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This study analyses how care regimes in South Korea, the United Kingdom, and Sweden shape the roles of and support policies for informal caregivers within long-term care systems for older adults. South Korea considers informal caregivers both as resources and co-clients, but its well-being support is limited, financial aid criteria are relatively strict, and while employment-care reconciliation policies exist, familistic culture hinders their use. The United Kingdom assigns co-worker and co-client roles, offering well-being support, broader financial aid, and expanding employment-care reconciliation. Sweden prioritises formal care and recognises informal caregivers as co-clients, placing the strongest emphasis on improving their well-being while strictly regulating financial aid and employment-care reconciliation. Despite differences, all three countries emphasise informal caregiver well-being and have established frameworks for financial support and employment-care reconciliation policies. Future policies should enhance quality control, regulate financial aid, strengthen employment-care reconciliation support, and expand formal care, while addressing the potential negative impacts of dual caregiver roles.
Limited longitudinal research examining developmental changes in visuospatial working memory (WM) among children and adolescents with autism spectrum disorder (ASD) has prompted our investigation.
Methods
We assessed 123 autistic children and adolescents and 145 typically developing controls (TDC) using the Cambridge Neuropsychological Test Automated Battery at baseline (Time 1 [mean age ± SD]: ASD: 13.04 ± 2.86; TDC: 11.53 ± 2.81) and 2–9 years later (Time 2: ASD: 18.08 ± 3.17; TDC: 16.41 ± 3.09) to measure changes of visuospatial (working) memory over time. The linear mixed model was used to compare the differences between ASD and TDC and estimate the effect of changes over time, age, ASD diagnosis, and interactions of Time×Age×ASD. The overall Age×ASD effect was calculated in the spline regression.
Results
Autistic children and adolescents exhibited significantly poorer performance on all spatial tasks and some visual tasks than their TDC counterparts at Time 1 and Time 2, after adjusting for sex, age, attention deficit/hyperactivity disorder (ADHD), and full-scale intelligence quotient. There was an overall improvement from Time 1 to Time 2 across all tasks with significant Age×Time interactions. Significant Age×ASD interactions were observed in the delayed matching to sample, pattern recognition memory (PRM), spatial span (SSP), and spatial working memory (SWM) tasks with no significant Time×ASD interactions. In the quadratic nonlinear model, Age×ASD interactions were significant in PRM and SSP.
Conclusion
Despite significant improvements during the follow-up period, autistic children and adolescents continue to experience persistent deficits in SWM, with a weaker age-related improvement in visuospatial WM than TDC.
The modal auxiliary form must plus perfect aspect (must have +V-en) has recently acquired the meaning of direct evidentiality in Multicultural London English, the new London dialect. Because the new meaning is a recent innovation we have a rare opportunity to witness its development at first hand, unlike earlier changes in the history of must. Our analysis supports the view that the classic definition of evidentiality in terms of information source is too narrow to explain the expression of evidentiality in spoken interaction, and that a broader definition in terms of epistemic authority is more appropriate. We argue that the direct evidential meaning is a coherent further step in the semantic changes undergone by must during its history. It represents a previously undocumented pathway in the grammaticalisation of evidentiality. It also supports the view that evidentiality is not a purely lexical phenomenon in English.
An independent evaluation of The Resilience Project’s School Partnership Program in Australian secondary schools found that longer participation (6+ years) in this whole-school programme was associated with improved student outcomes, including reduced symptoms of depression and anxiety. This commentary aims to: (a) describe whole-school approaches to improving health and well-being, with reference to their historical context and some selected key studies; (b) highlight the lack of data on the effectiveness of whole-school approaches for reducing depression and anxiety; (c) signal the potential benefits of whole-school approaches when sustainably implemented; and (d) reinforce the need for research that examines links between implementation factors and outcomes. Overall, this commentary underscores the value of viewing schools as complex social systems where multiple components can align to enhance mental health and well-being outcomes for students.
