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This article reconsiders prevailing assumptions of bureaucratic continuity in postwar Japan by examining the case of the Ministry of Communications during the Allied Occupation. While existing scholarship emphasizes institutional inertia, this study shows how structural reform and inter-institutional negotiations involving both American authority and Japanese agency reshaped parts of Japan’s administrative system. The case calls for a more differentiated, organization-focused perspective on postwar reforms and demonstrates that these transformations had enduring effects beyond 1952.
The global COVID-19 pandemic has changed how elected officials govern, campaign, and present themselves. One key change is that politicians across the world often wear face masks when in public. To what extent does this practice influence how the public perceives politicians? We investigate this question in Japan, a country where people – though not politicians – often wore face masks even before the novel coronavirus outbreak. Conducting a survey experiment with a nationally representative sample of about $1500$ Japanese residents, we find that masks do influence public perceptions and that women politicians lose more public support when wearing masks than men. Given the nature of political campaigns in the COVID-19 world, we think that our results have broad implications for women politicians competitiveness, specifically, and for politics and gender, more generally. We outline these in the conclusion along with several new research directions.
Shiga toxin-producing Escherichia coli (STEC) are zoonotic, foodborne pathogens that cause outbreaks of infectious gastrointestinal disease, including haemolytic uraemic syndrome (HUS) which can be fatal. In November 2023, a foodborne outbreak of STEC serotype O26:H11 stx2a/eae, involving 40 cases (54% female and 76% aged 0–9 years old), including 19 children with HUS. Whole-genome sequencing analysis revealed the outbreak strain was multidrug resistant and likely originated from outside the United Kingdom. Epidemiological analysis showed greatest odds of exposure among cases for consumption of a dried fruit product, predominantly in multi-packs. Batch numbers of the packs consumed by cases were rarely available, and where recorded, other packs in the same the batch were unavailable for testing; therefore, targeted microbiological testing was not possible. Fruit for drying can become contaminated when the crop is exposed to irrigation water or rainwater run off containing animal faeces. For STEC, where detection of the causative agent in food is challenging, we recommend establishing multi-source weight of evidence frameworks that promote the application of epidemiological and food chain evidence for public health action and the expansion of global surveillance networks to enhance the detection of foodborne threats at home and abroad.
This study investigated the prevalence of advance directives among patients receiving community care within the East London NHS Foundation Trust (ELFT), and to identify factors associated with their clinical application.
We analysed data from electronic health records of 4807 patients (aged 18–75 years), managed under the Care Programme Approach (CPA) in ELFT during 2021–2022. Demographic, clinical, service-level and patient-reported measures were analysed (binomial logistic regression).
Results
A total of 31.2% of patients on the CPA had an advance directive. Black ethnicity, treatment in the forensic service or Newham, Luton and Bedfordshire localities, housing in socio-therapeutic facilities, diagnosis of personality disorder, ten or more previous admissions and engagement with DIALOG+ were positively associated with having an advance directive. DIALOG+ is the first approach that has been specifically developed to make routine patient–clinician meetings therapeutically effective. It is based on quality of life research, utilising the DIALOG scale (a patient-reported outcome measure), concepts of patient-centred communication, IT developments and components of solution-focused therapy, and is supported by an app.
Clinical implications
This study highlights a complex interplay of cultural, social and systemic factors that influence advance care plan status. Structured communication, stronger therapeutic relationships and staff facilitation are likely to encourage advance care planning.
Spatial studies of British Victorian cities have been historically limited either in scope or specificity due to the unwieldiness of census data. However, over the last decade, the digitization of historical source material has created new possibilities for the exploration of geodemographic patterns. For the case of Manchester, the “shock city” of the British Industrial Revolution, these advancements are especially pertinent in order to settle long-standing debates as to the extent of segregation in the city. This article presents a method for the highly granular georeferencing of census data for the Manchester Township for the second half of the nineteenth century by drawing on historical material, including geographic and commercial surveys. Linking households to specific buildings presents increased possibilities for studies of heterogeneity and neighborhood patterns at a micro-scale. This approach ultimately lays the groundwork for future revisitations of nineteenth-century cities and the traditional claims that have been made around their urban dynamics.
Poverty is a risk factor for poor health. We sought to determine the practices, barriers, knowledge and comfort with poverty screening and intervention amongst family physicians (FPs), family medicine residents (FMRs) and family nurse practitioners (NPs) in Saskatchewan, Canada during the COVID-19 pandemic.
