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Individuals living with severe mental illness can have significant emotional, physical and social challenges. Collaborative care combines clinical and organisational components.
Aims
We tested whether a primary care-based collaborative care model (PARTNERS) would improve quality of life for people with diagnoses of schizophrenia, bipolar disorder or other psychoses, compared with usual care.
Method
We conducted a general practice-based, cluster randomised controlled superiority trial. Practices were recruited from four English regions and allocated (1:1) to intervention or control. Individuals receiving limited input in secondary care or who were under primary care only were eligible. The 12-month PARTNERS intervention incorporated person-centred coaching support and liaison work. The primary outcome was quality of life as measured by the Manchester Short Assessment of Quality of Life (MANSA).
Results
We allocated 39 general practices, with 198 participants, to the PARTNERS intervention (20 practices, 116 participants) or control (19 practices, 82 participants). Primary outcome data were available for 99 (85.3%) intervention and 71 (86.6%) control participants. Mean change in overall MANSA score did not differ between the groups (intervention: 0.25, s.d. 0.73; control: 0.21, s.d. 0.86; estimated fully adjusted between-group difference 0.03, 95% CI −0.25 to 0.31; P = 0.819). Acute mental health episodes (safety outcome) included three crises in the intervention group and four in the control group.
Conclusions
There was no evidence of a difference in quality of life, as measured with the MANSA, between those receiving the PARTNERS intervention and usual care. Shifting care to primary care was not associated with increased adverse outcomes.
Centripetal approaches to democracy in divided societies seek to promote inter-ethnic accommodation and moderation by making politicians dependent on the electoral support of groups other than their own base. Such cross-ethnic voting stands in contrast to situations where politicians need only the support of their own co-ethnics to win elections. This distinction can be used to evaluate the utility of centripetal electoral systems in promoting voting across ethnic divides. To do so, this article begins by considering some critiques of centripetalism, showing that cross-ethnic voting is more common in both institutional design and actual practice than some critics believe. It then moves on to examine cases of cross-ethnic voting via ethnically designated party lists, cross-regional party formation rules, at-large communal or sectoral seat reservations, and uni-directional vote-pooling, using these cases to construct an index of strong, moderate and weak centripetal electoral systems.
The effect of initial conditions on transition to turbulence is studied in a variable-density shock-driven flow. Richtmyer–Meshkov instability (RMI) evolution of fluid interfaces with two different imposed initial perturbations is observed before and after interaction with a second shock reflected from the end wall of a shock tube (reshock). The first perturbation is a predominantly single-mode long-wavelength interface which is formed by inclining the entire tube to 80$^{\circ }$ relative to the horizontal, yielding an amplitude-to-wavelength ratio, $\unicode[STIX]{x1D702}/\unicode[STIX]{x1D706}=0.088$, and thus can be considered as half the wavelength of a triangular wave. The second interface is multi-mode, and contains additional shorter-wavelength perturbations due to the imposition of shear and buoyancy on the inclined perturbation of the first case. In both cases, the interface consists of a nitrogen-acetone mixture as the light gas over carbon dioxide as the heavy gas (Atwood number, $A\sim 0.22$) and the shock Mach number is $M\approx 1.55$. The initial condition was characterized through Proper Orthogonal Decomposition and density energy spectra from a large set of initial condition images. The evolving density and velocity fields are measured simultaneously using planar laser-induced fluorescence (PLIF) and particle image velocimetry (PIV) techniques. Density, velocity, and density–velocity cross-statistics are calculated using ensemble averaging to investigate the effects of additional modes on the mixing and turbulence quantities. The density and velocity data show that a distinct memory of the initial conditions is maintained in the flow before interaction with reshock. After reshock, the influence of the long-wavelength inclined perturbation present in both initial conditions is still apparent, but the distinction between the two cases becomes less evident as smaller scales are present even in the single-mode case. Several methods are used to calculate the Reynolds number and turbulence length scales, which indicate a transition to a more turbulent state after reshock. Further evidence of transition to turbulence after reshock is observed in the velocity and density fluctuation spectra, where a scaling close to $k^{-5/3}$ is observed for almost one decade, and in the enstrophy fluctuation spectra, where a scaling close to $k^{1/3}$ is observed for a similar range. Also, based on normalized cross correlation spectra, local isotropy is reached at lower wave numbers in the multi-mode case compared with the single-mode case before reshock. By breakdown of large scales to small scales after reshock, rapid decay can be observed in cross-correlation spectra in both cases.
Using Przeworski et al.’s paradigmatic work on democracy and development as a touchstone, this review examines East Asia’s lessons for comparative politics. It focuses particularly on the challenges that China and South-East Asia present for modernization theory, a foundation stone of political science. In most of the rich world, including north-east Asian cases of modernization such as Korea and Taiwan, economic development and democratization have tended to go hand in hand. In South-East Asia, by contrast, almost none of the expected relationships between democracy and development seems to work. The most striking anomaly of all today is China, which appears to be moving ever further away from democratic reform as it grows richer. This disjuncture between theory and practice is explored, along with other, more positive, East Asian contributions to scholarship on democracy and development.
