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Edited by
Jonathan Cylus, European Observatory on Health Systems and Policies,Rebecca Forman, European Observatory on Health Systems and Policies,Nathan Shuftan, Technische Universität Berlin,Elias Mossialos, London School of Economics and Political Science,Peter C. Smith, Imperial College of Science, Technology and Medicine, London
Chapter 2.2 investigates the design and implementation of health benefits packages in different contexts. A benefits package is the range of health care goods and services that people covered by a system or scheme are entitled to or should be able to access. Key learning includes that
All health systems have budgetary constraints and set some limits to entitlement, and therefore have some kind of benefits package.
Benefits packages may be explicitly defined or implicit only, with the latter more common in high income countries and the former more common in low and middle income countries.
What is included or excluded, and the ways these decisions are made, vary widely but well-designed benefit packages should address population health needs and ensure the efficient use of health system resources
Defining a package of care is complex and often highly sensitive – using evidence and economic evaluation to determine what to include (or exclude) supports efficiency and equity and allows policy-makers to explain and defend their choices.
There are a range of evidence-led instruments that can support policy choices such as health technology assessment (HTA), which incorporates economic evaluation.
Any decision-making process should
– Gain agreement and buy-in from key stakeholders on the ultimate goals of the benefits package and the level of explicitness.
– Take into account the specific characteristics of the setting where the benefits package will be implemented including its cultural values, market configuration, political system and wealth.
In this chapter we look at a type of non-thermal rocket, the ion engine. This uses electric or magnetic fields to ionize and accelerate a propellant. Although there are many types, we focus here on the so-called gridded ion engine to illustrate the general principles, and to identify how the effective exhaust velocity, thrust, and power depend on characteristics of the engine. We examine a real interplanetary mission, Dawn, that uses this engine. We finish by looking briefly at some of the other types of ion engine.
This article examines a corpus of seventeenth-century letters written by Japanese-born Christian women exiled to Batavia following Tokugawa Japan’s anti-Christian measures of the late 1630s. Known as jagatara-bumi (Jakarta letters), these texts were produced under conditions of enforced separation, delayed communication, and close surveillance, circulating through Dutch, Chinese, and Nagasaki intermediaries. Situating them within the contexts of Tokugawa persecution, transregional communicative regimes, and early modern epistolary cultures, the article argues that letter-writing functioned as a form of epistolary endurance: a practice of sustaining relational presence across distance and faced with uncertainty. It develops the concept of a ‘grammar of separation’ to describe the historically situated, patterned ways in which rupture was articulated and managed in exile. Rather than reading these letters as transparent records, it treats them as structured practices shaped by convention, constraint, and hybrid religious vocabularies, analysed across emotional, textual, social, and spiritual registers.
Edited by
Jonathan Cylus, European Observatory on Health Systems and Policies,Rebecca Forman, European Observatory on Health Systems and Policies,Nathan Shuftan, Technische Universität Berlin,Elias Mossialos, London School of Economics and Political Science,Peter C. Smith, Imperial College of Science, Technology and Medicine, London
Chapter 2.5 sets out how long term care is provided and how it is paid for. Long-term care (LTC) refers to a broad package of personal, social and medical services provided over extended periods of time which may be delivered by care professionals or by informal care givers. Key learning includes that
Population ageing, particularly in advanced economies, creates growing demands for LTC.
There are inequities in the need for and access to LTC. Older people, women, those with lower incomes and lower levels of education are all more likely to need care, but less likely to have access to it.
Funding arrangements for LTC are problematic in many countries
– Voluntary insurance and out of pocket payments commonly fill public coverage gaps but create inequities.
– Asset-tests for eligibility for publicly funded care are essentially regressive wealth taxes due to the unequal distribution of LTC needs.
– Encouraging for-profit provision theoretically fosters competition, availability and responsiveness but the pressures to generate profits can jeopardize quality and safety.
