online support was not associated with lower loneliness. Furthermore, proactive social media engagement such as posting uplifting content, joining online communities, or raising awareness about social issues were associated with lower levels of loneliness. The results provide guidance on specific youth behaviors and online communities beyond a focus on screen time while highlighting the continued need for social support to ameliorate loneliness, such as gender-sexuality alliance networks.

Making more of less: using divestitures to unlock pharmaceutical innovation.

Pharmaceutical managers have been encouraged to look to acquisitions and alliances for innovation. However, the literature warns that the capacity of a company to 'absorb' new knowledge is limited. Here, we introduce corporate divestitures as a tool for freeing up managerial attention. We build a sample of 349 companies, which announced 1784 divestitures and filed 63523 patents, over a 15-year period. We show that innovating companies that divest more produce more and improved patents, and those that divest to create corporate focus also produce more breakthroughs. In doing so, we introduce divestitures as an innovation tool, highlight the importance of the absorptive capacity of a company when discussing innovation, and add nuance to the discussion on external tools for innovation.

Gender Sexuality Alliances and School Safety: Who Benefits Most, and Do Additive School-Led Practices Strengthen the Link?

While Gender and Sexuality Alliances (GSAs) are associated with higher acceptance of sexual diversity and lower bullying-victimization, it is unclear which individual and school-level attributes strengthen these associations. Nationally representative data (N = 1,567 students; Mage = 15.4, SD = 0.16; 34% boys, 66% girls, 51% heterosexual, 49% sexually-diverse after propensity score matching) in 139 Dutch secondary schools were used. Multilevel regression analyses revealed that GSA presence was linked to more inclusive attitudes about sexual diversity and a safer disclosure climate among sexually-diverse students, and lower general bullying-victimization when the school had a GSA combined with school practices to tackle bullying. School professionals and researchers are recommended to recognize the significance of individual and school-level factors that affect GSA correlates.

Holding the Space: Individual- and Group-level Factors Predicting Member Retention in Gender-Sexuality Alliances.

Involvement in extracurricular groups is associated with positive outcomes for youth. Gender-Sexuality Alliances (GSAs) are school-based clubs that may provide benefits to sexual and gender minority (SGM) youth and their allies, yet little is known about what factors predict member retention. The current study explores individual- and group-level predictors of youth's sustained or discontinued membership in GSAs during a school year. Participants were 410 youth (Mage = 15.56; 83% sexual minority; 57% cisgender female; 70% White) and 50 advisors in 32 GSAs purposively sampled across Massachusetts who completed surveys at the beginning and end of the school year. Sexual minority youth and youth who took on more leadership roles at the beginning of the year were less likely to have left their GSA by the end of the school year. Youth who perceived higher levels of social support from their GSA trended less likely to leave their GSA as well, although the association was not significant. Youth who engaged in more advocacy were more likely to have left. Youth in GSAs with greater structure to their meetings were less likely to discontinue their membership; specifically, having a meeting agenda was uniquely predictive of member retention. Implications for GSA inclusivity and practices to promote retention within GSAs and similar social justice-oriented clubs are discussed.

Mobilising strategic alliances with community organisations to address work-related mental injury: a qualitative study guided by collaboration theory.

BACKGROUND: A critical policy issue in Australia and worldwide is the escalating rates of work-related mental injury that have been linked to the lack of help-seeking behaviours of at-risk workers. Strategic alliances between community organisations, statutory bodies, and mental health service providers could expand the efficacy and reach of mental health literacy and peer support initiatives that can encourage help-seeking, however, there is limited evidence to support the development of such approaches. This study used a qualitative design based on collaboration theory to explore the factors influencing community organisation leaders' decisions to provide such initiatives through collaboration with relevant third parties. METHODS: Repositories of submissions into mental health reviews and publicly available registers in Australia were used to identify twenty-two participant organisations (n = 22), which were categorised according to the International Classification of Non-Profit Organisations (Culture & Recreation, Social Services, and Development & Housing). Eleven of these organisations demonstrated an interest in collaborating with third parties and extending efforts to deliver work-related mental health initiatives through contributions to mental health reviews. Leaders were interviewed to understand differences in perspectives on potential collaborations. RESULTS: Organisations that did not make submissions were reluctant to engage in such efforts due to limitations in expertise/capacity, and perceived mission misalignment. Third-party support from statutory bodies and mental health service providers addressing these perceived limitations may improve their confidence, and willingness to engage. Regardless of their category, all considered the benefit of such collaboration included improving the acceptability, approachability, availability, and efficacy of work-related mental health initiatives. Equity was seen as supporting decision-making/leadership, while power imbalance was a barrier. Third-party contributions that could facilitate collaboration included expert support/credibility, administration, formal structures, supportive policy, and joining networks, however, red tape was a challenge. Shared values, vision, practice, and networking were identified as supporting positive communication and interpersonal relations. CONCLUSION: The study establishes that, adequately supported and resourced, community organisations are willing to align strategically with statutory bodies and mental health service providers to use their unique position in the community to deliver work-related mental health literacy and peer support programmes for at-risk workers to improve help-seeking behaviours.

