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Healthcare resource use and costs for people with type 2 diabetes mellitus with and without severe mental illness in England: longitudinal matched-cohort study using the Clinical Practice Research Datalink
- Han-I. Wang, Lu Han, Rowena Jacobs, Tim Doran, Richard I. G. Holt, Stephanie L. Prady, Simon Gilbody, David Shiers, Sarah Alderson, Catherine Hewitt, Jo Taylor, Charlotte E. W. Kitchen, Sue Bellass, Najma Siddiqi
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- Journal:
- The British Journal of Psychiatry / Volume 221 / Issue 1 / July 2022
- Published online by Cambridge University Press:
- 21 September 2021, pp. 402-409
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- July 2022
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Background
Approximately 60 000 people in England have coexisting type 2 diabetes mellitus (T2DM) and severe mental illness (SMI). They are more likely to have poorer health outcomes and require more complex care pathways compared with those with T2DM alone. Despite increasing prevalence, little is known about the healthcare resource use and costs for people with both conditions.
AimsTo assess the impact of SMI on healthcare resource use and service costs for adults with T2DM, and explore the predictors of healthcare costs and lifetime costs for people with both conditions.
MethodThis was a matched-cohort study using data from the Clinical Practice Research Datalink linked to Hospital Episode Statistics for 1620 people with comorbid SMI and T2DM and 4763 people with T2DM alone. Generalised linear models and the Bang and Tsiatis method were used to explore cost predictors and mean lifetime costs respectively.
ResultsThere were higher average annual costs for people with T2DM and SMI (£1930 higher) than people with T2DM alone, driven primarily by mental health and non-mental health-related hospital admissions. Key predictors of higher total costs were older age, comorbid hypertension, use of antidepressants, use of first-generation antipsychotics, and increased duration of living with both conditions. Expected lifetime costs were approximately £35 000 per person with both SMI and T2DM. Extrapolating nationally, this would generate total annual costs to the National Health Service of around £250 m per year.
ConclusionsOur estimates of resource use and costs for people with both T2DM and SMI will aid policymakers and commissioners in service planning and resource allocation.
Localised streak solutions for a Blasius boundary layer
- Richard E. Hewitt, Peter W. Duck
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- Journal:
- Journal of Fluid Mechanics / Volume 849 / 25 August 2018
- Published online by Cambridge University Press:
- 26 June 2018, pp. 885-901
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Streaks are a common feature of disturbed boundary-layer flows. They play a central role in transient growth mechanisms and are a building block of self-sustained structures. Most theoretical work has focused on streaks that are periodic in the spanwise direction, but in this work we consider a single spatially localised streak embedded into a Blasius boundary layer. For small streak amplitudes, we show the perturbation can be described in terms of a set of eigenmodes that correspond to an isolated streak/roll structure. These modes are new, and arise from a bi-global eigenvalue calculation; they decay algebraically downstream and may be viewed as the natural three-dimensional extension of the classical two-dimensional Libby & Fox (J. Fluid Mech., vol. 17 (3), 1963, pp. 433–449) solutions. Despite their bi-global nature, we show that a subset of these eigenmodes (including the slowest decaying) is fundamentally related to the solutions first presented by Luchini (J. Fluid Mech., vol. 327, 1996, pp. 101–116), as derived for spanwise-periodic disturbances (at small spanwise wavenumber). This surprising connection is made by an analysis of the far-field decay of the bi-global state. We also address the fully non-parallel downstream development of nonlinear streaks, confirming that the aforementioned eigenmodes are recovered as the streak/roll decays downstream. Encouraging comparisons are made with available experimental data.
Hydrodynamics and Sound M.S. Howe Cambridge University Press, The Edinburgh Building, Shaftesbury Road, Cambridge CB2 2RU, UK. 2007. 463pp. Illustrated. £50. ISBN 0-521-86862-9.