Countries face urgent pressures on LTC and could usefully consider
– Increasing public expenditure and broadening the funding mix for LTC
– Better, fairer pooling of resources across generations
– Revenue sources independent of payroll contributions since labour markets as a revenue base will shrink at the same time that demand for ageing-related LTC increases
– Better data and indicators to assess access, quality, and value for money
– Patient-centred and coordinated approaches to LTC.
The concluding chapter proposes ‘Hype Studies’ as a new interdisciplinary field concerned with the institutionalisation, evaluation, and strategic management of promissory narratives. It synthesises insights across different disciplines to argue for a symmetrical sociology of hype that treats it neither as deception nor mere enthusiasm, but as a structuring force of innovation economies. The chapter identifies key research directions, including the professionalisation of hype expertise, reflexivity in hype practices, the role of rankings in shaping competitive stratification, and the management of speculative cycles. It also calls for extending analysis beyond the digital economy to other promissory economies more broadly, comparing how hype is differently tamed across sectors. Finally, it considers the ethical and political dimensions of hype, outlining the possibility of ‘responsible hype’ as a mode of engaging with technological futures.
Debt financing plays a critical role in the financial sustainability of nonprofit organizations, yet scholarly understanding of the factors influencing nonprofits’ access to debt remains limited. This study explores the antecedents of creditworthiness among Chinese nonprofits, focusing on the role of political connections, revenue diversification, and organizational size. Drawing on signaling theory, we argue that these factors serve as credible signals to lenders, reducing information asymmetry and thereby enhancing nonprofits’ access to debt. Using survey data from Chinese nonprofits, we find that political connections and organizational size significantly improve creditworthiness, while revenue diversification does not. The findings also reveal a heavy reliance on debt among Chinese nonprofits, highlighting the importance of debt financing as a useful financial tool in resource-constrained environments. This study adds to the literature on nonprofit debt by presenting evidence from the unique and underexplored authoritarian context of China and by offering practical insights for nonprofits seeking to enhance their creditworthiness.
Wild radish (Raphanus raphanistrum L.) is a highly competitive annual broadleaf weed that significantly constrains wheat (Triticum aestivum L.) production, particularly under increasing herbicide resistance and limited chemical control options. Optimizing sowing geometry offers a practical, nonchemical approach to enhance crop competitiveness and suppress weed growth. A field study was conducted during 2022 and 2023 to evaluate the impact of different sowing geometries on R. raphanistrum suppression and wheat productivity. The experiment was arranged in a randomized complete block design with seven treatments, including broadcast sowing; line sowing at 11, 22, and 33 cm; ridge sowing (30 cm); bed sowing (60 cm); and cross sowing (22 cm). Sowing geometry significantly influenced R. raphanistrum density and biomass at all growth stages (15 to 45 d after sowing). Narrow spacing (11 cm) consistently resulted in the lowest weed density and biomass, while the wider 33-cm spacing resulted in the highest weed pressure. Crop growth and yield responses were consistent across years, with 11-cm line sowing producing the highest number of productive tillers (393.7 m−2), grains per spike (42.9), biological yield (15.4 Mg ha−1) and grain yield (6.0 Mg ha−1) averaged across 2 yr. This treatment was closely followed by cross sowing (22 cm). In contrast, wider spacing (33 cm) reduced grain yield by approximately 25% to 30% due to increased weed competition and reduced crop competitiveness. Correlation and principal component analyses revealed a strong negative association between late-season weed biomass and wheat productivity, emphasizing the importance of sustained weed suppression during critical growth stages. Overall, narrow row spacing, particularly 11-cm line sowing, enhanced crop competitiveness, effectively suppressed R. raphanistrum, and maximized wheat yield, demonstrating its potential as an eco-friendly strategy for integrated weed management.
