Despite the prominence of exogenous factors in theories of policy change, the precise mechanisms that link such factors to policy change remain elusive: The effects of exogenous factors on the politics underlying policy change are not sufficiently conceptualized and empirically analyzed. To address this gap, we propose to distinguish between truly exogenous factors and policy outcomes to better understand policy change. Specifically, we combine the Advocacy Coalition Framework with policy feedback theory to conceptualize a complete feedback loop among policy, policy outcomes, and subsequent politics. Aiming at theory‐building, we use policy feedback mechanisms to explain why advocacy coalitions change over time. Empirically, we conduct a longitudinal single case study on policy‐induced technological change in the German energy subsystem, an extreme case of policy outcomes, from 1983 to 2013. First, using discourse network analysis, we identify four patterns of actor movements, explaining coalition decline and growth. Second, using process tracing, we detect four policy feedback mechanisms explaining these four actor movements. With this inductive mixed‐methods approach, we build a conceptual framework in which policy outcomes affect subsequent politics through feedback mechanisms. We develop propositions on how coalition change and feedback mechanisms explain four ideal‐typical trajectories of policy change.
The successful implementation of the Paris Agreement requires substantial energy policy change on the national level. In national energy policy-making, climate change mitigation goals have to be balanced with arguments on other national energy policy goals, namely limiting cost and increasing energy security. Thus far, very little is known about the relative importance of these goals and how they are related to political partisanship. In order to address this gap, we focus on parliamentary discourse around low-carbon energy futures in Germany over the past three decades and analyze the relative importance of, and partisanship around, energy policy goals. We find that the political discourse revolves around four, rather than three, goals as conventionally assumed; improving the competitiveness of the national energy technology industry is not only an additional energy policy goal, it is also highly important in the political discourse. In general, the relative importance of these goals is rather stable over time and partisanship around them is limited. Yet, a sub-analysis of the discourse on renewable energy technologies reveals a high level of partisanship, albeit decreasing over time. Particularly, the energy industry goal's importance increases while its partisanship vanishes. We discuss how these findings can inform future energy policy research and provide a potential inroad for more ambitious national energy policies.
Background Novel mRNA-based vaccines play an important role in current vaccination campaigns against SARS-CoV-2. They are highly efficacious and generally well tolerated. Vaccination in patients with immune-mediated kidney diseases is recommended. A number of cases with de novo or relapsing glomerulonephritis shortly after vaccine application were reported, some of which presented with gross hematuria. Methods We collected 10 cases of macrohematuria following mRNA-based SARS-CoV-2 vaccination at our tertiary care institution and referring centers. Additionally we pooled all 25 published cases from the literature with ours to analyse their clinical characteristics. Results Most macrohematuria episodes (72.2%) began within 2 days after vaccination, the majority after the second dose. In some individuals, repeated episodes occured after subsequent doses of the same vaccine. 65.7% of patients never had macrohematuria before. 45.7% were known to suffer from IgAN, the rest had no prior renal diagnosis. IgAN was the most frequent new diagnosis but ANCA-associated vasculitis and anti-GBM disease were also identified. AKI occurred in 28.6% of patients, a rise in serum creatinine not meeting KDIGO AKI criteria in 28.6%. Treatment ranged from conservative management, RAAS-inhibitors, steroids and cyclophosphamide to plasmapheresis. While renal outcomes were mainly favourable in isolated IgAN, they were poor in patients with additional or isolated small vessel vasculitis. Conclusion Awareness of gross hematuria after SARS-CoV-2 vaccination is important. Close follow-up and additional work-up in particular in individuals without known underlying kidney disease or worsening renal function is essential. For patients with vaccine associated macrohematuria an alternative vaccine class might be considered for subsequent vaccinations.
Misfolding of the cellular prion protein (PrPC) into the scrapie prion protein (PrPSc) results in progressive, fatal, transmissible neurodegenerative conditions termed prion diseases. Experimental and epidemiological evidence point toward a protracted, clinically silent phase in prion diseases, yet there is no diagnostic test capable of identifying asymptomatic individuals incubating prions. In an effort to identify early biomarkers of prion diseases, we have compared global transcriptional profiles in brains from pre-symptomatic prion-infected mice and controls. We identified Cst7, which encodes cystatin F, as the most strongly upregulated transcript in this model. Early and robust upregulation of Cst7 mRNA levels and of its cognate protein was validated in additional mouse models of prion disease. Surprisingly, we found no significant increase in cystatin F levels in both cerebrospinal fluid or brain parenchyma of patients with Creutzfeldt-Jakob disease compared to Alzheimer’s disease or non-demented controls. Our results validate cystatin F as a useful biomarker of early pathogenesis in experimental models of prion disease, and point to unexpected species-specific differences in the transcriptional responses to prion infections.
When addressing complex societal problems, public regulation is increasingly complemented by private regulation. Extant literature has provided valuable insights into the effectiveness of such complex governance structures, with most empirical studies focusing on how public regulation influences private regulation. Conversely, the impact of private on public regulation is less well studied. Here, we investigate this impact with a focus on technological change as possible mechanism. Based on a case study of energy efficiency in buildings in Switzerland, we find evidence of a symbiotic interaction between public and private regulation that leads to ratcheting-up of regulatory stringency. We identify technological change as the mechanism linking private and public regulation. We discuss the relevance of our findings for governance literature and regulators.
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