- Richard E. Hewitt
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- Journal:
- The Aeronautical Journal / Volume 111 / Issue 1124 / October 2007
- Published online by Cambridge University Press:
- 30 March 2016, p. 668
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Hydrodynamic Stability–Second edition P.G. Drazin and W.H. Reid Cambridge University Press, The Edinburgh Building, Shaftesbury Road, Cambridge CB2 2RU, UK. 2004. 605pp. Illustrated. £26. ISBN 0-521-52541-1. - Theory and Computation in Hydrodynamic Stability W.O. Crimanle et al Cambridge University Press, The Edinburgh Building, Shaftesbury Road, Cambridge CB2 2RU, UK. 2003. 441pp. Illustrated. £60. ISBN 0-521-63200-5.
- Richard E. Hewitt
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- The Aeronautical Journal / Volume 110 / Issue 1104 / February 2006
- Published online by Cambridge University Press:
- 30 March 2016, p. 125
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Three-dimensional boundary layers with short spanwise scales
- Richard E. Hewitt, Peter W. Duck
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- Journal of Fluid Mechanics / Volume 756 / 10 October 2014
- Published online by Cambridge University Press:
- 02 September 2014, pp. 452-469
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We investigate three-dimensional (laminar) boundary layers that include a spanwise scale comparable to the boundary-layer thickness. A forcing of short spanwise scales requires viscous dissipation to be retained in the two-dimensional cross-section, perpendicular to the external flow direction, and in this respect the flows are related to previous work on corner boundary layers. We use two examples to highlight the main features of this category of boundary layer: (i) a flat plate of narrow (spanwise) width, and (ii) a narrow (spanwise) gap cut into an otherwise infinite flat plate; in both cases the plate is aligned with a uniform oncoming stream. We find that a novel feature arises in connection with the external flow; the presence of a narrow gap/plate (or indeed any comparable short-scale feature of long streamwise extent) necessarily modifies the streamwise mass flux in that vicinity, which in turn induces an associated boundary-layer transpiration on the same short spanwise length scale. This (short-scale) transpiration region leads to a half-line-source/sink correction to the outer inviscid, irrotational flow. Crucially, the volumetric flux associated with this line-source/sink must be explicitly included as part of the computational procedure for the leading-order boundary layer, and as such there is a weak interaction between the outer (inviscid) flow and the boundary layer. This is a generic feature of boundary layers that are forced through the presence of short-scale spanwise variations.
Pulsatile jets
- RICHARD E. HEWITT, PETER W. DUCK
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- Journal of Fluid Mechanics / Volume 670 / 10 March 2011
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- 12 January 2011, pp. 240-259
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We consider the evolution of high-Reynolds-number, planar, pulsatile jets in an incompressible viscous fluid. The source of the jet flow comprises a mean-flow component with a superposed temporally periodic pulsation, and we address the spatiotemporal evolution of the resulting system. The analysis is presented for both a free symmetric jet and a wall jet. In both cases, pulsation of the source flow leads to a downstream short-wave linear instability, which triggers a breakdown of the boundary-layer structure in the nonlinear regime. We extend the work of Riley, Sánchez-Sans & Watson (J. Fluid Mech., vol. 638, 2009, p. 161) to show that the linear instability takes the form of a wave that propagates with the underlying jet flow, and may be viewed as a (spatially growing) weakly non-parallel analogue of the (temporally growing) short-wave modes identified by Cowley, Hocking & Tutty (Phys. Fluids, vol. 28, 1985, p. 441). The nonlinear evolution of the instability leads to wave steepening, and ultimately a singular breakdown of the jet is obtained at a critical downstream position. We speculate that the form of the breakdown is associated with the formation of a ‘pseudo-shock’ in the jet, indicating a failure of the (long-length scale) boundary-layer scaling. The numerical results that we present disagree with the recent results of Riley et al. (2009) in the case of a free jet, together with other previously published works in this area.
