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Democratic therapeutic communities (TCs), use a “flattened hierarchy” model whereby staff and clients are considered to have an equal voice, sharing administrative and some therapeutic responsibility. Using the sociological framework of interaction ritual chain theory, the purpose of this paper is to explain how TC client members negotiated and enforced community expectations through an analysis of power within everyday interactions outside of structured therapy.

The study used narrative ethnography, consisting of participant observation with two democratic communities, narrative interviews with 21 client members, and semi-structured interviews with seven staff members.

The findings indicate social interactions could empower clients to recognise their personal agency and to support one another. However, these dynamics could be destructive when members were excluded or marginalised. Some clients used their interactions at times to consolidate power amongst dominant members.

It is argued that the flattened hierarchy approach theoretically guiding TC principles does not operate as a flattened model in practice. Rather, a fluid hierarchy, whereby clients shift and change social positions, seems more suited to explaining how the power structure worked within the communities, including amongst the client group. Recognising the hierarchy as “fluid” may open dialogues within TCs as to whether, and how, members experience exclusion.

Explorations of power have not specifically focused on power dynamics between clients. Moreover, this is one of the first papers to look at power dynamics outside of structured therapy.

Customer experience research predominantly anchors the customer journey on a specific offering, implying an inherently firm-centric perspective. Attending calls for a more customer-centric approach, this study aims to develop a goal-oriented view of customer journeys.

This study interprets the results of a phenomenological study of a transformative journey toward a sober life with the self-regulation model of behavior to advance understanding of customer journeys.

The consumer's journey toward a higher-order goal encompasses various customer journeys toward subordinate goals, through which consumers engage in iterative cognitive and behavioral processes to adjust or maintain their experienced situation vis-à-vis the goal. Experiences drive behavior toward the goal. It follows that negative experiences may contribute to goal attainment.

This study highlights the importance of looking at the consumers' higher-order goals to obtain a more holistic understanding of the customer journey.

Companies and organizations should extend their view beyond the immediate goals of their customers to identify relevant touchpoints and other customer journeys that affect the customer experience.

This study proposes conceptualization of the customer journey, comprising goal-oriented processes at different hierarchical levels, and it demonstrates how positive and negative customer experiences spur behaviors toward the higher-order consumer goal. This conceptualization enables a more customer-centric perspective on journeys.

This study aims to provide a comprehensive overview on positive drivers and negative factors connected to the Covid-19 pandemic which can jointly shape wine tourism intentions.

The present study relies on a large sample of 399 US wine tourists. Partial least square structural equation modelling is adopted for data analysis.

Results reveal that willingness to avoid Covid risk while travelling negatively impacts wine tourism intentions and competitively mediates the effect of Covid phobia. Both situational and personal involvement with wine are key antecedents of future wine tourism intentions.

This research contributes to understand the role of willingness to avoid travel-related risks during health crises. Furthermore, it improves existing knowledge on the effect of wine involvement on wine tourism intentions, highlighting the predictive relevance of situational involvement in explaining this relationship.

Results constitute critical information to practitioners and destination management operators for improving their resilience under similar circumstances. Updated information on wine tourists’ profile is also provided.

To the best of the authors’ knowledge, this is among the first studies exploring how positive and negative drivers act synergically in affecting wine tourism intentions after the Covid-19 outbreak.

Haloperidol is a first-generation antipsychotic butyrophenone that is lipophilic, readily absorbed, and extensively metabolized in the liver. The occurrence of elevated liver enzymes with haloperidol is reported to be 2.4% with cases generally occurring in the setting of chronic use. In this case, we present a patient who developed elevated liver enzymes 1-2 days after starting haloperidol treatment on two separate occasions and in the context of negative hepatic viral and autoimmune serology. Liver enzymes consistently had alanine transaminase > aspartate transaminase and peaked at 288 U/L prior to discontinuation of the medication. The patient was taken off haloperidol after serology resulted and clozapine regimen started. He was able to tolerate clozapine well with recovery of his transaminitis and psychiatric stabilization.