Editorials and commentaries have a central role in shaping debate, priorities and values within psychiatry. Reflecting on the first decade of BJPsych Open, we consider how topical writing both responds to and helps define emerging scientific, social, ethical and political challenges. Looking ahead, we suggest that global instability, technological change and pressures on academic freedom will increasingly shape psychiatric discourse, underscoring the importance of editorial independence, methodological rigour and openness to the airing of contested ideas in guiding the journal’s next decade.
The Emergency Paramedic Act (EPA; Notfallsanitätergesetz), implemented in 2014, expanded the legal authority of German paramedics to independently perform defined invasive and pharmacological interventions under specific conditions. However, real-world implementation of these competencies within the physician-based German Emergency Medical Services (EMS) system remains insufficiently described.
Objective:
The aim of this study was to evaluate the frequency, type, temporal development, and regional variation of invasive and pharmacological/therapeutic interventions performed independently by paramedics over a six-year period.
Methods:
A retrospective, descriptive multicenter analysis of digital EMS documentation was conducted across three districts in Saxony, Germany, from January 1, 2019 through December 31, 2024. All missions were screened (n = 197,842). Paramedic-led missions without physician presence were included; physician-attended missions and non-emergency interfacility transports were excluded. Interventions were classified according to the 2024 Federal Association of Medical Directors of EMS competency catalogue. Frequencies were analyzed by year and district. Temporal trends were assessed using the Mann–Kendall test, and regional differences were explored using one-way ANOVA with Tukey HSD post hoc testing. All inferential analyses were exploratory.
Results:
Of 197,842 missions, 156,417 (79.1%) were paramedic-led without physician presence. Invasive procedures occurred in 7.6% of missions and were predominantly peripheral intravenous (IV) access (5.7%). Advanced airway management and intraosseous (IO) access were rare (<0.1%). Pharmacological/therapeutic administrations occurred in 11.3% of missions and increased from 9.4% in 2019 to 12.1% in 2024 (Mann–Kendall test), whereas overall invasive procedure rates remained stable.
Conclusion:
Ten years after implementation of the EPA, invasive and pharmacological interventions performed independently by German paramedics remain relatively infrequent and largely confined to basic measures. Advanced procedures are rarely applied, reflecting continued structural characteristics of the physician-based EMS model.
We describe the K-moduli spaces of weighted hypersurfaces of degree $2(n+3)$ in $\mathbb {P}(1,2,n+2,n+3)$. We show that the K-polystable limits of these weighted hypersurfaces are also weighted hypersurfaces of the same degree in the same weighted projective space. This is achieved by an explicit study of the wall crossing for K-moduli spaces $M_w$ of certain log Fano pairs with coefficient w whose double cover gives the weighted hypersurface. Moreover, we show that the wall crossing of $M_w$ coincides with variation of GIT except at the last K-moduli wall which gives a divisorial contraction. Our K-moduli spaces provide new birational models for some natural loci in the moduli space of marked hyperelliptic curves.
To assess the impact of ethnicity on survival following paediatric cardiac surgery.
Methods:
Observational study of a regional tertiary paediatric cardiac surgical centre in Yorkshire, UK. All children (age 0–15 years) undergoing their first cardiac surgical procedure from January 2005 to December 2021 inclusive. The primary outcome was 5-year survival. Secondary outcomes included 30-day, 1-year, and pre-discharge survival.
Results:
3,508 children (46% female) underwent their first cardiac surgical procedure during the study period. Within the study cohort 2,578 (73%) children were White, 634 (18%) were South Asian, 95 (3%) were Black and 201 (6%) were from other ethnic groups. South Asian children were more likely to have a functionally single-ventricle (10% vs. 7% White; relative risk 1.41, 95% confidence interval 1.15–1.69).
Mortality after surgery, adjusted for deprivation, was higher for South Asian (hazard ratio 1.50, 1.12–2.01) and Black children (hazard ratio 1.69, 0.93–3.06), compared to White children. Survival differences were not present at discharge or 30 days post-procedure, but widened progressively at 90 days, 1 year and 5 years. This was not influenced by diagnosis or pre-operative risk factors. One-year survival improved for South Asian children across the study period and was similar to that of White children from 2017–2021 (94.7% (89.8–97.3%) vs. 96.8% (94.9–97.9%) White).