Contributors
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- By Rose Teteki Abbey, K. C. Abraham, David Tuesday Adamo, LeRoy H. Aden, Efrain Agosto, Victor Aguilan, Gillian T. W. Ahlgren, Charanjit Kaur AjitSingh, Dorothy B E A Akoto, Giuseppe Alberigo, Daniel E. Albrecht, Ruth Albrecht, Daniel O. Aleshire, Urs Altermatt, Anand Amaladass, Michael Amaladoss, James N. Amanze, Lesley G. Anderson, Thomas C. Anderson, Victor Anderson, Hope S. Antone, María Pilar Aquino, Paula Arai, Victorio Araya Guillén, S. Wesley Ariarajah, Ellen T. Armour, Brett Gregory Armstrong, Atsuhiro Asano, Naim Stifan Ateek, Mahmoud Ayoub, John Alembillah Azumah, Mercedes L. García Bachmann, Irena Backus, J. Wayne Baker, Mieke Bal, Lewis V. Baldwin, William Barbieri, António Barbosa da Silva, David Basinger, Bolaji Olukemi Bateye, Oswald Bayer, Daniel H. Bays, Rosalie Beck, Nancy Elizabeth Bedford, Guy-Thomas Bedouelle, Chorbishop Seely Beggiani, Wolfgang Behringer, Christopher M. Bellitto, Byard Bennett, Harold V. Bennett, Teresa Berger, Miguel A. Bernad, Henley Bernard, Alan E. Bernstein, Jon L. Berquist, Johannes Beutler, Ana María Bidegain, Matthew P. Binkewicz, Jennifer Bird, Joseph Blenkinsopp, Dmytro Bondarenko, Paulo Bonfatti, Riet en Pim Bons-Storm, Jessica A. Boon, Marcus J. Borg, Mark Bosco, Peter C. Bouteneff, François Bovon, William D. Bowman, Paul S. Boyer, David Brakke, Richard E. Brantley, Marcus Braybrooke, Ian Breward, Ênio José da Costa Brito, Jewel Spears Brooker, Johannes Brosseder, Nicholas Canfield Read Brown, Robert F. Brown, Pamela K. Brubaker, Walter Brueggemann, Bishop Colin O. Buchanan, Stanley M. Burgess, Amy Nelson Burnett, J. Patout Burns, David B. Burrell, David Buttrick, James P. Byrd, Lavinia Byrne, Gerado Caetano, Marcos Caldas, Alkiviadis Calivas, William J. Callahan, Salvatore Calomino, Euan K. Cameron, William S. Campbell, Marcelo Ayres Camurça, Daniel F. Caner, Paul E. Capetz, Carlos F. Cardoza-Orlandi, Patrick W. Carey, Barbara Carvill, Hal Cauthron, Subhadra Mitra Channa, Mark D. Chapman, James H. Charlesworth, Kenneth R. Chase, Chen Zemin, Luciano Chianeque, Philip Chia Phin Yin, Francisca H. Chimhanda, Daniel Chiquete, John T. Chirban, Soobin Choi, Robert Choquette, Mita Choudhury, Gerald Christianson, John Chryssavgis, Sejong Chun, Esther Chung-Kim, Charles M. A. Clark, Elizabeth A. Clark, Sathianathan Clarke, Fred Cloud, John B. Cobb, W. Owen Cole, John A Coleman, John J. Collins, Sylvia Collins-Mayo, Paul K. Conkin, Beth A. Conklin, Sean Connolly, Demetrios J. Constantelos, Michael A. Conway, Paula M. Cooey, Austin Cooper, Michael L. Cooper-White, Pamela Cooper-White, L. William Countryman, Sérgio Coutinho, Pamela Couture, Shannon Craigo-Snell, James L. Crenshaw, David Crowner, Humberto Horacio Cucchetti, Lawrence S. Cunningham, Elizabeth Mason Currier, Emmanuel Cutrone, Mary L. Daniel, David D. Daniels, Robert Darden, Rolf Darge, Isaiah Dau, Jeffry C. Davis, Jane Dawson, Valentin Dedji, John W. de Gruchy, Paul DeHart, Wendy J. Deichmann Edwards, Miguel A. De La Torre, George E. Demacopoulos, Thomas de Mayo, Leah DeVun, Beatriz de Vasconcellos Dias, Dennis C. Dickerson, John M. Dillon, Luis Miguel Donatello, Igor Dorfmann-Lazarev, Susanna Drake, Jonathan A. Draper, N. Dreher Martin, Otto Dreydoppel, Angelyn Dries, A. J. Droge, Francis X. D'Sa, Marilyn Dunn, Nicole Wilkinson