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With global population ageing and shifting morbidity and disability patterns, the demand for long-term care is increasing. The chapter highlights the impact of demographic changes, particularly the rise in the older population and the growing need for dementia care, on long-term care demand. It advocates for a paradigm shift from institutionalized nursing homes to home-based care and stresses the need for policy support to enhance informal caregiving and develop a robust long-term care workforce. Additionally, it underscores the significance of recognizing long-term care as a social and human right and establishing a regulatory framework to ensure high-quality care.
An important feature of the dynamics of double-diffusive fluids is the spontaneous formation of thermohaline staircases, where wide regions of well-mixed fluid are separated by sharp density interfaces. Recent developments have produced a number of one-dimensional reduced models to describe the evolution of such staircases in the salt fingering regime relevant to mid-latitude oceans; however, there has been significantly less work done on layer formation in the diffusive convection regime. We aim to fill this gap by presenting a new model for staircases in diffusive convection based on a regularisation of the $\gamma$-instability (Radko 2003 J. Fluid Mech. vol. 805, 147–170), with a range of parameter values relevant to both polar oceans and astrophysical contexts. We use the results of numerical simulations to inform turbulence-closure parametrisations as a function of the horizontally averaged kinetic energy $e$, and ratio of the haline to thermal gradients $R_0^*$. These parametrisations result in a one-dimensional model that reproduces the critical value of $R_0^*$ for the layering instability, and the spatial scale of layers, for a wide range of parameter values, although there is a mismatch between the range of $R_0^*$ for layer formation in the model and observational values from polar oceans. Staircases form in the one-dimensional model, evolving gradually through layer merger events that closely resemble simulations.
Since the 1978 discovery of an islet “Oodaaq Island” north of Greenland, then considered to be the northernmost island in the world, multiple islets have been reported and apparently disappeared with regular intervals in the permanent sea ice-covered area offshore the northernmost part of Greenland. In this paper, we report results of comprehensive investigations at all quoted positions of reported islets, with bathymetry measurements, as well as supplementary lidar, ice thickness and gravity measurements during a helicopter reconnaissance. The bathymetry measurements confirm the non-existence of all the reported islets, and the northernmost land in the world is thus confirmed to be the moraine island “Inuit Qeqertaat” (Kaffeklubben Island) at latitude 83°39′54″ N, 30°37′45 ″ W. All reported islet positions are found at ocean depths from 26 m to 47 m, with no indications of shallow banks or submarine rocks at the reported positions. It is therefore concluded that all reported islets or new islands since 1978 have been stranded icebergs, likely originating from marine-terminating glaciers near Cape Morris Jesup, and stranded for up to several years in the relatively shallow and nearly permanently sea ice-covered areas around Inuit Qeqertaat.
The accession of British colonies to the League was drafted so as not to set a precedent, yet by 1923, another British Dominion had acceded to the League. Chapter Four covers the unanticipated accession of Ireland to the League, and how Britain attempted to use League membership to manage more active anti-colonial struggles within its Empire. This chapter examines how Irish nationalists perceived the League, both as a promising vehicle of international recognition and liberation, but also as a tool of British imperialism. Furthermore, it explores the role the League played in the negotiations around the Anglo-Irish ‘Treaty’ that created the Irish Free State, and how the League acted as a guarantor of the agreement. Finally, this chapter observes how the Free State approached League membership, and how the entry of the so called ‘restless Dominion’ would test the doctrine of inter se.
Having secured a seat at the Paris Peace Conference at the end of the First World War, British and Dominion officials pushed for the accession of British colonies to the new League of Nations. Chapter Two probes the legal bases, as well as the political arguments employed to convince United States’ President Woodrow Wilson, why the Dominions and India should be separate member states from Britain at the League. As Britain and the Dominions pushed Wilson for colonial accession to the League, this chapter also examines political pressures, both within the United States, as well as from anti-colonial nationalists from within British colonies, who wanted their own membership of the League, separate from the one proposed by Britain. In doing so, this chapter answers whether colonial membership came about through British imperial design, or through anti-colonial pressures of the ‘Wilsonian Moment’.