Conclusions:
Black and South Asian children have a greater risk of death following cardiac surgery compared to White children, independent of pre-operative risk. The majority of excess deaths occurred after hospital discharge. Although inequities have steadily reduced over the past two decades, the explanation for this effect remains unclear.
This paper explores and compares smoking advertisements and anti-smoking and anti-cancer messages in Australia’s migrant press, particularly newspapers, from 1930 to 1960. It investigates the ways in which smoking was promoted to migrant communities through their newspapers, contrasts this with the increasing prevalence of anti-smoking and broader anti-cancer messages, and explores whether there were any shifts in advertising and in anti-smoking messages following the growing research linking smoking and cancer (particularly lung cancer) from 1950. These messages were ultimately tied to this growing research, as well as the various Australian state and national anti-cancer campaign committees which emphasised early diagnosis and swift treatment as the best method to combat a range of cancers. Yet the Australian authorities, although finally acknowledging the dangers of cigarette smoking, rejected any government intervention other than providing the medical reports to the public. Greek-language newspapers (notably To Ethnico Vema) form an important case study; however, other foreign-language and migrant community papers were also consulted, including Italian, Jewish, and French.
To assess the feasibility of implementing C-reactive protein point-of-care testing (CRP-PoCT) for patients presenting with respiratory tract infections (RTIs) in primary care.
Design:
Feasibility study.
Setting:
General practice (GP) and community pharmacy in rural Victoria.
Patients (or Participants):
Five GPs and a community pharmacist used CRP-PoCT for RTI patients aged 12–65 years for two months between August and December 2023.
Methods:
Data on testing, prescribing, and implementation barriers and facilitators were collected from patient records and surveys of GPs and pharmacists. Feasibility outcomes were analyzed using descriptive statistics and content analysis.
Results:
Fifty-five patients were screened, with recruitment rates of 87.5% (35/40) in GP clinics and 67% (10/15) in community pharmacies, and a retention rate of 100%. Adherence to the testing protocol was 100% in both settings; however, adherence to the prescribing protocol was 76% in GP practices and 100% in pharmacies. Common RTI symptoms were cough (70%, n = 30), fever (58%, n = 25), and sore throat (44%, n = 19). Antibiotics were prescribed to 36.4% (12/33) of GP patients and 10% (1/10) of pharmacy patients. Pharmacists managed patients with OTC medicines (80%, 8/10) or immediate GP referral (10%, 1/10). CRP-PoCT feasibility was rated highly by GPs [median 6/7 (IQR 4–6)] and moderately by the pharmacist (4/7). Key implementation facilitators identified were nurse/technician support, medicare funding, clear workflows, and GP–pharmacy collaborative practice agreement.
Conclusion:
With mitigation of practical challenges, CRP-PoCT can be feasibly implemented in rural GP–pharmacy settings to enhance antibiotic stewardship for acute respiratory infections in primary care.
The idea of “self-reliance” has endured in Chinese political discourse for nearly a century, transcending profound changes in China’s political, economic and strategic circumstances. Although it is frequently misinterpreted as economic isolation or autarky, the idea of self-reliance in China has always acknowledged the country’s engagement with the global economy. Drawing on the discursive institutionalist concept of ideational resilience, we show that self-reliance comprises three interlocking elements: autonomy, interdependence and order-shaping. While these sit in tension with one another, they have also accommodated one another since the earliest articulations of the idea. This tripartite structure has enabled Chinese leaders since the Republican era to reinterpret and usefully deploy the idea of self-reliance. Our findings underscore the resilience of Chinese foreign economic policy ideas, as well as the ideational logic behind Xi Jinping’s seemingly contradictory pursuit of technological self-reliance, open global markets and greater connectivity with the developing world.