We simulate thermal convection in a two-dimensional square box using the no-slip condition on all boundaries, and isothermal bottom and top walls, and adiabatic sidewalls. We choose 0.1 and 1 for the Prandtl number $Pr$ and vary the Rayleigh number $Ra$ between $10^6$ and $10^{12}$. We particularly study the temporal evolution of integral transport quantities towards their steady states. Perhaps not surprisingly, the velocity field evolves more slowly than the thermal field, and its steady state – which is nominal in the sense that large-amplitude low-frequency oscillations persist around plausible averages – is reached exponentially. We study these oscillation characteristics. The transient time for the velocity field to achieve its nominal steady state increases almost linearly with the Reynolds number. For large $Ra$, the Reynolds number itself scales almost as $Ra^{2/3}\, Pr^{-1}$, and the Nusselt number as $Ra^{2/7}$.
There are few economic evaluations of adjunctive psychosocial therapies for bipolar disorder.
Aims
Estimate the cost–utility of in-person psychosocial therapies for adults with bipolar disorder added to treatment as usual (TAU), from an Australian Government perspective.
Method
We developed an economic model, estimating costs in 2021 Australian dollars (A$) and outcomes using quality-adjusted life-years (QALYs) gained and disability-adjusted life-years (DALYs) averted. The model compared psychoeducation, brief psychoeducation, carer psychoeducation, cognitive–behavioural therapy (CBT) and family therapy when added to TAU (i.e. pharmacotherapy) over a year for adults (18–65 years) with bipolar disorder. The relative risk of relapse was sourced from two network meta-analyses and applied to the depressive phase in the base case. Probabilistic sensitivity analysis and one-way sensitivity analyses were conducted, assessing robustness of results.
Results
Carer psychoeducation was preferred in the base case when the willingness-to-pay (WTP) threshold is below A$1000 per QALY gained and A$1500 per DALY averted. Brief psychoeducation was preferred when WTP is between A$1000 and A$300 000 per QALY gained and A$1500 and A$450 000 per DALY averted. Family therapy was only preferred at WTP thresholds above A$300 000 per QALY gained or A$450 000 per DALY averted. In sensitivity analyses, brief psychoeducation was the preferred therapy. Psychoeducation and CBT were dominated (more costly and less effective) in base-case and sensitivity analyses.
Conclusions
Carer and brief psychoeducation were found to be the most cost-effective psychosocial therapies, supporting use as adjunctive treatments for adults with bipolar disorder and their families in Australia.
The objective of this paper is to present the Environmental Sustainability in Health Technology Assessment (ESHTA) Working Group’s (WG’s) opinion on the definition and scope of early Health Technology Assessment (HTA) developed by a WG under HTA International. The aim is to provide suggestions on how early HTA can support the goals of enhancing environmental sustainability in healthcare.
Methods
The HTAi ESHTA WG presents our opinion on the proposed definition and scope of early HTA. This includes a broad range of perspectives from stakeholder groups including patient experts, a policy maker, a statistician, HTA researchers and a healthcare professional, located across lower to higher resource settings and several jurisdictions. We suggest how early HTA can support the goals of enhancing environmental sustainability in healthcare.
Results
HTA agencies play a crucial role in embedding sustainability into their evaluations and practices. Integrating environmental sustainability into HTA at three critical stages – product conceptualization, reimbursement decisions, and point of care – can optimize resource use and reduce environmental impacts. Developing sustainability metrics, defining environmental impact categories, and identifying suitable methods for assessing health technologies are essential steps. Early engagement is also vital for optimizing trade-offs and increasing acceptance by diverse stakeholders.
Conclusions
Incorporating environmental sustainability into early HTA can enhance the likelihood of regulatory approval and reimbursement, ultimately benefiting patients and healthcare systems. By integrating sustainability considerations at the design stage, the potential for environmental impact reduction is maximized. Future efforts should focus on developing comprehensive guidelines and methods, ensuring collaboration between early HTA and ESHTA WGs.
In the past decade, feminist scholars and women's rights activists have used the feminist judgment method to reimagine the relationship between law and gender justice, resulting in rewritten 'feminist' judgments from courts around the world. This groundbreaking book extends this approach and applies it to a wide range of decisions of the International Criminal Court (ICC), the Hague-based court with power to prosecute war crimes, crimes against humanity, genocide and aggression in over 120 countries. With over 60 contributors from the Global North and Global South, including countries where the ICC has been active, this book reflects an international and intersectional feminism. Diverse contributions reveal the gendered implications of crimes (both sexual and non-sexual), command responsibility, defences, complementarity, head of state immunity, sentencing, reparations and more. This title is also available as Open Access on Cambridge Core.
