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This chapter advanced the analytical framework of the book, which revolves around the role of the state in governing large-scale decarbonization through collaborative climate governance with interactions of non-state and sub-state actors, networks and multi-stakeholder partnerships in the various governance relations. We provide a coherent framework rooted in theoretical and conceptual debates on the multitude of relations between the state and non-state actors in the governance of climate change. By connecting these governance relations to three evaluative themes of the politics of decarbonization (justice, effectiveness, and legitimacy), we theorize how the state shapes decarbonization processes in a landscape of non-state and sub-state climate action. The chapter situates the book’s contributions to the wider scholarship and highlights the theoretical debates that the empirical chapters will revisit.
Healthcare is inextricably bound to productivity, efficiency, and economic development. Although many methods for analyzing productivity and efficiency have been extensively covered, relatively little focus has been placed on how those methods can be applied to health care in a coherent and comprehensive manner. The Cambridge Handbook of Healthcare outlines current foundations and states of the art on which future research can build. It brings together experts in this growing field to cover three key sources and aspects of human welfare – productivity, efficiency, and healthcare. Beginning with academic focused chapters, this book bridges and provides outreach to the practice and regulation of the health care industry and includes academic and regulatory perspectives, including overviews of major evidence from international empirical applications. Each chapter is dedicated to a particular topic and delivered by international experts on that topic.
Though it is derived from individual thriving, community thriving cannot be reduced to the aggregate of individual experiences. Rather, community thriving is defined as the function of a community’s sustainability and its effectiveness at producing well-being outcomes. An overview of community concepts related to thriving, thus defined, is offered, and the implications of well-being, fairness, and worthiness in a community context are detailed. The chapter concludes with specific historical illustrations and steps readers can take to enhance the thriving of their own communities.
This paper introduces a new set of comprehensive and cross-country-comparable indexes of migration policy selectivity. Crucially, these reflect the multidimensional nature of the differential treatment of migrants. We use these indexes to study the evolution of migration policy selectivity and estimate how they affect migration flows. Combining all publicly available and relevant data since WWII, we build three composite indexes that identify selectivity in terms of skills, economic resources and nationality. First, we use these to characterize migration policies in 42 countries between 1990 and 2014. Second, we examine the relationship between the selectivity of migration policy and migration flows. Each of the three dimensions of migration policy is found to correlate strongly and significantly with both the size and structure of migration flows.
Problematic drinking frequently co-occurs with depression among young adults, but often remains unaddressed in depression treatment. Evidence is insufficient on whether digital alcohol interventions can be effective in this young comorbid population. In a randomized controlled trial, we examined the effectiveness of Beating the Booze (BtB), an add-on digital alcohol intervention to complement depression treatment for young adults.
Methods
Participants were randomized to BtB + depression treatment as usual (BTB + TAU, n = 81) or TAU (n = 82). The primary outcome was treatment response, a combined measure for alcohol and depression after 6-month follow-up. Secondary outcomes were number of weekly drinks (Timeline Follow-back) and depressive symptoms (Center for Epidemiologic Studies Depression scale). Treatment response was analyzed using generalized linear modeling and secondary outcomes using robust linear mixed modeling.
Results
Low treatment response was found due to lower than expected depression remission rates. No statistically significant between-group effect was found for treatment response after 6-month follow-up (odds ratio 2.86, p = 0.089, 95% confidence interval [CI] 0.85–9.63). For our secondary outcomes, statistically significant larger reductions in weekly drinks were found in the intervention group after 3-month (B = −4.00, p = 0.009, 95% CI −6.97 to −1.02, d = 0.27) and 6-month follow-up (B = −3.20, p = 0.032, 95% CI −6.13 to −0.27, d = 0.23). We found no statistically significant between-group differences on depressive symptoms after 3-month (B = −0.57, p = 0.732, 95% CI −3.83 to 2.69) nor after 6-month follow-up (B = −0.44, p = 0.793, 95% CI −3.69 to 2.82).
Conclusions
The add-on digital alcohol intervention was effective in reducing alcohol use, but not in reducing depressive symptoms and treatment response among young adults with co-occurring depressive disorders and problematic alcohol use.
Trial registration:
Pre-registered on October 29, 2019 in the Overview of Medical Research in the Netherlands (OMON), formerly the Dutch Trial Register(https://onderzoekmetmensen.nl/en/trial/49219).