Over the past two decades, numerous East Asian states have undergone transitions to democracy. One of the most distinctive aspects of democratization has been the way East Asian democracies have sought to manage political change by institutional innovations that aim to influence the development of the region's party systems. These reforms have typically tried to promote more centrist and stable politics by encouraging fewer, and hence larger, political parties. The result is an increasing evolution of the region's electoral and party system constellations toward more majoritarian elections and, in some cases, nascent two-party systems.
In what countries and among which individuals in Asia is China's influence seen as least favorable? Drawing upon AsiaBarometer survey data from 12 Asian societies between 2006 and 2008, this study tests a series of hypotheses aimed at identifying those variables that most consistently predict individuals’ perceptions of China. With the exceptions of Japan, South Korea, Taiwan and Vietnam, a clear plurality or a majority of respondents in each polity views China's influence positively. Concerns about domestic economic management were most consistently associated with perceptions of China that are more unfavorable, while greater levels of contact with the Chinese film and television culture were consistently associated with perceptions of China that are more favorable. These results suggest that China is more likely to be seen as an economic rather than military threat by Asian publics, and that Asia may prove responsive to a nuanced soft power campaign by Beijing in the future.
Google Insights for Search provides a new and rich data source for political scientists, which may be particularly useful for state politics scholars. We outline the prior uses of Google Insights for Search in social and health sciences, explain the data-generating process, and test for the first time the validity of this data for state politics research. Our empirical test of validity shows that Google searches for ballot measures' names and topics in state one week before the 2008 Presidential election correlate with actual participation on those ballot measures. This demonstrates that the more Internet searches there were for a ballot measure, the less likely voters were to rolloff (not answering the question), and establishes the construct validity for this data for one important topic in state politics research. We also outline the limitations to this data source.
Democracy is inherently difficult in societies divided along deep ethnic cleavages. Elections in such societies will often encourage 'centrifugal' politics which reward extremist ethnic appeals, zero-sum political behaviour and ethnic conflict, and which consequently often lead to the breakdown of democracy. Reilly examines the potential of 'electoral engineering' as a mechanism of conflict management in divided societies. He focuses on the little-known experience of a number of divided societies which have used preferential, vote-pooling electoral systems - such as Papua New Guinea, Sri Lanka, Northern Ireland and Fiji. Examination of these cases shows that electoral systems which encourage bargaining between rival political actors, which promote the development of broad-based, aggregative political parties and which present campaigning politicians with incentives to attract votes from a range of ethnic groups can, under certain conditions, encourage the development of moderate, accommodatory political competition in divided societies.
Elections held as part of a peace deal following a violent conflict highlight several crucial dilemmas of democratization in post-war societies. Such “post-war elections” are now a feature of almost all efforts to democratize war-torn regions, with peace agreements routinely including provisions for elections to be held as part of the process of conflict termination, often with the assistance, supervision, or sometimes direct control of the international community. But while post-war elections have become an integral element of contemporary peace agreements, they can also themselves become the focus of increasing tension and renewed violence. Taking a comparative perspective, this chapter focuses on several inherent dilemmas of post-war elections, including issues of timing, sequencing, mechanics, political parties, and the role of the international community. In each of these areas, post-war elections force difficult choices to be made between short-term versus long-term priorities, representation versus stability, domestic versus international legitimacy, and a range of other sometimes incompatible objectives.
These dilemmas are reinforced by the competing discourses that dominate both academic and policy discussions of post-war elections. On the one hand, elections and democracy are often seen as a primary means of conflict management, with theorists arguing for the benefits of democratic competition in managing the tensions inherent in all societies, including war-torn ones (see Przeworski 1991). On the other hand, an increasing body of work points to the dangers of holding elections in conflict-prone societies, and the empirical reality that societies in the early stages of democratization are often more, not less, conflict prone (Snyder 2000).
By
Ronald Prinn, Department of Earth, Massachusetts Institute of Technology,
John M. Reilly, Joint Program on the Science, Massachusetts Institute of Technology,
Marcus Sarofim, Joint Program on the Science, Massachusetts Institute of Technology,
Chien Wang, Department of Earth, Massachusetts Institute of Technology,
Benjamin Felzer, Marine Biological Laboratory
Urban air pollution has a significant impact on the chemistry of the atmosphere and thus potentially on regional and global climate. Already, air pollution is a major issue in an increasing number of megacities around the world, and new policies to address urban air pollution are likely to be enacted in many developing countries irrespective of the participation of these countries in any explicit future climate policies. The emissions of gases and microscopic particles (aerosols) that are important in air pollution and climate are often highly correlated because of shared generating processes. Most important among these processes is combustion of fossil fuels and biomass which produces carbon dioxide (CO2), carbon monoxide (CO), nitrogen oxides (NOx), volatile organic compounds (VOCs), black carbon (BC) aerosols, and sulfur oxides (SOx, consisting of some sulfate aerosols, but mostly SO2 gas which subsequently forms white sulfate aerosols). In addition, the atmospheric lifecycles of common air pollutants such as CO, NOx, and VOCs, and of the climatically important methane (CH4) and sulfate aerosols, both involve the fast photochemistry of the hydroxyl free radical (OH). Hydroxyl radicals are the dominant “cleansing” chemical in the atmosphere, annually removing about 3.7 gigatonnes (1 GT = 1015 g) of reactive trace gases from the atmosphere; while the environmental impact of each gas is different, this amount is similar to the total mass of carbon removed annually from the atmosphere by the land and ocean combined (Ehhalt, 1999; Prinn, 2003).