As Relações Intersubjetivas e os espaços de Simbolização destinados às Equipes Profissionais que Implementam Políticas Públicas / Intersubjective Relations and Spaces of Symbolization Intended for Professional Teams that Implement Public Policies / Relaciones Intersujetivas y Espacios de Simbolización Destinados a Equipos Profesionales que Implementan Políticas Públicas

Considerando que um grupo é um agenciamento de vínculos intersubjetivos, que permite a expressão de relações entre vários sujeitos, o objetivo deste artigo é discutir a importância dos espaços de simbolização direcionados às equipes profissionais, no que se refere ao impacto destas ações na implementação de políticas públicas. Para esta discussão utilizar-se-á de uma experiência de campo profissional objeto de discussão no processo de doutorado. Participou do campo um grupo de educadores de oficinas culturais e artísticas (oficineiros de cultura) em uma intervenção de Grupo Operativo. Essa equipe profissional (participantes do campo) era composta por doze servidores públicos da Secretaria Municipal de Cultura (SMC) de uma cidade no interior de São Paulo. A duração da intervenção de Grupo Operativo foi de um ano. O trabalho permitiu compreender a importância de espaços que permitam trabalhar/simbolizar as experiências das equipes, no trabalho realizado durante a implementação das políticas: as experiências podem ser elaboradas e reconstruídas, a partir do que é depositado sobre a equipe, seja pela instituição na qual trabalham ou pelos usuários.

Whereas a group is an agency of intersubjective links, which allows the expression of relationships between several subjects, the aim of this article is to discuss the importance of symbolization spaces directed at professional teams, regarding the impact of these actions on the implementation of public policies. For this discussion, field experience will be used the professional subject of discussion in the doctoral process. A group of educators of cultural and artistic workshops (culture "coordinators" named in Brazil "culture oficineiros") in an Operative Group intervention. This professional team (field participants) was composed of twelve public servers of the Municipal Secretariat of Culture (SMC) of a city in the interior of São Paulo. The duration of the Operative Group intervention was one year. The work made it possible to understand the importance of spaces that allow working/symbolizing the experiences of the teams, in the work implementation of policies: experiences can be developed and developed by the reconstructed, from what is deposited on the team, either by the institution in which they work or by users.

Considerando que un grupo es una agencia de vínculos intersubjetivos, que permite la expresión de relaciones entre varios temas, el objetivo de este artículo es discutir la importancia de simbolización dirigida a los equipos profesionales, sobre el impacto de estas acciones en la implementación de políticas públicas. Para esta discusión, se utilizará una experiencia de campo, tema profesional de discusión en el proceso de doctorado. Un grupo de educadores de talleres culturales y artísticos (coordinadores de cultura llamados "oficineiros de cultura" en Brasil) en una intervención de Grupo Operativo. Este equipo profesional (participantes de campo) estaba compuesto por doce servidores autoridades de la Secretaría Municipal de Cultura (SMC) de una ciudad del interior de São Paulo. La duración de la intervención del Grupo Operativo fue de un año. El trabajo permitió comprender la importancia de los espacios que permiten trabajar/simbolizar las experiencias de los equipos, en el trabajo de implementación de políticas: las experiencias pueden ser elaborados y reconstruidos, a partir de lo depositado en el equipo, ya sea por la institución en la que trabajan o por los usuarios.

How membership in the North Atlantic Treaty Organization transforms public support for war.

