Legal waivers embedded in corporate settlement agreements are commonly framed as neutral devices of dispute resolution. They promise finality, prevent double recovery and manage litigation risk. Yet in practice, waivers function as structural tools of accountability avoidance. This article examines the use of legal waivers within operational-level grievance mechanisms, focusing on three dimensions: the UNGPs’ procedural formalism, the cost dynamics of corporate settlements, and the opacity created by confidentiality provisions. It argues that the UNGPs’ emphasis on process legitimacy neglects the substantive consequences of waivers, that cost volatility incentivises their routine use, and that confidentiality provisions entrench information asymmetry while obstructing judicial oversight. The article concludes by advancing a hybrid regulatory model which prohibits blanket confidentiality of terms governing settlement agreements and advocates for greater transparency through a differentiated disclosure regime and increased judicial scrutiny by domestic courts.

Stretching for 1.5km and consisting of approximately 5200 precisely aligned holes, Monte Sierpe in southern Peru is a remarkable construction that likely dates to at least the Late Intermediate Period (AD 1000–1400) and saw continued use by the Inca (AD 1400–1532). Yet its function remains uncertain. Here, the authors report on new analyses of drone imagery and sediment samples that reveal numerical patterns in layout, potential parallels with Inca knotted-string records and the presence of crops and wild plants. All this, the authors argue, suggests that Monte Sierpe functioned as a local, Indigenous system of accounting and exchange.

The growing demand for psychiatric services, coupled with the increasing complexity of clinical presentations, is compounded by systemic pressures – among them inadequate resources, fragmented service configurations, and regulatory and legal frameworks that seem to apportion blame to the individual rather than recognising the wider systemic context. These factors can leave clinicians feeling disempowered and demoralised. This editorial is a call to renew hope, to reaffirm that psychiatrists, using their everyday medical and psychiatric expertise in personalising the biopsychosocial care they provide to their patients, can make a critical difference when dealing with suicidal states. Effective relational psychiatry offers hope to both clinicians and patients. We must not lose it.

International students frequently report suicidal thoughts and behaviours, but often do not seek help. We evaluated the feasibility, acceptability, and preliminary effectiveness of an adapted version of safeTALK suicide prevention training for international students. Eight workshops were delivered in Melbourne, Australia (N = 128; 62.5% female, M age = 23.4). In this single-arm study, surveys were completed pre-, post-, and three months post-training, and 17 participants completed follow-up interviews. The training was rated as acceptable, helpful, and safe. Linear mixed models indicated increased confidence to intervene and stronger intentions to refer individuals to formal help sources, with improvements sustained at follow-up. Suicide stigma showed a small post-training reduction that was not sustained. Suicide literacy only improved three months post-training. Attrition limited inferences about long-term effects. Qualitative feedback supported the training’s value but highlighted the need for further cultural adaptation. Findings support adapted gatekeeper training as a promising strategy for suicide prevention among international students.

Using data from the 2018–2019 National Congregations Study, I explore the relationship between women’s descriptive and substantive representation in American religious congregations. In particular, I examine the relationship between the presence of clergywomen or gender inclusive leadership policies (i.e., congregational policies allowing women to serve as the head pastor or priest) and a congregation’s participation in “women’s issues” political activism. Statistical analysis reveals partial support for my hypotheses. Collective gender representation, as demonstrated through the presence of gender inclusive leadership policies within a congregation, predicts pro-LGBT activism and the number of “women’s issues” a congregation pursues. This project serves to extend understanding of 1) how descriptive gender representation relates to the substantive representation of women’s interests in religious congregations and 2) the comparability of women’s leadership across political and religious contexts.