This volume introduces the legal philosopher Adolf Reinach and his contributions to speech act theory, as well as his analysis of basic legal concepts and their relationship to positive law. Reinach's thorough analysis has recently garnered growing interest in private law theory, yet his 'phenomenological realist' philosophical approach is not in line with contemporary mainstream approaches. The essays in this volume resuscitate and interrogate Reinach's unique account of the foundations of private law, situating him in contemporary private law theory and broader philosophical currents. The work also makes Reinach's methods more accessible to those unfamiliar with early phenomenology. Together these contributions prove that while Reinach's perspective on private law shares similarities and points of departure with trends in today's legal theory, many of his insights remain singular and illuminating in their own right. This title is also available as Open Access on Cambridge Core.
Comparative social policy research frequently deals, implicitly or explicitly, with time and timing in the development of welfare states. We identify three types of such temporal theorizations – i.e. stage models, timed orders, and periodizations – and analyze their relevance for global social policy development. We do so by employing sequence and cluster analysis to a new comprehensive dataset of social policy adoption in 164 countries over 140 years (1880–2019). While our analysis reveals certain common stages of social policy consolidation – from education mandates and health care systems over work-related protections to care services – we also find varying trajectories which challenge conventional regional clustering narratives. Moreover, our analysis highlights two periods which have so far not featured prominently in comparative welfare state research: The interwar years (1919–1929) and the period of decolonization (1949–1969).
Physical exercise improves mental and physical health of individuals with severe mental illness (SMI); however, its impact on metabolic syndrome remains unclear.
Aims
To evaluate the effects of exercise interventions on metabolic syndrome components in individuals with SMI and explore interactions between exercise and antipsychotic medications on metabolic outcomes.
Methods
Following PRISMA guidelines, we systematically searched PubMed, CINAHL, Web of Science, and APA PsycINFO through October 10, 2023, for randomized controlled trials (RCTs) assessing the effects of exercise on waist circumference, blood pressure, glucose, triglycerides, and HDL cholesterol in SMI. Risk of bias was evaluated using the Cochrane RoB-2 tool. Data were pooled using random-effects models in Comprehensive Meta-Analysis and JASP.
Results
Ten RCTs (N = 773; mean age 39.9 ± 7.36 years; 38.7% female; 71.5% schizophrenia spectrum disorders) met inclusion criteria. Pooled analyses revealed no significant effects of exercise on waist circumference (SMD = 0.206, 95% CI [−0.118, 0.530], p = 0.171), systolic blood pressure (SMD = 0.194, 95% CI [−0.115, 0.504], p = 0.219), diastolic blood pressure (SMD = −0.21, 95% CI [−0.854, 0.434], p = 0.522), HDL (SMD = 0.157, 95% CI [−0.36, 0.674], p = 0.551), triglycerides (SMD = −0.041, 95% CI [−0.461, 0.38], p = 0.849), or glucose (SMD = −0.071, 95% CI [−0.213, 0.071], p = 0.326). Heterogeneity was moderate to high.
Conclusions
Exercise interventions did not significantly improve metabolic syndrome components in SMI. Future trials must prioritize tailored regimens, adjunctive therapies, and rigorous control of medication effects.
We construct two families of orthogonal polynomials associated with the universal central extensions of the superelliptic Lie algebras. These polynomials satisfy certain fourth-order linear differential equations, and one of the families is a particular collection of associated ultraspherical polynomials. We show that the generating functions of the polynomials satisfy fourth-order linear PDEs. Since these generating functions can be represented by superelliptic integrals, we have examples of linear PDEs of fourth order with explicit solutions without complete integrability.