How do military alliances affect public support for defending targets of aggression? We studied this question by fielding an experiment on 14,000 voters in 13 member countries of the North Atlantic Treaty Organization (NATO). Our experiment involved a hypothetical scenario in which Russia attacked a target country. We randomly varied the identity of the target (Bosnia, Finland, Georgia, or Sweden), and whether the target was a member of NATO at the time of the attack. We found that voters in every member country were far more willing to use military force to defend each target when the target was in NATO, than when the target was outside the alliance. The expansion of NATO could, therefore, transform European security by altering the likelihood and scale of future wars. We also uncovered important heterogeneity across targets: the benefits of joining NATO were considerably larger for Bosnia and Georgia than for Finland and Sweden, since most voters in NATO countries would defend Finland and Sweden even if they remained outside the alliance. Finally, the effect of NATO was much stronger among voters who perceived NATO as valuable for their own country. Rhetorical attacks on NATO could, therefore, undermine the alliance by eroding the public's willingness to defend other members, whereas rhetoric highlighting the benefits of NATO could bolster defense and deterrence. These findings advance knowledge about the effects of alliances, while also informing policy debates about the value and size of NATO.

Inter-group alliance dynamics in Indo-Pacific bottlenose dolphins (Tursiops aduncus).

The social intelligence hypothesis holds that complex social relationships are the major selective force underlying the evolution of large brain size and intelligence. Complex social relationships are exemplified by coalitions and alliances that are mediated by affiliative behavior, resulting in differentiated but shifting relationships. Male Indo-Pacific bottlenose dolphins in Shark Bay, Australia, form three alliance levels or 'orders', primarily among non-relatives. Strategic alliance formation has been documented within both first- and second-order alliances and between second-order alliances ('third-order alliances'), revealing that the formation of strategic inter-group alliances is not limited to humans. Here we conducted a fine-scale study on 22 adult males over a 6-year period to determine if third-order alliance relationships are differentiated, and mediated by affiliative interactions. We found third-order alliance relationships were strongly differentiated, with key individuals playing a disproportionate role in maintaining alliances. Nonetheless, affiliative interactions occurred broadly between third-order allies, indicating males maintain bonds with third-order allies of varying strength. We also documented a shift in relationships and formation of a new third-order alliance. These findings further our understanding of dolphin alliance dynamics and provide evidence that strategic alliance formation is found in all three alliance levels, a phenomenon with no peer among non-human animals.

Soil properties and plant species can predict population size and potential introduction sites of the endangered orchid Cypripedium calceolus.

Background and Aims: To counteract the ongoing worldwide biodiversity loss, conservation actions are required to re-establish populations of threatened species. Two key factors predominantly involved in finding the most suitable habitats for endangered plant species are the surrounding plant community composition and the physicochemical parameters of the soil rooting zone. However, such factors are likely to be context- and species-dependent, so it remains unclear to what extent they influence the performance of target species. Methods: We studied large and small Swiss populations of the endangered orchid Cypripedium calceolus. We measured functional traits related to C. calceolus plant and population performance (clonal patch area, plant height, number, of leaf, stems, flowers and fruits), realized vegetation surveys, soil profile analyses, and tested for relationships between plant traits and the surrounding vegetation structure or soil physicochemical parameters. Results: Large populations contained bigger patches with more stems and leaves, and produced more flower per individual than small populations. Neither vegetation alliances nor soil classes per se could predict C. calceolus functional traits and population size. However, functional traits explaining population performance and size were related to specific soil parameters (soil organic matter content, pH and phosphorus), in addition to a combination of presence-absence of plant indicator species, relating to ecotones between forests and clearings. Conclusion: We show that even for species that can grow across a wide range of vegetation groups both indicator species and specific soil parameters can be used to assess the most favourable sites to implement (re)-introduction actions. Supplementary Information: The online version contains supplementary material available at 10.1007/s11104-023-05945-4.

Gender-Sexuality Alliance Advisors' Self-Efficacy to Address Transgender Issues: An Interpersonal Protective Factor for Transgender Student Depression.

Purpose: Our purpose was to assess the association between Gender-Sexuality Alliances (GSAs) advisors' self-efficacy to address transgender issues and their students' depressive symptoms, by students' gender identity (i.e., transgender vs. cisgender). We predict that higher advisor self-efficacy will be associated with decreases in student depressive symptoms for transgender students, though not necessarily for cisgender students. Methods: Data come from surveys of student members (n = 366) and advisors (n = 58) of 38 purposively sampled GSAs in Massachusetts high schools, in 2016-2017 and 2017-2018. We used a linear mixed-effects model to assess the association between advisor self-efficacy to address transgender issues and student change in Center for Epidemiological Studies Depression-10 scores between the beginning and end of the school year by gender identity, adjusting for student covariates. Results: Students were 10-20 years old (mean = 15, standard deviation [SD] = 1.4); 28% were transgender, 28% were students of color, and 86% were lesbian, gay, bisexual, or queer/questioning or other non-heterosexual identity. The GSA advisor self-efficacy scores ranged from 13 to 25 with a mean of 20.4 (SD = 3.0). Greater advisor self-efficacy to address transgender issues was associated with a decrease in depressive symptoms for transgender students (estimate = -0.47, p = 0.01), but not for cisgender students. Conclusions: GSA advisor self-efficacy to address transgender issues could be protective for transgender student depressive symptoms. Thus, increasing advisor self-efficacy to address transgender issues may help decrease depressive symptomatology for transgender youth, and intervention work in this area is needed to bolster this claim.