The book concludes with a reflection on the challenge of grey zones as being one of first principles, which represents a risk to the integrity and long-term future of the organisation. It emphasises that the populations in areas of conflict and contestation are the most vulnerable rights holders in Europe, yet the most isolated. The Council of Europe must address this systematic problem as a matter of urgency and with the decisive attention of Member States and both statutory and non-statutory actors.
Comprehensive geriatric assessment (CGA) has been one of the cornerstones of geriatric medicine since its introduction by Marjory Warren in 1936. This kind of assessment is defined as a multidimensional and multidisciplinary process related to identifying medical, social, and functional needs and developing an integrated care plan designed to meet the patien’st needs.The practice and applications of CGA have been used to various degrees in mainstream care for older people in the UK and internationally.
Some limitations still exist around the wider implementation of CGA, as its practice relies on members of the multidisciplinary team (MDT) and on an effective communication between them, the patients, and their families. This kind of assessment has been criticised for not adequately acknowledging frailty and for not using patient-reported outcome measures to test its efficacy.
Randomised controlled studies, systematic reviews, and meta-analyses provided considerable evidence for the clinical and financial effectiveness of CGA in various hospital specialties. However, there are still concerns about the generalisability of CGA in community settings. Further research to identify target populations for CGA-led interventions and a consensus on outcome measures are required to realise CGA benefits.
In this chapter we describe required skills and practical tips to deliver CGA across a variety of settings.
This chapter draws upon the normative resources of political community to construct an account of the 'antecedents' of statehood: the factual prerequisites that nascent entities characteristically must demonstrate in order to mount a plausible statehood claim. These antecedents, which will be familiar to doctrinal lawyers from sources such as the 1933 Montevideo Convention on the Rights and Duties of States, are: a permanent population, a relatively determinate territory, an 'effective' government, and some degree of governmental independence. In addition to grounding each antecedent within both historical and contemporary practice, this chapter demonstrates their coherence with the ethical value of politics, thereby reconstructing these elements of international law into a normatively coherent whole. Several aspects of this reconstruction will strike readers familiar with state creation as controversial. In particular, I advance a novel conception of governmental 'effectiveness' that turns upon the capacity of nascent states to facilitate ethically valuable political action.
Emphasizing the pivotal role of caregivers in the cancer care continuum, a program designed to educate caregivers of cancer patients undergoing chemotherapy underscores their significance. The palliative care education initiative strives to cultivate a compassionate and effective care environment, benefiting both patients and caregivers. By imparting education, fostering positive attitudes, offering support, encouraging appropriate behaviors, and providing essential resources, the program aims to enhance the overall caregiving experience and contribute to the well-being of those navigating the challenges of cancer treatment.
Objectives
To evaluate the effectiveness of a palliative care education program for caregivers of cancer patients receiving chemotherapy.
Methods
The research employed a purposive sample comprising 155 caregivers who were actively present with their cancer patients throughout the pre- and post-test phases within a quasi-experimental research design. The study took place at the outpatient oncology center of Al-Shifa Medical Complex in Port Said City, Egypt. To gather comprehensive data, 4 instruments were utilized: a demographic questionnaire, a nurse knowledge questionnaire, a scale measuring attitudes toward palliative care, and an assessment of reported practices in palliative care. This methodological approach allowed for a thorough exploration of caregiver perspectives, knowledge, attitudes, and practices within the context of a palliative care education program.
Results
Before the palliative care education program, only 1.3% of caregivers had a good overall level of knowledge about cancer and palliative care; this increased to 40.6% after the program. Similarly, before the palliative care education program, 32.9% of caregivers had a positive overall attitude, which increased to 72.3% after the program. Similarly, 27.1% of caregivers had an overall appropriate palliative care practice during the pre-test phase, which increased to 93.5% after the palliative care education program.
Significance of the results
The palliative care education program significantly improved caregivers’ knowledge, attitudes, and practice scores. It is strongly recommended that caregivers of cancer patients receive continuing education in palliative care. In addition, it is crucial to conduct further research with a larger sample size in different situations in Egypt.
This chapter considers the impact of the sanctions in the short-term: both the economic impact on the Russian state and the Russian people, as well as sanctions’ failure to prevent further military action by Russia in Ukraine. Unintended knock-on or ripple effects of the sanctions are also discussed, as are the effects of the sanctions on world trading patterns and the economic health of other nations. The chapter also considers the potential long-term effects of sanctions on the Russian economy.