Methods:
A survey was distributed by email and newsletters to FPs, FMRs and NPs in Saskatchewan during 2022.
Results:
Eighty-three FPs, 35 FMRs and 25 NPs responded. Time, patient factors, practitioner knowledge and availability of community resources/services were reported barriers. Comfort discussing government benefits with patients was low, with slight differences amongst provider groups (p =.042). Thirty-one (40.3%) FPs, 7 (20.6%) FMRs and 17 (68.0%) NPs had referred a patient to a government benefit. Eight (6%) respondents used the Poverty Screening Tool.
Discussion:
Further research and training is needed to integrate poverty screening and intervention into primary care, given practitioners’ role as healthcare’s initial point of contact.
Communicating a cancer diagnosis to a child is a complex challenge for parents. This study aims to explore (1) the communication strategies and beliefs of parents with cancer when communicating with their children and (2) the needs of these parents.
Methods
Semi-structured interviews were conducted with parents with cancer being treated at an Italian comprehensive cancer center and their healthy partners, when present. The interviews were analyzed through a constructivist approach using reflexive thematic analysis. The number of parents to be interviewed was not predetermined, but the meaning saturation procedure was followed.
Results
Ten parents were interviewed, meaning saturation was reached at the seventh interview. Five themes were created: (1) the challenges parents faced at this sensitive time; (2) the emotions parents experienced; (3) the beliefs that may have influenced how they communicate the illness to their children; (4) the strategies parents used to communicate the illness to their children and (5) parents’ perception of their children’s understanding of the illness. Fifty-seven needs, often unmet, were also identified and were grouped into three categories: (1) “existential” needs; (2) support needs; and (3) needs related to continuing to be and act as parents.
Significance of results
This study provides important insights for healthcare professionals to consider in order to better support and care for these parents.
Hyman Minsky stands as one of the most influential economists of the twentieth century. His contributions to macroeconomic theory are primarily situated within the post-Keynesian tradition. This paper provides a concise overview of the fundamental elements of Minsky’s theoretical framework, focusing on his principal insights, the financial instability hypothesis, and its broader implications. Although Minsky developed his theory predominantly during the 1980s, it remained largely overlooked until the emergence of the global financial crisis in 2008. The present study seeks to evaluate the socioeconomic conditions and prevailing perceptions during the intervening period that contributed to the marginalisation and underappreciation of Minsky’s approach and policy recommendations. In so doing, the paper critically analyses several potential explanations for the relative neglect of his theoretical contributions.
This paper investigates the causal effects of sovereign debt crises in a sample of 50 defaulting economies between 1870 and 2010. As default is potentially endogenous, we use the narrative approach to identify plausibly exogenous episodes. We find economically and statistically significant costs of up to 3.2 percent of GDP before recovering to the pre-crisis level after five years. The average aftermath, however, conceals a large heterogeneity by default cause. Defaults originating from negative supply shocks, political crises, or adverse terms of trade are associated with higher costs. Demand shocks, in contrast, have a moderate effect that is quickly reversed.
Culturally adapted diabetes self-management education (DSME) programs are effective in improving glycemic control and diabetes outcomes among minority populations, but data on program costs and cost-effectiveness are limited. This study aimed to assess the cost and cost-effectiveness of a culturally adapted DSME (adapted DSME) compared to a standard DSME model among Marshallese adults with type 2 diabetes (T2D).
Methods:
Retrospective cost and cost-effectiveness analyses (CEA) were conducted using data from the community-based trial, conducted between May 2015 and May 2018. We applied an activity-based costing approach to quantify the implementation resources. The CEA was performed using an incremental implementation cost-effectiveness ratio (ICER) measure, expressed as costs for additional unit change in hemoglobin A1c (HbA1c) over 12 months between adapted DSME and standard DSME. We further estimated the replication costs for the adapted DSME for implementation in other settings. The analysis was conducted from a community implementation perspective with a one-year time horizon.
Results:
Total program costs were $1,227 per participant for the adapted DSME and $122 per participant for the standard DSME. The ICER was $1434 per additional unit reduction in HbA1c. Replication costs for the adapted DSME were estimated at $125,473 (range: $62,737–$188,210).
Conclusions:
The culturally adapted DSME has been shown to be effective in managing T2D and may serve as a cost-effective lifestyle intervention for Marshallese individuals beyond the trial period. Future research should assess its broader economic and health impacts.