As the Irish Free State came into being, Egypt too was declared independent. Whilst in Ireland, League membership was rapidly forthcoming, negotiations for Egypt’s accession were protracted, with Egypt acceding in 1937, the last member state to join the League. Chapter Five investigates why Egypt, which was never formally a colony of the British Empire and from 1922 deemed an independent state, was obstructed by Britain from joining the League for fifteen years. This chapter examines the contested relationship between the Egyptian nationalist Wafd party, that sought Egyptian independence, and Britain, that sought Egyptian acquiescence to a treaty of alliance. Egypt’s contested accession to the League reveals the risks that colonial membership to the League posed to British imperial policy, and how Britian could act as a gatekeeper for the accession of their colonies to the League. Finally, this chapter reveals how the actions of another imperial party, Italy, and its growing encroachment into North-East Africa would ultimately lead to a compromise that would see Egypt’s accession to the League.
Surface gravity waves induce a drift on objects floating on the water’s surface. This study presents laboratory experiments investigating the drift of large two-dimensional floating objects on deep-water, unidirectional, regular waves, with wave steepness ranging from 0.04 to 0.31 (0.04 $\lt k{a_w}\lt$ 0.31, where $k$ is the wavenumber and $a_w$ the wave amplitude). The objects were carefully designed to have a rectangular cross-section with a constant aspect ratio; their size varied from 2.6 $\%$ to 27 $\%$ of the incident wavelength. We observed Lagrangian behaviour for small objects. Small and large objects exhibited fundamentally different drift behaviour at high compared with low wave steepness, with a regime shift observed at a certain size and wave steepness. The scaling of object drift with steepness depends on the relative size of the object. For small objects, drift scales with steepness squared, whereas drift becomes a linear function of steepness as the object size increases. For objects that are relatively large but smaller than 13–16% of a wavelength (low to high steepness), we provide experimental evidence supporting the mechanisms of drift enhancement recently identified by Xiao et al. (J. Fluid Mech., vol. 980, 2024, p. A27) and termed the ‘diffraction-modified Stokes drift’. This enhanced drift behaviour, compared with the theoretical Stokes drift for infinitely small fluid parcels, is attributed to changes in the objects’ oscillatory motion and local wave amplitude distribution (standing wave pattern) due to the presence of the object. In the case of larger objects, similar to Harms (J. Waterw. Port Coast. Ocean Eng., vol. 113(6), 1987, pp. 606–622), we relate the critical size at which drift is maximised to their vertical bobbing motion. We determine the domain of validity for both Stokes drift and the diffraction-modified Stokes drift model of Xiao et al. (J. Fluid Mech., vol. 980, 2024, A27) in terms of relative size and wave steepness and propose an empirical parametrisation based on our experimental data.
We develop a model to perform a cost–benefit analysis of bus fare subsidies under financial constraints that preclude the purchase of additional buses. Our model considers users’ costs in the provision of bus services and the lack of road pricing to internalize urban transport externalities in a context where financial constraints severely limit the institutional ability to plan and design the bus system. Because of financial constraints, the bus system can hardly accommodate demand during peak times: buses travel overcrowded, passengers cannot board the first bus to arrive at the bus stop, and they cannot arrive at their destination at their desired time. Another salient aspect of our model is the inclusion of motorcycles as a second private transport mode. Motorcycles are typical in many urban agglomerations in the emerging world and engender many negative transport externalities. According to our results, fare subsidies provide social benefits in Metropolitan Asunción. During peak hours, a higher subsidy is justified as the reduction of the unpriced external costs of substitute modes compensates for the increased cost created by an additional bus passenger. In the off-peak, a higher subsidy is justified (i) as the higher frequencies induced by the new bus ridership reduce waiting times and (ii) because of the reduction of the unpriced external costs of substitute modes. Although our model does not explicitly include inequality aversion, we discuss the distributional aspects of subsidies in the context of middle-income countries.
Individuals with a psychiatric inpatient admission in adolescence have a high risk of schizophrenia-spectrum disorders (SSDs) when followed to adulthood. Whether psychotic symptoms predict subsequent SSDs in inpatient cohorts, however, is an important unanswered question.