Duran, Rifaat Ebied, Mark J. Edwards, William H. Edwards, Leonard H. Ehrlich, Nancy L. Eiesland, Martin Elbel, J. Harold Ellens, Stephen Ellingson, Marvin M. Ellison, Robert Ellsberg, Jean Bethke Elshtain, Eldon Jay Epp, Peter C. Erb, Tassilo Erhardt, Maria Erling, Noel Leo Erskine, Gillian R. Evans, Virginia Fabella, Michael A. Fahey, Edward Farley, Margaret A. Farley, Wendy Farley, Robert Fastiggi, Seena Fazel, Duncan S. Ferguson, Helwar Figueroa, Paul Corby Finney, Kyriaki Karidoyanes FitzGerald, Thomas E. FitzGerald, John R. Fitzmier, Marie Therese Flanagan, Sabina Flanagan, Claude Flipo, Ronald B. Flowers, Carole Fontaine, David Ford, Mary Ford, Stephanie A. Ford, Jim Forest, William Franke, Robert M. Franklin, Ruth Franzén, Edward H. Friedman, Samuel Frouisou, Lorelei F. Fuchs, Jojo M. Fung, Inger Furseth, Richard R. Gaillardetz, Brandon Gallaher, China Galland, Mark Galli, Ismael García, Tharscisse Gatwa, Jean-Marie Gaudeul, Luis María Gavilanes del Castillo, Pavel L. Gavrilyuk, Volney P. Gay, Metropolitan Athanasios Geevargis, Kondothra M. George, Mary Gerhart, Simon Gikandi, Maurice Gilbert, Michael J. Gillgannon, Verónica Giménez Beliveau, Terryl Givens, Beth Glazier-McDonald, Philip Gleason, Menghun Goh, Brian Golding, Bishop Hilario M. Gomez, Michelle A. Gonzalez, Donald K. Gorrell, Roy Gottfried, Tamara Grdzelidze, Joel B. Green, Niels Henrik Gregersen, Cristina Grenholm, Herbert Griffiths, Eric W. Gritsch, Erich S. Gruen, Christoffer H. Grundmann, Paul H. Gundani, Jon P. Gunnemann, Petre Guran, Vidar L. Haanes, Jeremiah M. Hackett, Getatchew Haile, Douglas John Hall, Nicholas Hammond, Daphne Hampson, Jehu J. Hanciles, Barry Hankins, Jennifer Haraguchi, Stanley S. Harakas, Anthony John Harding, Conrad L. Harkins, J. William Harmless, Marjory Harper, Amir Harrak, Joel F. Harrington, Mark W. Harris, Susan Ashbrook Harvey, Van A. Harvey, R. Chris Hassel, Jione Havea, Daniel Hawk, Diana L. Hayes, Leslie Hayes, Priscilla Hayner, S. Mark Heim, Simo Heininen, Richard P. Heitzenrater, Eila Helander, David Hempton, Scott H. Hendrix, Jan-Olav Henriksen, Gina Hens-Piazza, Carter Heyward, Nicholas J. Higham, David Hilliard, Norman A. Hjelm, Peter C. Hodgson, Arthur Holder, M. Jan Holton, Dwight N. Hopkins, Ronnie Po-chia Hsia, Po-Ho Huang, James Hudnut-Beumler, Jennifer S. Hughes, Leonard M. Hummel, Mary E. Hunt, Laennec Hurbon, Mark Hutchinson, Susan E. Hylen, Mary Beth Ingham, H. Larry Ingle, Dale T. Irvin, Jon Isaak, Paul John Isaak, Ada María Isasi-Díaz, Hans Raun Iversen, Margaret C. Jacob, Arthur James, Maria Jansdotter-Samuelsson, David Jasper, Werner G. Jeanrond, Renée Jeffery, David Lyle Jeffrey, Theodore W. Jennings, David H. Jensen, Robin Margaret Jensen, David Jobling, Dale A. Johnson, Elizabeth A. Johnson, Maxwell E. Johnson, Sarah Johnson, Mark D. Johnston, F. Stanley Jones, James William Jones, John R. Jones, Alissa Jones Nelson, Inge Jonsson, Jan Joosten, Elizabeth Judd, Mulambya Peggy Kabonde, Robert Kaggwa, Sylvester Kahakwa, Isaac Kalimi, Ogbu U. Kalu, Eunice Kamaara, Wayne C. Kannaday, Musimbi Kanyoro, Veli-Matti Kärkkäinen, Frank Kaufmann, Léon Nguapitshi Kayongo, Richard Kearney, Alice A. Keefe, Ralph Keen, Catherine Keller, Anthony J. Kelly, Karen Kennelly, Kathi Lynn Kern, Fergus Kerr, Edward Kessler, George Kilcourse, Heup Young Kim, Kim Sung-Hae, Kim Yong-Bock, Kim Yung