Depictions of numeracy among non-Europeans were a prominent feature of seventeenth- and eighteenth-century Anglo-European travel writing, but remain largely overlooked in the extensive scholarship on travel, knowledge, and empire. This article shifts attention from traditionally ‘scientific’ forms of numeracy such as mathematics and astronomy towards more fundamental counting, calculation, and communication skills, to examine the way in which mutually reinforcing hierarchies of otherness and numerical knowledge were constructed in travel accounts. Focusing particularly on writings about China and the Americas, it demonstrates the way in which European written and mathematically precise numeracy was perceived as superior to oral, embodied, and object-based practices observed elsewhere. Exploring the reception of these ideas in eighteenth-century Britain reveals that numeracy became integral to emergent notions of European modernity and civilization. The example of numeracy, this article suggests, demonstrates the interrelationship between social relations in national context and global power structures.
The diagnosis and treatment of personality disorder are both highly contentious subjects. It is argued in this article that we have misunderstood personality pathology as yet another form of mental illness that should require treatment for its alleviation or removal. But it is not a typical mental illness; personality is a stable persistent component of the self and needs a different treatment approach based on adaptation.
The new psychosocial goal-setting and manualised support intervention for independence in dementia (NIDUS-Family) is a manualised dementia care intervention.
Aims
To evaluate whether goal-setting plus NIDUS-Family is more effective than the control condition (goal-setting and routine care) in supporting dyads’ (family carers and care recipients with dementia) attainment of personalised goals; and to determine participant-perceived goal relevance over 24 months.
Method
We randomised dyads from community settings (2:1): to NIDUS-Family, a manualised psychological intervention tailored to goals that dyads set by selecting modules, delivered in 6–8 video call/telephone sessions over 6 months then 2–3 follow-ups monthly for 6 months; or to control. Outcomes were goal attainment scaling (GAS) (primary) at 18 and 24 months, functioning, quality of life, time until care home admission or death, carer anxiety and depression. Primary analysis, a mixed-effects model, accounted for randomisation group, study site, time, intervention arm facilitator and repeated measurements.
Results
In the period 2020–2021, 204 participants were randomised to intervention and 98 to control; 164 (54.3%) and 141 (46.7%) dyads completed 18- and 24-month outcomes, respectively.
In the primary analysis, including 277 participants contributing 6-, 12-, 18- or 24-month outcomes, adjusted GAS mean differences (intervention–control) at 18 and 24 months were 11.78 (95% CI 6.64, 16.93) and 8.67 (95% CI 3.31, 14.02), respectively. Secondary outcome comparisons were not significant. The hazard ratio for dying or care home admission was 0.80 (95% CI 0.45, 1.42; intervention versus control), and 0.87 (95% CI 0.41, 1.82) and 0.59 (95% CI 0.26, 1.33) for death and care home admission, respectively. Among baseline GAS goals, carers considered 436 (78.0%) relevant at 18 months and 383 (78.5%) at 24 months.
Conclusions
NIDUS-Family improved attainment of GAS goals over 2 years.
The white mullet, Mugil curema (Mugilidae), is a catadromous euryhaline fish with an omnivorous diet, and is distributed mainly along the Pacific and Atlantic coasts of the Americas. Mullets represent an important economic resource for the artisanal fisheries in Mexico. In this study, 73 individuals of M. curema were analysed; specimens were sampled in 4 coastal lagoons of the Yucatán Peninsula, Mexico, between 2022 and 2024. Parasite identification was accomplished by using DNA sequences. Nineteen parasite taxa were found, including 1 monopisthocotylan, 1 copepod, 1 acanthocephalan, 1 nematode, and 15 trematodes. Specimens were sequenced for a nuclear or mitochondrial molecular marker. Ten taxa are reported for the first time in this host species, including the adult trematodes Saccocoelioides olmecae; Schikhobalotrema sp. 1 and sp. 2, Hemiuridae gen. sp., the larval trematodes Mesostephanus microbursa, M. cubaensis, Cardiocephaloides medioconiger, Saccularina sp., Bucephalus sp., as well as the larval nematode Contracaecum fagerholmi. Of the 21 metazoan parasites recorded, 58% were adults and 42% were larval stages. The checklist of the metazoan parasites of M. curema was updated. Our study contributes to the understanding of the parasite diversity of an economically important fish species with a wide distribution range and corroborates the usefulness of combining morphological and molecular data for species identification and for linking larval forms with adults to complete parasite life cycles. Our results will be useful in further studies of parasites as bioindicators of ecosystem health, and studies of the role of parasites in food webs in coastal lagoons.