The Mineiro Belt is an example of the Tonalite-Trondhjemite-Granodiorite (TTG)-Sanukitoid transition, exemplified by the Lagoa Dourada (LDS, 2350 Ma) and the Alto Maranhão (AMS, 2130 Ma) suites. Their opaque mineralogy, along with the amphibole chemistry, was investigated to better understand the granitic magmatism at that time. The LDS contains magnetite, ilmenite, chalcopyrite and pyrite as opaque primary phases, while the AMS includes ilmenite, pyrrhotite, chalcopyrite, pyrite, magnetite, pentlandite and sphalerite. With magnetite predominating in the LDS and ilmenite in the AMS, they should be classified as magnetite and ilmenite series granitoids, respectively. In the TTGs, the amphiboles are ferrotschermakite, whereas in the sanukitoids, they are primarily Mg-hornblende to actinolite. Despite the opaque mineralogy, the positive correlation between Fe# and AlIV in the amphiboles, along with the lower Fe# values in the ilmenite-bearing sanukitoids, suggests higher fO2 conditions compared to the magnetite-bearing TTGs. Although both opaque assemblages indicate fO2 values above the FMQ buffer, exceeding 10−18 bars for the ilmenite-bearing sanukitoids and 10−17 bars for the magnetite-bearing TTGs, their crystallization occurs close to the equilibrium reaction titanite + magnetite + quartz – Fe-Mg-Ca silicates + ilmenite. The assemblages show that the magnetite-bearing TTGs crystallized at lower temperatures (700–800°C) than ilmenite-bearing sanukitoids (800°C), showing a temperature dependency of fO2 once the latter register higher fO2, despite being ilmenite-series granitoids. This intriguing scenario may be due to a combination of heterogeneously metasomatized magma sources, temperature condition, fH2O and sediment entrance in the subduction, explained by the changes in crustal growth processes towards modern plate tectonics.
Geometrical optics (GO) is widely used for reduced modelling of waves in plasmas, but it fails near reflection points, where it predicts a spurious singularity of the wave amplitude. We show how to avoid this singularity by adopting a different representation of the wave equation. Instead of the physical coordinate $x$ and the wavevector $k$, we use the ray time $\tau$ as the new canonical coordinate and the ray energy $h$ as the associated canonical momentum. To derive the envelope equation in the $\tau$-representation, we construct the Weyl symbol calculus on the $(\tau , h)$ space and show that the corresponding Weyl symbols are related to their $(x, k)$ counterparts by the Airy transform. This allows us to express the coefficients in the envelope equation through the known properties of the original dispersion operator. When necessary, solutions of this equation can be mapped to the $x$-space using a generalised metaplectic transform. However, the field per se might not even be needed in practice. Instead, knowing the corresponding Wigner function usually suffices for linear and quasilinear calculations. As a Weyl symbol itself, the Wigner function can be mapped analytically, using the aforementioned Airy transform. We show that the standard Airy patterns that form in regions where conventional GO fails are successfully reproduced within metaplectic GO (MGO) simply by remapping the field from the $\tau$-space to the $x$-space. An extension to mode-converting waves is also presented. This formulation, which we call generalised MGO, can be particularly useful, for example, for reduced modelling of the O–X conversion in inhomogeneous plasma near the critical density, an effect that is important for fusion applications and also occurs in the ionosphere. Overall, MGO can replace GO for any practical purposes, because it better handles cutoffs and is similar otherwise.
In this paper, I argue that Taurek’s positive view, namely that we ought to show equal respect and concern to those affected by our actions, commits him to saving the bigger number in some cases. This leads to an adjustment of his negative claim, namely that numbers don’t count. Numbers don’t count in the sense he was interested in, i.e., sums of harms or benefits (across different people) lack moral significance. Numbers do count, however, when considering how to act fairly which is what equal respect demands. This adjustment supports Taurek’s general view on how to think about moral matters.