Effective health-care makes a large and increasing contribution to preventing disease and prolonging life by reducing the population burden of disease. However, only the right kind of health-care delivered in the right way, at the right time, to the right person can improve health. Health-care interventions that are powerful enough to improve population health are also powerful enough to cause harm if incorrectly used. How can public health specialists know whether their interventions are having the desired effect? Clinicians can monitor the impact of their treatments on an individual patient basis, but how do we examine the impact of a new service? This chapter looks at what we mean by quality of health-care and considers some frameworks for its evaluation.
How much of what health and other professionals do is based soundly in science? Answers to the question, ‘Is our practice evidence based?’ depend on what we mean by practice and evidence.
The expansion of evidence-based medicne (EBM) has been a major influence on medical practice over the past 25 years. In this chapter, we examine the nature of what is nowadays more broadly referred to as evidence-based health-care (EBHC) and discuss its limitations. It is worth noting that in the UK this field continues to expand, particularly into the arena of social care, which often goes hand in hand with the provision of health-care. Increasingly, the term ‘evidence-based practice’ (EBP) is used as a catch-all. While this chapter focuses on health-care, the principles of EBP we describe apply equally to other disciplines, including public health and policy.
Many international organisations have recently acknowledged the significance of whistleblowing in preventing institutional corruption, particularly in the public sector. Likewise, many countries have enacted whistleblower protection laws, though a robust whistleblower protection system certainly requires much more than legislation. One challenge in developing effective protection systems is finding empirical evidence to evaluate existing systems. Can we measure the effectiveness of whistleblower protection systems accross different countries? What conditions do we need to make the whistleblower protection system work effectively in the public sector? This paper investigates two cases: South Korea and the Republic of Kosovo. South Korean data comes from the Anti-Corruption and Civil Rights Commission of South Korea, while its counterpart from Kosovo comes from a survey of 400 public officials about whistleblower protection. By analysing both datasets, this paper creates a new index that evaluates the effectiveness of whistleblower protection. Composed of quantitative and qualitative sub-indices, the index serves as a digital comparison tool for assessing whistleblower protection systems across different countries and at different times. In addition to enacting high-quality laws, this index identifies several additional measures that can strengthen whistleblower protection systems in the public sector.
Salmonella spp. is a common zoonotic pathogen, causing gastrointestinal infections in people. Pigs and pig meat are a major source of infection. Although farm biosecurity is believed to be important for controlling Salmonella transmission, robust evidence is lacking on which measures are most effective. This study enrolled 250 pig farms across nine European countries. From each farm, 20 pooled faecal samples (or similar information) were collected and analysed for Salmonella presence. Based on the proportion of positive results, farms were categorised as at higher or lower Salmonella risk, and associations with variables from a comprehensive questionnaire investigated. Multivariable analysis indicated that farms were less likely to be in the higher-risk category if they had ‘<400 sows’; used rodent baits close to pig enclosures; isolated stay-behind (sick) pigs; did not answer that the hygiene lock/ anteroom was easy to clean; did not have a full perimeter fence; did apply downtime of at least 3 days between farrowing batches; and had fully slatted flooring in all fattener buildings. A principal components analysis assessed the sources of variation between farms, and correlation between variables. The study results suggest simple control measures that could be prioritised on European pig farms to control Salmonella.
The past decade has seen outside states, coalitions or regional organisations lead military operations at the (real or alleged) ‘invitation’ of one of the parties embroiled in military strife – notably, in Mali, Syria, Yemen, and The Gambia. This chapter addresses key legal questions, starting with the validity of a government’s ‘consent’. Others include the legal nature and the effects of such consent, and how a government might lose its capacity to consent to military action in its own territory. The chapter includes analysis of the legal doctrines that might limit the lawfulness of the intervention despite such consent, including the invalidity of consent, the ‘negative equality’ doctrine or complete abstention, unlawful purposes, and other grounds of illegality, such as the inviting state’s complicity in international crimes. In the cases examined in the volume, the intervening states typically invoked multiple legal grounds, of which invitation is only one, and the UN Security Council has been intensely involved: the chapter appraises the legal significance of these novel features. It concludes with a summary of the trialogue method and an overview of the subsequent chapters.