Patient and public involvement (PPI) increasingly features in the shaping, design, and conduct of mental health research. This review identifies and synthesizes evidence of barriers and facilitators of PPI in mental health research within university settings. The search strategy followed PRISMA guidance and involved keyword searches in eight peer reviewed databases, grey literature, hand searching two journals, requests to national mental health organizations, and backwards and forwards citation searching. We included primary mental health studies on patient and public involvement, with data on facilitators and barriers. Data were extracted capturing author, date and country of publication, study aim, participant and research team composition, data collection and analysis methods, and levels of PPI. Quality appraisal was conducted using the CASP Checklist for Qualitative Research, with an additional item on intersectionality. We conducted an inductive thematic analysis, before holding a peer-debriefing session with a lived experience working group. The final dataset included 51 articles that were either of a qualitative design or contained analyzed qualitative data. Barriers and facilitators were grouped around the following themes: the structure of the research environment, organizational culture, and individual needs. Good practice exists, but the wider research environment and power imbalances within universities constrain PPI. For PPI in mental health research to reach its full potential, the redistribution of power, building capacity for all, the provision of safe working environments, and widening inclusion in the research process are necessary. This review involved researchers with lived experience of mental ill health.

Background: Ventilator-associated pneumonia (VAP) primarily occurs due to the aspiration of secretions containing microorganisms from the oropharynx or stomach into the lungs. Preventing aspiration is a critical strategy for reducing VAP incidence. This study analyzed the impact of aspiration prevention measures—head-of-bed elevation (HOBE) and enhanced oral care—on VAP rates in adult intensive care units (ICUs). Method: This interventional study was conducted in the adult ICU of a 2,734-bed tertiary care hospital. A total of 8 ICUs (medical, surgical, cardiology, cardiovascular, neurology and neurosurgery) with 112 beds observed an increase in VAP incidence from January to April 2023, prompting enhanced measures in May 2023. The first intervention involved revising and reinforcing indications for head-of-bed elevation (HOBE) while strengthening monitoring and on-site feedback. During clinical procedures such as positional changes requiring a supine position, oropharyngeal suctioning was performed before lowering the head of the bed, and staff were trained to ensure prompt restoration of the HOBE to the appropriate position afterward. The second intervention improved oral care by replacing chlorhexidine and gauze with tooth brushing. A protocol was developed requiring 2 minutes of brushing teeth, artificial airways, tongue, and palate using a silicone toothbrush moistened with saline or sterile water, excluding patients with contraindications such as bleeding risks. Monitoring revealed missed areas during brushing, necessitating additional simulation training using dental models and colored toothpaste to confirm plaque removal. The pre-intervention period was conducted over 9 months (August 2022 to April 2023), while the intervention period lasted 17 months (July 2023 to November 2024). VAP incidence rates were compared before and after the intervention. Additionally, the incidence of VAP associated with pathogens such as Klebsiella pneumoniae, Acinetobacter baumannii, or Pseudomonas aeruginosa, often isolated from dental plaques of ICU patients, were analyzed. Results: The incidence rate of VAP per 1,000 ventilator days among adult ICU patients decreased from 3.9 (66/16,849) before the intervention to 2.4 (78/32,185) after the intervention (IRR, 0.62, 95% CI, 0.45-0.86; P = 0.007). Similarly, the incidence rate of VAP associated with pathogens K. pneumoniae, A. baumannii, or P. aeruginosa were 1.6 (27/16,849) before the intervention, and 1.0 (31/32,185) after the intervention (IRR, 0.60, 95% CI, 0.36-1.01; P = 0.07). Conclusion: As a result of implementing enhanced head-of-bed elevation and oral care protocols for ventilated patients in the adult ICU, the incidence of VAP significantly decreased. Further multicenter studies are needed to validate our findings.