Methods
The sample consisted of adolescents (aged 13–17) admitted to psychiatric inpatient care (Oulu, Finland) from April 2001 to March 2006. Psychotic symptoms were assessed with the Schedule for Affective Disorders and Schizophrenia. Specialized health care use and diagnoses were followed up in national health care registers until June 2023. Cox regression was used to predict SSDs by the presence of baseline psychotic symptoms.
Results
Of 404 adolescent inpatients admitted with non-psychotic mental disorders, 28% (n = 113) reported psychotic symptoms: 17% (n = 68) subthreshold and 11% (n = 45) full threshold. By the end of follow-up, 23% of the total cohort went on to be diagnosed with an SSD. Subthreshold psychotic symptoms did not differentiate patients who would subsequently develop SSDs (cumulative incidence 24%; HR = 1.42, 95%CI = 0.81–2.50). Full-threshold psychotic symptoms, on the other hand, were associated with an increased risk of subsequent SSDs (cumulative incidence 33%; HR = 2.00, 95%CI = 1.12–3.56). Most subsequent SSDs (83%), however, occurred in individuals who had not reported threshold psychotic symptoms during inpatient admission.
Conclusions
There was a high risk of subsequent SSDs among adolescent psychiatry inpatients when followed over time. SSDs were not predicted by subthreshold psychotic symptoms. Full-threshold psychotic symptoms were associated with an increased risk of subsequent SSDs, though with low sensitivity.
‘An anomaly among anomalies!’ exclaimed David Hunter Miller, the United States’ legal representative at the Paris Peace Conference in 1919. For Miller, in the decision to admit the British Empire’s ‘self-governing’ colonies, such as Canada, to the idealistic new organisation to secure world peace, the League of Nations had stretched international norms. What aggravated this already-peculiar situation for Miller was the admission of India, a British colony with few self-governing and representative institutions, no independent foreign policy, and no discernible international personality.
Contaminated surfaces in clinics pose a pathogen transmission risk. Far ultraviolet-C light (UVC), with a favorable safety profile for human exposure, has the potential for continuous pathogen inactivation in occupied clinical areas. This study demonstrated real-world bioburden reduction on surfaces, despite frequent contamination from routine use by staff and patients in clinics.
Improvements to agricultural sustainability are required to maintain productivity in the face of ongoing global challenges, and growers need multiple kinds of support to adopt new sustainability practices and transform cropping systems. Farms are socio-ecological systems, and developing such systems requires tandem changes to human and nonhuman systems. This study evaluates agricultural sustainability practices and perception in the Oregon hazelnut industry, a small, intensified, and rapidly growing orchard production system in the United States. Using a mixed methods approach based on participant observation and an online survey of hazelnut growers in the spring of 2023, we found that growers were widely receptive to the sustainability messaging of industry groups and had widespread adoption of certain sustainability practices including disease-resistant tree varieties and changes in pesticide use, among other practices promoted by researchers. Larger hazelnut growers were more likely to adopt the sustainability practices in our survey, especially certain pest management practices. Growers with older hazelnut orchards turned to more sources of information but also perceived more barriers to implementing new sustainability practices than growers with younger orchards. Growers voiced different opinions about sustainability costs, with some growers expressing economic concerns about sustainability practices and others recognizing the financial benefits of sustainability practices. Differences in the perceived importance of short- and long-term benefits framed some of these concerns about the costs and benefits of sustainability practices. We argue that successful sustainability outreach will address both the short-term economic benefits of certain practices and the long-term sustainability benefits. Growers widely recognize the importance of sustainability, but more messaging about the multiple benefits of sustainability practices can better address both environmental and economic concerns.
Is Christ hypostatically united to his human nature during Holy Saturday? If so, how, given that he is (in effect) an object whose parts are in different ‘places’? In this article, I argue that God the Son does indeed remain hypostatically united to his human nature during Holy Saturday and that this is salvifically salient. One way to construe this ongoing union through somatic death is by means of the analogy of a ‘dead limb’ – Christ’s human body being that limb. I set out several ways of making sense of this claim consistent with a broadly orthodox account of the hypostatic union as a contribution to the theology of Holy Saturday and the intermediate state more broadly.