Engaging directly with agonistic thought, Chapter 6 asks whether contestation about corporate human rights abuses, over the long-term, shapes democratic institutions more broadly. What is clear in agonistic scholarship is that confrontation must be incorporated or integrated into democratic institutions. This chapter empirically tests this relationship. It finds that contestation improves measures of respect for human rights and civic empowerment. That is, without any formal or informal response, simply speaking out and making abuses known improves respect for human rights, generally. The data also illustrate that, regardless of the outcome, there is a positive cumulative effect of trials over time, demonstrating the importance of reflexive innovation. In contrast, simply engaging in non-judicial remedy alone does not improve respect for human rights. The analysis shows that there is a positive, cumulative relationship between respect for human rights and those non-judicial remedy efforts led by the state. If corporations lead the non-judicial remedy effort, however, they do nothing to improve respect for human rights or more robust civic engagement over the long-term.
To systematically review the impact of choice architecture interventions (CAI) on the food choice of healthy adolescents in a secondary school setting. Factors potentially contributing to the effectiveness of CAI types and numbers implemented and its long-term success were examined.
Design:
PUBMED and Web of Science were systematically searched in October 2021. Publications were included following predefined inclusion criteria and grouped according to the number and duration of implemented interventions. Intervention impact was determined by a systematic description of the reported quantitative changes in food choice and/or consumption. Intervention types were compared with regard to food selection and sustained effects either during or following the intervention.
Setting:
CAI on food choice of healthy adolescents in secondary schools.
Participants:
Not applicable.
Results:
Fourteen studies were included; four randomised controlled trials and five each of controlled or uncontrolled pre–post design, respectively. Four studies implemented a single CAI type, with ten implementing > 1. Three studies investigated CAI effects over the course of a school year either by continuous or repeated data collection, while ten studies’ schools were visited on selected days during an intervention. Twelve studies reported desired changes in overall food selection, yet effects were not always significant and appeared less conclusive for longer-term studies.
Conclusions:
This review found promising evidence that CAI can be effective in encouraging favourable food choices in healthy adolescents in a secondary school setting. However, further studies designed to evaluate complex interventions are needed.
The year 2022 marks 15 years since the entry into force of the United Nations Educational, Scientific and Cultural Organization’s 2005 Convention on the Protection and Promotion of the Diversity of Cultural Expressions. Among its objectives, this treaty aims at acknowledging the specific nature – economic and cultural – of cultural activities, goods, and services, reaffirming the sovereign right of states to adopt or implement measures they deem appropriate for the protection and the promotion of the diversity of cultural expressions as well as reinforcing international cooperation for more balanced cultural exchanges. Since its adoption, this treaty has been criticized for its low level of constraint. However, data collected over the years show that parties rely extensively on the Convention to undertake diverse initiatives to achieve the treaty’s objectives. Based on concrete examples, this article aims to show that the effectivity of a legal instrument does not only rely on its degree of constraint but also on other factors, including monitoring mechanisms put in place in the context of its implementation.
Nudges are widely employed tools within organizations, but they are often criticized for harming autonomy and for being ineffective. We assess these two criticisms simultaneously: can nudges be both autonomy-preserving and effective in changing behavior? We developed three nudges – an opinion leader nudge, a rule-of-thumb and self-nudges – to reduce a particularly sticky behavior: email use. In a survey experiment of 4,112 healthcare employees, we tested their effect on perceived autonomy and subjective effectiveness. We also tested traditional policy instruments for comparison. Next, to assess objective effectiveness, we conducted a quasi-field experiment in a large healthcare organization with an estimate of 1,189 active email users. We found that each nudge in isolation, but especially when combined, was perceived to be both autonomy-preserving and effective, and more so than traditional policy instruments like an access limit or a monetary reward. We also found some evidence that the combination of all nudges decreased actual email use. This paper advances the literature by showing how innovations in nudge design improve nudges’ ability to be autonomy-preserving and effective.
There are many expert teachers working in the global South and we can learn a great deal from them. Neither of these claims should be surprising, yet to date there has been almost no research conducted on expert teachers working in Southern contexts. Instead, the huge sums of money invested in attempting to improve teacher quality in the South have frequently been directed towards introducing exogenous practices or interventions that may be culturally inappropriate, practically infeasible and ultimately unsustainable – often failing as a result. In this pioneering book, Jason Anderson provides an authoritative overview of the practices, cognition and professionalism of expert teachers working in low-income contexts. By drawing upon both systematic reviews of teacher expertise and effectiveness research, and his own fieldwork in India, he argues that without an understanding of expert teachers working in all contexts worldwide, we cannot truly understand expertise itself.