Background: The Republic of Korea ranks second among OECD countries for tuberculosis (TB) incidence. National TB control guidelines mandate latent TB infection (LTBI) screening and treatment for healthcare workers (HCWs), especially those in high-risk departments. At our 2,700-bed tertiary hospital in Seoul, annual LTBI screening and treatment have been actively implemented since 2017, targeting HCWs at elevated risk of TB exposure. This study evaluates LTBI conversion rates among high-risk HCWs and characteristics of HCWs with conversion (converters) over the past five years. Methods: Following national guidelines, HCWs were classified into three high-risk groups: those likely to have routine contact with pulmonary TB patients (Group A), those caring for immunocompromised patients (Group B), and those at risk of respiratory infections despite no routine TB contact (Group C). Annual screening included interferon-gamma release assay (IGRA) and chest radiography. HCWs with positive IGRA results (≥0.35 IU/m) were strongly encouraged to undergo latent tuberculosis treatment. We analyzed data from HCWs working in high-risk tuberculosis units who had worked for more than five years from 2020 to 2024. HCWs with prior IGRA positivity were excluded. Results: Among, 1467 HCWs, 15.9% (233/1,467) had been diagnosed with LTBI before 2020, while the cumulative LTBI conversion rate between 2020 and 2024 was 5.3% (65/1,234). The annual LTBI conversion rates ranged between 0.7% and 1.5%. The median age of converters was 42 years, significantly older than non-converters (median 38 years; P = 0.02). Male converters comprised 24.6% (16/65) compared to 14.6% (171/1,169) in the non-converter group (P = 0.03). Longer tenure was observed among converters (median 16 years) than non-converters (median 12 years; P = 0.01). Although medical technicians and emergency room staff exhibited higher conversion rates, these differences were not statistically significant. Among LTBI cases, 78.8% completed treatment, with 9.1% demonstrating reversion. The annual incidence of active tuberculosis among HCWs at our hospital significantly declined to an average of 0.2 cases per year between 2020 and 2024, compared to 4.4 cases per year between 2015 and 2019 Conclusions: Annual LTBI screenings revealed conversion rates of approximately 1%, primarily affecting older, long-tenured, and male HCWs. Active LTBI treatment effectively reduced the risk of active TB among hospital staff.

Background: Universal decolonization using chlorhexidine gluconate (CHG) foaming soap in a hospital system has been shown to reduce healthcare-associated infections (HAIs) and colonization by multidrug-resistant organisms. Limited data exist on optimal strategies to improve compliance, and the impact of improved compliance on HAI rates. This study evaluates the effect of increasing CHG compliance on MRSA HAI rates. Methods: In 2022, our acute care VA hospital started universal CHG bathing treatment, by requiring a daily CHG bath for all patients in intensive care units and medical/surgical floors, unless contraindicated. Despite this, compliance was below goal. We performed root cause analyses to identify factors contributing to poor compliance, and then initiated a bundled intervention, including nursing staff education on the benefits of CHG bathing to reduce HAIs, how to reframe discussions with patients about refusals, removal of one alternative soap product from the inventory, and moving the CHG bathing product in clean supply rooms to be in proximity with other patient hygiene products for easier access. We evaluated the utilization of CHG bathing products through inventory data on utilization of 4 fluid ounce bottles of 4.0% weight/volume CHG solution, documentation of at least one CHG bath in the electronic medical record (EMR) per unique hospitalization, and HAI rates per National Healthcare Safety Network (NHSN) definitions for methicillin resistant Staphylococcus aureus (MRSA), before (08/2023-02/2024) and after (03/2024-12/2024) implementation of the bundle. Results: Identified barriers to CHG adherence included use of less effective alternative soap agents, perceptions of patient skin irritation from CHG, difficulty integrating CHG into existing workflows, and lack of understanding of the benefits of CHG bathing. After bundled interventions, inventory usage CHG bottles increased from 170 to 270 bottles per 1,000 bed days of care (BDOC) (p Conclusion: An intervention of staff education, removal of an alternative soap product, and improving access to CHG bathing products in supply rooms, resulted in improved CHG bathing adherence, and was associated with a reduction in MRSA HAIs in an acute care VA hospital. Interestingly, the decrease in MRSA HAIs was achieved despite an absence of complete adherence. Further data on additional strategies to improve compliance and strategies to improve healthcare worker documentation should be explored.

Antimicrobial resistance is an urgent public health threat, and despite significant consumption of antimicrobials in pregnancy, there remain opportunities for improvement of their use in the obstetric population. Improvement in antimicrobial utilization can be streamlined by assessing baseline characteristics, utilization of diagnostic testing, awareness of peripartum protocols, and recognition of penicillin allergies. In a single healthcare system including 8 obstetric hospitals, an administrative review identified 199 different regimens used among 8,528 patients based on American College of Obstetrician and Gynecologists (ACOG) guidelines. Other notable factors include 65.6% of patients having no cultures obtained despite being started on empiric antibiotics, duplicative coverage when multiple clinical scenarios overlap, and a high incidence of reported penicillin allergies with obstetric providers lacking comfort to reconcile and de-label allergies. By reviewing these individual aspects, this can highlight opportunities for improvement of antimicrobial use and stewardship in obstetric populations.