Suk, Richard King, Thomas M. King, Robert M. Kingdon, Ross Kinsler, Hans G. Kippenberg, Cheryl A. Kirk-Duggan, Clifton Kirkpatrick, Leonid Kishkovsky, Nadieszda Kizenko, Jeffrey Klaiber, Hans-Josef Klauck, Sidney Knight, Samuel Kobia, Robert Kolb, Karla Ann Koll, Heikki Kotila, Donald Kraybill, Philip D. W. Krey, Yves Krumenacker, Jeffrey Kah-Jin Kuan, Simanga R. Kumalo, Peter Kuzmic, Simon Shui-Man Kwan, Kwok Pui-lan, André LaCocque, Stephen E. Lahey, John Tsz Pang Lai, Emiel Lamberts, Armando Lampe, Craig Lampe, Beverly J. Lanzetta, Eve LaPlante, Lizette Larson-Miller, Ariel Bybee Laughton, Leonard Lawlor, Bentley Layton, Robin A. Leaver, Karen Lebacqz, Archie Chi Chung Lee, Marilyn J. Legge, Hervé LeGrand, D. L. LeMahieu, Raymond Lemieux, Bill J. Leonard, Ellen M. Leonard, Outi Leppä, Jean Lesaulnier, Nantawan Boonprasat Lewis, Henrietta Leyser, Alexei Lidov, Bernard Lightman, Paul Chang-Ha Lim, Carter Lindberg, Mark R. Lindsay, James R. Linville, James C. Livingston, Ann Loades, David Loades, Jean-Claude Loba-Mkole, Lo Lung Kwong, Wati Longchar, Eleazar López, David W. Lotz, Andrew Louth, Robin W. Lovin, William Luis, Frank D. Macchia, Diarmaid N. J. MacCulloch, Kirk R. MacGregor, Marjory A. MacLean, Donald MacLeod, Tomas S. Maddela, Inge Mager, Laurenti Magesa, David G. Maillu, Fortunato Mallimaci, Philip Mamalakis, Kä Mana, Ukachukwu Chris Manus, Herbert Robinson Marbury, Reuel Norman Marigza, Jacqueline Mariña, Antti Marjanen, Luiz C. L. Marques, Madipoane Masenya (ngwan'a Mphahlele), Caleb J. D. Maskell, Steve Mason, Thomas Massaro, Fernando Matamoros Ponce, András Máté-Tóth, Odair Pedroso Mateus, Dinis Matsolo, Fumitaka Matsuoka, John D'Arcy May, Yelena Mazour-Matusevich, Theodore Mbazumutima, John S. McClure, Christian McConnell, Lee Martin McDonald, Gary B. McGee, Thomas McGowan, Alister E. McGrath, Richard J. McGregor, John A. McGuckin, Maud Burnett McInerney, Elsie Anne McKee, Mary B. McKinley, James F. McMillan, Ernan McMullin, Kathleen E. McVey, M. 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Phan, Isabel Apawo Phiri, William S. F. Pickering, Derrick G. Pitard, William Elvis Plata, Zlatko Plese, John Plummer, James Newton Poling, Ronald Popivchak, Andrew Porter, Ute Possekel, James M. Powell, Enos Das Pradhan, Devadasan Premnath, Jaime Adrían Prieto Valladares, Anne Primavesi, Randall Prior, María Alicia Puente Lutteroth, Eduardo Guzmão Quadros, Albert Rabil, Laurent William Ramambason, Apolonio M. Ranche, Vololona Randriamanantena Andriamitandrina, Lawrence R. Rast, Paul L. Redditt, Adele Reinhartz, Rolf Rendtorff, Pål Repstad, James N. Rhodes, John K. Riches, Joerg Rieger, Sharon H. Ringe, Sandra Rios, Tyler Roberts, David M. Robinson, James M. Robinson, Joanne Maguire Robinson, Richard A. H. Robinson, Roy R. Robson, Jack B. Rogers, Maria Roginska, Sidney Rooy, Rev. Garnett Roper, Maria José Fontelas Rosado-Nunes, Andrew C. Ross, Stefan Rossbach, François Rossier, John D. Roth, John K. Roth, Phillip Rothwell, Richard E. 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Yee, Viktor Yelensky, Yeo Khiok-Khng, Gustav K. K. Yeung, Angela Yiu, Amos Yong, Yong Ting Jin, You Bin, Youhanna Nessim Youssef, Eliana Yunes, Robert Michael Zaller, Valarie H. Ziegler, Barbara Brown Zikmund, Joyce Ann Zimmerman, Aurora Zlotnik, Zhuo Xinping
- Edited by Daniel Patte, Vanderbilt University, Tennessee