The Virtuousness of Ethical Networks: How to Foster Virtuous Practices in Nonprofit Organizations.

Ethical networks are an emerging form of social alliance based on collaboration between organizations that share a common ethical commitment. Grounded in a theoretical framework of virtue-based business ethics and focusing on nonprofit alliances, this study investigates the virtuousness of ethical networks; that is, how they trigger virtuous practices in their member nonprofit organizations. Adopting a qualitative grounded theory approach, the study focuses on one of the largest Italian ethical networks of nonprofit organizations operating in the social care sector. The findings show that shared ethical values and religious beliefs are positively associated with ethical network building. Based on these findings, a circular model of virtuousness is proposed in which ethical networks foster virtuous practices among their members at four levels: (1) the strategic orientation level, (2) the institutional level, (3) the organizational level, and (4) the relational level. At each of these levels, ethical networks foster a habituation to virtues and the propagation of virtuous behaviors among their members. Theoretical, practical, and social implications of the research findings are discussed.

Don't Be Too Political: Depoliticization, Sexual Orientation, and Undergraduate STEM Major Persistence.

Lesbian, gay, bisexual, and queer (LGBQ) students persist in STEM majors at a lower rate than their heterosexual peers. This study posits that heteronormativity, as an instance of depoliticization in STEM affecting LGBQ students, could be a primary contributing factor. Using national, longitudinal data from the Higher Education Research Institute (HERI) at UCLA, this study tested LGBQ-related college experiences to determine if they help explain the retention gap between LGBQ STEM students and their heterosexual peers. Through multilevel regression modeling, we found that LGBQ status is not a significant predictor of retention in STEM after controlling for LGBQ-related experiences. The results suggest that LGBQ-related and other politicized experiences predict lower retention in STEM for heterosexual students, meaning a culture of depoliticization in STEM may be detrimental to more students than those in minoritized social identity groups.

Cooperation and coopetition among retailers-third party logistics providers alliances under different risk behaviors, uncertainty demand and environmental considerations.

Optimal profits for third-party logistics providers (3PLs) can be analyzed using the networks model to determine decision-making processes within transshipment and logistics, distribution networks, etc. Increasing academic attention is currently being focused upon fields examining 3PLs' operations within logistics networks. This paper studies cooperative game theory (CGT) of retailers-3PLs that make an alliance with each other with a specified demand function. The logistics network involves several suppliers and retailers-3PLs alliances, a distribution graph consisting of several nodes and arcs as well as multiple customers. Retailers-3PLs purchase the same goods from suppliers and sell to customers after shipping via the network; they also consider environmental issues to reduce pollutants and emissions fines. The proposed nonlinear programming (NLP) model aims to find the best flow and price of goods under cooperation conditions among retailers-3PLs by analyzing their risk levels. Controlling uncertainty in the models is accomplished by Mulvey's robust approach. In a general coalition, fair profit distribution methods are applied to share the profits among retailers-3PLs under different risk situations. We conduct a numerical analysis to present the application of our proposed model and find whether coalitions and cooperation between retailers-3PLs reduce costs and increase profits. Finally, we report the sensitivity analysis results regarding the penalties imposed for pollutant emissions, along with suggestions for future research. The results reveal that since their profit is greater in the coalition mode, they tend to cooperate with each other, whatever the amount of pollution fines be.

Putting Research on LGBTQ+ Youth in Schools to Use: The Stories and Numbers Project.

Publicly engaged social science can help to maximize research use for program and policy change toward equity. In what follows, we describe The Stories and Numbers Project as an example of publicly engaged research that moves the robust science of supporting LGBTQ+ (and all) students beyond the university and into the public sphere. We provide an overview of LGBTQ+ young people's experiences of their school climate and the science of LGBTQ+-supportive safe school strategies to contextualize the need for the Project. We discuss the theoretical foundations of the Project, as well as the experiences and resources that made the Project possible. We outline our multi-pronged strategy for research dissemination to LGBTQ+ students and key nodes of their social networks. Finally, we conclude with the lessons learned from the Stories and Numbers Project, and how they can be leveraged to activate research for social change.