The experience of psychosis in schizophrenia spectrum disorders involves significant distress and functional impairment, contributing to immense social and economic costs. Current gold standard treatment guidelines emphasize the use of antipsychotic medications, though responses to these treatments vary widely, with the potential for detrimental side effects. However, increasing placebo responses in randomized controlled trials since the 1960s complicate the development of new medications. Elevated placebo responses are common in psychiatric populations, including those with psychosis, and are influenced by individual beliefs and prior experiences. Despite extensive research on placebo mechanisms in conditions such as depression and pain, little is known about mechanisms of these effects in psychosis. This narrative review examines the predictors and belief formation processes underlying placebo and nocebo phenomena in psychosis. We discuss features of randomized controlled trials for antipsychotic medications, individual symptom heterogeneity, and contextual factors. Findings related to placebo effects for motivation and cognition-enhancing drugs are also discussed. We then consider the possibility that theories of predictive coding and aberrant salience provide explanation for aspects of both placebo effects and schizophrenia spectrum symptoms. The role of outcome expectations broadly and in the context of reward processing is considered. We conclude with some recommendations for future placebo research in psychosis, emphasizing the diversity of placebo effects, assessment concerns, cultural considerations, and methodological aspects. Future multidisciplinary research is required to further elucidate placebo effects in schizophrenia spectrum disorders.
To evaluate performance of registered nurse assessments of the PEN-FAST penicillin allergy clinical decision rule compared to antimicrobial stewardship pharmacists.
This study took place across 4 inpatient hospitals within a large health system in Houston, Texas.
Methods:
We implemented PEN-FAST rule questions into the electronic health record (EHR) for registered nurses to perform. Patients were randomly selected in a prospective fashion, with nurse documented scores hidden, for re-assessment by antimicrobial stewardship pharmacists to compare risk stratification and scores.
Results:
Overall agreement of high risk and low risk results was 84.3%. Registered nurse evaluations with the PEN-FAST clinical decision rule for detecting a high-risk patient demonstrated a sensitivity of 67%, specificity of 89.8%, positive predictive value of 67.9%, and negative predictive value of 89.5%. Additionally, 34.4% of patients with a documented penicillin allergy admitted to tolerating amoxicillin or amoxicillin/clavulanate since their last recalled reaction to penicillin.
Conclusions:
Registered nurse assessment of the PEN-FAST clinical decision rule demonstrated good performance and can effectively be used to screen for low-risk penicillin allergy patients. Incorporation of the PEN-FAST rule into EHR can be scaled into large health systems to help appropriately stratify patients with low- and high-risk penicillin allergies and improve documentation.
Although web-based data collection has become increasingly popular in (linguistic) research over the past years, many researchers are still cautious about collecting data via the internet. Thus, this study aims at comparing web-based and lab-based testing of linguistic manipulations that have resulted in robust findings in previous lab-based research on bilingual language processing. A total of 134 L1 German students of L2 English participated in two experiments in a web-based (n = 78) or lab-based setting (n = 56). The study examined potential language co-activation through cognates in an English Lexical Decision Task (Experiment 1) and the use of L2 lexical and syntactic information in English relative clause processing in a Self-paced Reading Task (Experiment 2). We found comparable evidence of lexical and syntactic processing in both groups in both experiments. Critically, this paper provides important methodological implications for web-based data collections with second language learners.
An analytical formulation is provided that describes the first two natural modes of the fluid–structure interaction of an incompressible current with a pitching and heaving flexible plate. The objective is twofold: first, to present a general derivation of analytical expressions for the lift, moment and the flexural moments exerted by an inviscid flow on a pitching and heaving plate whose deformation is general enough that the coupling of the flexural moments with the structural equations allows solving analytically the first two natural modes of the system; second, to analyse the propulsion performance of the foil when actuated near the first two natural frequencies. For the second purpose, one also needs the thrust force generated through the motion and the general deformation of the foil considered, which is analytically derived using the linearized vortex impulse theory, extending and systematizing previous works. The analytical expressions, once viscous effects are taken into consideration through nonlinear transverse damping and offset drag coefficients, are compared with small-amplitude available experimental data, discussing their limitations. It is found that low stiffness pitching and heaving are quite different, with a pitching flexible foil only generating thrust near the second resonant frequency, whereas heaving always generates thrust, with the maximum slightly below the second natural frequency. Maximum thrust for large stiffness pitching is around the first natural frequency. The maximum efficiency occurs at frequencies close to the first natural mode if the foil is sufficiently rigid, but it is not related to the natural frequencies as the rigidity decreases.