People with severe persistent mental illness pose a significant challenge to managed care organizations and society in general. The financial costs are staggering as is the community impact including homelessness and incarceration. This population also has a high incident of chronic comorbid disorders that not only drives up healthcare costs but also significantly shortens longevity. Traditional case management approaches are not always able to provide the intense and direct interventions required to adequately address the psychiatric, medical and social needs of this unique population. This article describes a Medicare Advantage Chronic Special Needs Program that provides a Medical Home, Active Community Treatment, and Integrated Care. A comparison of utilization and patient outcome measures of this program with fee for service Medicare found significant reduction in utilization and costs, as well as increased adherence to the management of chronic medical conditions and preventative services.

The purpose of this paper is to reconsider, from a historical perspective, New Zealand’s reputation as a country largely without corruption, with particular reference to the colonial government’s confiscation of Māori land in the 19^th century and beyond.

This paper is based on published historical commentary.

The findings are that much of the Māori land confiscation was rendered legal for illegitimate purposes, and that the colonial and successive New Zealand governments abrogated the country’s foundational document, the Treaty of Waitangi, signed between the colonial government and many Māori chiefs in 1840. Adverse consequences for Māori have been felt to this day, despite the Treaty settlements process that began with the Māori renaissance in the mid-1970s.

The academic analysis of corruption in New Zealand has seldom if ever adopted this historical perspective.

Medical students experience higher rates of mental illness than the general population. With competition rising for success in medical school, and residency, increasing incidence of distress are leading this population to experience higher rates of thoughts of dropping out of school, and even suicide. Since many stigmas deter medical students from receiving mental health counseling, such as the perceived inability to handle the stresses of medical school, and the potential lack of competitiveness for residencies if reported, prevention of mental illness may be a better course to take in reducing prevalence in this population. Regular exercise has demonstrated a positive effect on not only promoting physical health, but also mental health. Exercise encourages a healthy mood, positive self esteem, and better cognition, while decreasing the chances of depression, anxiety, and burnout. Implementing exercise time into medical school curriculums, just like the basic sciences, albeit for less time in the day, could provide a feasible way to ensure that all students are taking time to partake in this important activity for their well being. Though medical schools are rigid with attempts to make changes in their curriculum, thirty minutes a day, three to five times a week of exercise of the students' choice not only is more cost effective than counseling, but it also reduces the chances that they will experience burnout, which if left untreated could transcend into a compromised training experience.

In this article, the author discusses works from the French Documentation Movement in the 1940s and 1950s with regard to how it formulates bibliographic classification systems as documents. Significant writings by Suzanne Briet, Éric de Grolier and Robert Pagès are analyzed in the light of current document-theoretical concepts and discussions.

Conceptual analysis.

The French Documentation Movement provided a rich intellectual environment in the late 1940s and early 1950s, resulting in original works on documents and the ways these may be represented bibliographically. These works display a variety of approaches from object-oriented description to notational concept-synthesis, and definitions of classification systems as isomorph documents at the center of politically informed critique of modern society.

The article brings together historical and conceptual elements in the analysis which have not previously been combined in Library and Information Science literature. In the analysis, the article discusses significant contributions to classification and document theory that hitherto have eluded attention from the wider international Library and Information Science research community. Through this, the article contributes to the currently ongoing conceptual discussion on documents and documentality.

Capgras Syndrome is a subcategory of delusional disorder. People affected by this syndrome believe that a close associate such as a friend or family member has been replaced by an identical imposter. This case report describes a 23-year-old woman with no prior psychiatric history, whom developed Capgras syndrome, via folie a deux, in the setting of poly-substance use. In this patient, a combination of Aripiprazole 10 mg daily and Escitalopram 10 mg daily were effective in resolving symptoms. Clonazepam was utilized for anxiety and Omega-3 fatty acids 1 g for anti-oxidative effects. Further studies are needed to investigate the effects of a variety of causes and treatments for Capgras Syndrome.