Effects of hierarchical management based on medical alliances on patency of arteriovenous graft in hemodialysis patients / 中华肾脏病杂志

Objective:To investigate the impacts of hierarchical management based on medical alliance on the patency of arteriovenous graft (AVG),and provide a basis for further exploration of optimal AVG management.Methods:In this retrospective cohort study, clinical and follow-up data of patients with AVG established in the First Affiliated Hospital of Zhengzhou University from January 1, 2018 to December 31, 2021 were analyzed. Patients were divided into medical alliance group and non-medical alliance group according to whether they were under hierarchical management model, and the patency rate of AVGs and the incidence of clinical events were compared between the two groups.Results:A total of 328 AVGs were included in this study, which were from 151 hemodialysis centers, including 189 AVGs (57.6%) from 72 centers in medical alliance group, and 139 AVGs (42.4%) from 79 centers in non-medical alliance group. The age of the patients was (55.57±11.80) years, among whom 130 (39.6%) were males and 126 (38.4%) were diabetic. The follow-up time of AVGs in this cohort was 15.5 (9.5, 26.2) months, with 15.4 (9.8, 25.2) months in medical alliance group and 15.5 (9.2, 27.3) months in non-medical alliance group. The incidence of thrombosis or occlusion (0.328 times/patient-year), graft dissection (0.007 times/patient-year), graft infection (0.030 times/patient-year), and catheter utilization (0.043 times/patient-year) in the medical alliance group were lower than those in the non-medical alliance group (0.589 times/patient-year, 0.040 times/patient-year, 0.054 times/patient-year and 0.147 times/patient-year, respectively), and there was no significant difference in clinic follow-up rates between the two group (1.91 times/patient-year vs. 1.94 times/patient-year). The median primary patency time was 17.4 (95% CI 11.3-23.5) months, the median primary assisted patency time was 32.6 (95% CI 25.0-40.2) months, and the median secondary patency time was 47.9 (95% CI 40.0-55.8) months in the medical alliance group, compared with 12.3 (95% CI 9.4-15.2) months, 19.4 (95% CI 14.3-24.5) months, and 34.6 (95% CI 29.3-39.9) months in the non-medical alliance group, respectively. Primary patency were significantly higher in the medical alliance group (77.4%, 62.2%, 39.9%, and 26.6%) than those in the non-medical alliance group (71.1%, 50.1%, 30.6%, and 13.4%) at 6, 12, 24, and 36 months (Log-rank test, χ2=4.504, P=0.034). Primary assisted patency were significantly higher in the medical alliance group (90.9%, 84.3%, 67.1%, and 46.1%) than those in the non-medical alliance group (89.2%, 75.7%, 42.0%, and 16.6%) at 6, 12, 24, and 36 months (Log-rank test, χ2=10.655, P=0.001). Secondary patency were significantly higher in the medical alliance group (96.8%, 91.8%, 84.2%, and 74.0%) than those in the non-medical alliance group (89.9%, 85.8%, 69.3%, and 47.5%) at 6, 12, 24, and 36 months (Log-rank test, χ2=11.634, P=0.001). Multivariate Cox regression analysis showed that it was a protective factor for primary patency ( HR=0.708, 95% CI 0.512-0.980, P=0.037), primary assisted patency ( HR=0.506, 95% CI 0.342-0.749, P=0.001) and secondary patency ( HR=0.432, 95% CI 0.261-0.716, P=0.001) under the medical alliance model. Conclusion:The hierarchical management based on medical alliances can improve the patency of AVGs and reduce the incidence of clinical events.

The European university alliances-an examination of organizational potentials and perils.

The European Union (EU) has repeatedly underlined the importance of higher education, research and innovation as drivers in the further development of Europe-economically, socially and culturally. One of the latest policy initiatives by the European Commission (EC) intended to promote this agenda is the European Universities Initiative (EUI) where alliances between universities across national borders are to identify new approaches for boosting European scientific cooperation. It might be argued that this development represents an attempt to find an organizational solution to the European policy ambitions in higher education, research and innovation. This article presents a framework for analysing European university alliances. Based on interviews with persons occupying key leadership and management roles in ten alliances, the article analyses the potential gains and perils alliances might face along four dimensions: their internal coordination, their ways of resolving conflicts, the commitment of member universities and the cultural characteristics of the alliances.