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- The Cambridge Dictionary of Christianity
- Published online:
- 05 August 2012
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- 20 September 2010, pp xi-xliv
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Long's vortex revisited
- RICHARD E. HEWITT, PETER W. DUCK
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- Journal:
- Journal of Fluid Mechanics / Volume 634 / 10 September 2009
- Published online by Cambridge University Press:
- 26 August 2009, pp. 91-111
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We reconsider exact solutions to the Navier–Stokes equations that describe a vortex in a viscous, incompressible fluid. This type of solution was first introduced by Long (J. Atmos. Sci., vol. 15 (1), 1958, p. 108) and is parameterized by an inverse Reynolds number ϵ. Long's attention (and that of many subsequent investigators) was centred upon the ‘quasi-cylindrical’ (QC) case corresponding to ϵ = 0. We show that the limit ϵ → 0 is not straightforward, and that it reveals other solutions to this fundamental exact reduction of the Navier–Stokes system (which are not of QC form). Through careful numerical investigation, supported by asymptotic descriptions, we identify new solutions and describe the full parameter space that is spanned by ϵ and the pressure at the vortex core. Some erroneous results that exist in the literature are corrected.
Asymptotic matching constraints for a boundary-layer flow of a power-law fluid
- JAMES P. DENIER, RICHARD E. HEWITT
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- Journal:
- Journal of Fluid Mechanics / Volume 518 / 10 November 2004
- Published online by Cambridge University Press:
- 20 October 2004, pp. 261-279
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We reconsider the three-dimensional boundary-layer flow of a power-law (Ostwald–de Waele) rheology fluid, driven by the rotation of an infinite rotating plane in an otherwise stationary system. Here we address the problem for both shear-thinning and shear-thickening fluids and show that there are some fundamental issues regarding the application of power-law models in a boundary-layer context that have not been mentioned in previous discussions. For shear-thickening fluids, the leading-order boundary-layer equations are shown to have no suitable decaying behaviour in the far field, and the only solutions that exist are necessarily non-differentiable at a critical location and of ‘finite thickness’. Higher-order effects are shown to regularize the singularity at the critical location. In the shear-thinning case, the boundary-layer solutions are shown to possess algebraic decay to a free-stream flow. This case is known from the existing literature; however here we shall emphasize the complexity of applying such solutions to a global flow, describing why they are in general inappropriate in a traditional boundary-layer context. Furthermore, previously noted difficulties for fluids that are highly shear thinning are also shown to be associated with the imposition of incorrect assumptions regarding the nature of the far-field flow. Based on Newtonian results, we anticipate the presence of non-uniqueness and through accurate numerical solution of the leading-order boundary-layer equations we locate several such solutions.