Trust is essential for effective collaboration. In advice settings, decision-makers’ trust in their advisors determines their willingness to follow advice. We propose that trust in the opposite direction, that is, the trust of the advisor in the decision-maker, can affect the use of advice. Specifically, we suggest that advice-taking is greater after a show of trust by the advisor than after an instance of distrust. We conducted four behavioral experiments using the trust game and judge–advisor system paradigms and one scenario study using a sample of currently employed professionals (N = 1599). We find that initial displays of trust by advisors result in greater acceptance of their advice (Studies 1A-B). This effect persists across different levels of advice quality, resulting in smaller underutilization of high-quality advice but also in overreliance on low-quality advice (Study 2). Decision-makers not only show greater willingness to follow advisors who trust them but also respond similarly to advisors who display trust in other people (Study 3). Finally, we find evidence for both perceived advisor competence and decision-makers’ motivation to reciprocate as mediators of the relation between advisors’ level of trust and decision-makers’ willingness to follow their advice (Study 4). Our findings shed light on the dynamics of trust and persuasion in advice relationships and provide insight for advisors who wish to maintain the effectiveness of their input.
As Ethiopia advances towards efficient resource utilization and UHC through strategic health purchasing, the institutionalization of HTA will play a critical role. This study aims to identify key stakeholders, analyze the political economy surrounding HTA and priority setting in Ethiopia, and assess existing skills and capacities for a robust and sustainable HTA system.
Methods
We employed a mixed-method approach, combining 16 key informant interviews, 24 document reviews, and a cross-sectional survey (n=65) to assess national HTA capacity. We employed the Walt and Gilson policy analysis triangle framework, alongside Campos and Reich’s framework, to evaluate the context, process, content, and actors influencing HTA institutionalization, and to explore the complex interplay of institutions, positions, power, and interests among various stakeholders.
Results
While there is a general commitment to implementing HTA across various government agencies and stakeholder groups, the institutionalization process faces several challenges, involving multiple agencies with overlapping mandates, raises bureaucratic challenges and potential conflicts, risking horizontal fragmentation as agencies compete for authority, budget, and influence. The involvement of other key stakeholders, such as professional associations, patients, and the public, is notably lacking. Challenges such as limited HTA expertise, high professional turnover, and gaps in specific HTA knowledge areas persist, with capacity-building efforts often failing to address organizational needs effectively.
Conclusions
The complexity of HTA institutionalization in Ethiopia underscores the necessity of managing intricate inter-agency dynamics, establishing a robust legal framework for an inclusive and transparent HTA process, building local capacity, and securing sustainable, domestically aligned funding.
The comparative literature has devoted considerable attention to why individuals join political parties. This is especially important in the context of the declining party membership and activism that political parties face in contemporary politics. While the question of why members join parties has been well-documented, considerably less work has considered incentives to join other party positions. In the Canadian case, for example, we know very little about the incentives to join an electoral district association (EDA). This is surprising given the consequential role—both formal and informal—that local party associations and their presidents have been known to play in intra-party politics (influencing candidate nomination, membership recruitment and so forth). This study applies Clark and Wilson's (1961) framework of material, solidary and purposive incentives to local party association membership and asks why individuals join their local party executive and whether this motivation shapes the subsequent character of the EDA.
Why is solidarity between people of color (PoC) so difficult to achieve? New evidence suggests solidarity can be activated through a sense of shared discrimination between PoC. Yet other research highlights many real-world obstacles to this solidarity, including recurring inter-minority conflicts. We consider system justification as one possible mechanism that undercuts PoC solidarity. System justification is a human motive to bolster the status quo. System justifiers who are PoC condone racial inequalities as stable, predictable, and just—which alleviates mental stressors associated with their own racially stigmatized status. We investigate system justification’s impacts on Asian Americans: a key party to many coalitions and conflicts with Black and Latino people. Using national survey data, we find that system justification is significantly associated with Asian opposition to solidarity with Black Lives Matter, net of racial resentment, and other key covariates. We then refine this result experimentally by exposing Asian adults to the model minority myth—a system-legitimizing ideology. Exposure to this myth triggers system justification, which then increases Asian opposition to pro-Black and pro-Latino policies, among other solidarity-based outcomes. Both results are primarily driven by conservative Asian Americans, highlighting a need to better appreciate Asian Americans’ ideological diversity in U.S. racial politics.