Are shifting party-union relationships impacting the vote intentions of union members in Canada? By analyzing voting intentions within the Canadian labour movement, the findings illuminate the complexity of union members’ electoral behaviour and the strategic opportunities for parties vying for their votes. The authors find that while union members continue to be more likely than the average voter to support the NDP, this support is nuanced by factors such as union type, gender, education, age, and income. Notably, the study finds that the Conservatives have made significant inroads among construction union members and those with college education, challenging traditional assumptions about Canadian labour politics.
This article is concerned with the history of eugenic sterilisation in Britain through the 1920s and 1930s. In this period, the Eugenics Society mounted an active but ultimately unsuccessful campaign to legalise the voluntary surgical sterilisation of various categories of people, including those deemed ‘mentally deficient’ or ‘defective’. We take as our explicit focus the propaganda produced and disseminated by the Eugenics Society as part of this campaign, and especially the various kinds of data mobilised therein. The parliamentary defeat of the Society’s Sterilisation Bill in July 1931 marks, we argue, a significant shift in the tactics of the campaign. Before this, the Eugenics Society framed sterilisation as a promising method for eradicating, or at least significantly reducing the incidence of, inherited ‘mental defect’. Subsequently, they came to emphasise the inequality of access to sterilisation between rich and poor, (re)positioning theirs as an egalitarian campaign aimed at extending a form of reproductive agency to the disadvantaged. These distinct phases of the campaign were each supported by different kinds of propaganda material, which in turn centred on very different types of data. As the campaign evolved, the numbers and quantitative rhetoric which typified earlier propaganda materials gave way to a more qualitative approach, which notably included the selective incorporation of the voices of people living with hereditary ‘defects’. In addition to exposing a rupture in the Eugenics Society’s propagandistic data practices, this episode underscores the need to further incorporate disabled dialogues and perspectives into our histories of eugenics.
Surgical sterilisation practices significantly increased in contraceptive capacity as the twentieth century unfolded. Despite this prolific uptake, sterilisation is markedly absent from histories of birth control and family planning and instead has remained addressed within histories of eugenics and coercion. The purpose of this article is twofold: firstly, to demonstrate a voluntary, contraceptive history of sterilisation that is distinct from, though connected to, involuntary and eugenic sterilisation; and secondly, to explain the integral role that individual doctors and their private practice played in the rise of contraceptive sterilisation in twentieth-century Australia. Through a combination of archival material and oral history interviews with twentieth-century practitioners of tubal ligation and vasectomy, this article reframes the history of surgical sterilisation, situating it firmly within the history of birth control.
The hospital setting is often perceived as slow to change. While employee-driven approaches offer a promising alternative to traditional top-down methods, guidance is limited. This study provides a description and formative evaluation of an employee-driven working group (WG) approach to tailor ward-specific measures to improve care in the dying phase. The aim is to evaluate the WG process and offer practical insights for transferability to other hospitals.
Methods
Formative mixed-methods evaluation of a WG process to tailor ward-specific evidence-informed measures on 10 wards outside specialized palliative care at 2 German medical centers. To analyze factors relevant for the WG process, the Consolidated Framework for Implementation Research 2.0 was applied. Data included baseline evaluation (medical record analysis, staff survey and focus groups, informal caregiver interviews), WG protocols, and an online survey with WG participants.
Results
Multiprofessional WGs were established on all hospital wards, with an average of 7 meetings per ward within 1 year and 4 participants per meeting. Adapting the process to participants’ wishes and needs were crucial, particularly regarding the desired degree of external input. We identified 4 barriers (e.g. declining participation, institutional limits) and 7 facilitators (e.g. involvement of staff in leading positions, multiprofessional composition). The WGs tailored 34 measures, e.g. team meetings to improve communication within the team. Participants’ views were generally positive: 91% felt able to share their thoughts, 66% were satisfied with the outcome, and 77% would participate again.
Significance of results
The employee-driven approach was feasible and useful for tailoring ward-specific measures. However, integrating top-down elements proved to be beneficial. The identified barriers and facilitators provide insights for transferring an employee-driven approach to other hospitals to improve care in the dying phase outside specialized palliative care settings.
Clinical trial registration
The study was registered in the German Clinical Trials Register (DRKS00025405).