Political parties are a crucial part of democratic political systems. With Indonesia's return to democracy in 1999, operational controls on political parties and the ban on the establishment of new parties were lifted. Subsequent electoral reform was designed to reshape the party system by encouraging fewer, larger, parties. This chapter looks at this process from a comparative perspective, situating the Indonesian reforms in a broader Asian context. It also attempts to answer some basic questions about institutional reform. What are the trade-offs inherent in different electoral rules and party system configurations? Where does the Indonesian party system sit within the spectrum of party systems around the world? And how do trends in Indonesia compare with those elsewhere in the Asia-Pacific region?
DEMOCRATISATION AND POLITICAL REFORM
The number of East Asian regimes that can be considered to meet the basic Schumpeterian definition of democracy–governments chosen through open and competitive elections–has snowballed over the past 20 years (Schumpeter 1947: 269). While at the end of the Cold War only Japan could lay claim to being an ‘established’ East Asian democracy, the years since then have ushered in a new era of liberalisation and democratisation across the region (Lijphart 1999). Major transitions from authoritarian rule to democracy began with the popular uprising against the Marcos regime in the Philippines in 1986 and the negotiated transitions from autocratic governments in South Korea and Taiwan in 1987. They continued with the resumption of civilian rule in Thailand in 1992; the UN intervention in Cambodia in 1993; the fall of Indonesia's Soeharto regime in 1998; and the international rehabilitation of East Timor which culminated in 2001. While the 2006 coup in Thailand was a clear step backwards, today more East Asian governments are chosen through democratic processes than ever before.
Over the past several decades, numerous investigators have studied the syndrome of delirium. Researchers have relied on a number of different case finding methods to detect the syndrome. This paper provides an overview of instruments used in studies of delirium. We assess the validity and reliability of these instruments and compare the advantages and disadvantages of the different methods. We then present the rationale for the development of the Delirium Symptom Interview, an instrument constructed for use in the Commonwealth-Harvard Study of delirium in elderly hospitalized patients.
There has long been agreement among scholars that the French National Convention can be usefully divided into three political categories, the Mountain, the Plain, and the Gironde, yet there has been much less agreement about the size and composition of these categories. In order to test existing categories of classification, especially those of Patrick (1969, 1972) and Lewis-Beck et al. (1988), this article examines a neglected body of data, the anti-inviolability opinions produced during King Louis XVI's trial, and uses them as an opinion poll with which to examine the political identity of a cross-section of deputies in the National Convention in the winter of 1792-93.
So far, this book has focussed largely upon the conflict-management potential of one preferential electoral system: the alternative vote. However, as discussed in Chapter 1, there are at least three different preferential voting systems used for national elections around the world consisting of two majority systems – AV and SV – plus the single transferable vote (STV) form of proportional representation. Interestingly, all of these system variations have been advocated, at various times as the most appropriate electoral systems for divided societies. STV in particular has attracted legions of admirers and many advocates in both homogeneous and multi-ethnic societies, but has been introduced in relatively few countries. SV was, as we have seen, introduced as part of Sri Lanka's 1978 constitutional settlement, and subsequently recommended by scholars like Donald Horowitz as being particularly appropriate for divided societies elsewhere. And, as we have also seen, AV has attracted a considerable degree of support in countries like Papua New Guinea, and was introduced in 1997 as part of the constitutional settlement in Fiji.
These and other forms of preferential voting also have an interesting history of experimentation in other regions, particularly in Europe and North America. STV, for example, has been used for elections in several European states since the 1920s, and was once also widespread in local jurisdictions in North America – at one stage being used for Canadian provincial elections in Alberta, Manitoba and British Columbia, and for council elections in around two dozen cities in the United States.
The story of the historical development of the various systems of preferential voting represents a fascinating study in the way institutions evolve and adapt over time. While a rank-ordering of preferences between different alternatives are a fundamental part of any decision-making process, it was not until the eighteenth century that electoral methods for such choices began to be formalised. Preferential voting as a concrete electoral system, rather than a theoretical decision-making rule, originally evolved as a compressed form of run-off election, in which a second round of voting takes place if no candidate secures a majority in the first round; the key to preference voting is its ability to aggregate preference rankings in one round, rather than having to go through successive sequences of elections. The possibilities of such aggregations of rank-orders, via assigning weighted scores to each preference rank, was originally suggested by the French mathematician Charles de Borda in the eighteenth century in relation to decision-making procedures for assemblies and committees, but was vigorously criticised by one of the giants in the field of voting theory, the Marquis de Condorcet, who instead advocated exhaustive pairwise comparisons between each candidate, rather than Borda's rank-order aggregations (McLean and Hewitt 1994, 45).