搜索结果：The Journal of conflict resolution

Climate change has been linked to water scarcity, land degradation, and food insecurity, exacerbating existing tensions and creating new conflicts in countries with weak political institutions. Despite the critical need for effective conflict management and climate adaptation measures, prior studies failed to emphasize the role climate change plays in civil clashes in conflict-affected countries. In this research, we undertake a comprehensive investigation of the effects of climate change and government stability on internal conflicts in 14 selected SSA nations between 1996 and 2016. The study embraces contemporary heterogeneous panel techniques to address heterogeneity and cross-sectional dependence issues that usually appear in panel data estimates. We employed second-generation unit root tests, such as CADF and CIPS, to determine the order of integration of the variables. In addition, Pedroni and Westerlund cointegration tests confirmed the long-run relationship among the variables. Although temperatures were insignificant, the long-run results of the pooled mean group (PMG) approach suggested that civil conflicts decline when precipitation increases. In addition, the outcomes indicate that environmental degradation and population growth are long-run aggravators of social unrest. The short-run results suggest that rising temperatures exacerbate civil conflicts in the selected SSA countries. However, the study found that government stability lessens internal conflicts in the short run, but not in the long run. The DOLS technique validated the long-run outcomes of the PMG technique. Based on the findings of the study, conflict-prone SSA countries should integrate climate change adaptation and conflict prevention strategies, implement sustainable water resource management practices, and endorse climate-related conflict resolution.

We developed a new phantom for technical evaluation of jawbone single-photon emission computed tomography (SPECT) examinations for medication-related osteonecrosis of the jaw (MRONJ). In this study, we verified the utility of the phantom by determining optimal image reconstruction parameters. We evaluated the image quality and quantification in jawbone SPECT images obtained by different reconstruction parameters using the phantom. The phantom images were acquired using a SPECT/computed tomography (CT) system and then reconstructed using ordered-subset expectation maximization (OSEM) iterative reconstruction with resolution recovery as well as scatter and attenuation correction with various update numbers and Gaussian filter full width at half maximums (FWHMs). The percent contrast (%contrast) and absolute recovery coefficient were calculated to determine the optimal reconstruction parameters (OSEMjaw). Nineteen patients with a clinical diagnosis of MRONJ who underwent bone SPECT/CT were enrolled for the clinical study. The performance of OSEMjaw was verified by comparison with OSEMcurrent determined by a spherical phantom, using the correlation between the mean standardized uptake value (SUVmean) and clinical staging and visual assessment as endpoints. In the phantom study, %contrast and absolute recovery coefficient increased with increasing update numbers. As the Gaussian filter FWHM increased, the quantitative accuracy and image sharpness decreased. The parameter determined by the phantom study (OSEMjaw) recommended 120 updates and no filter. In the clinical study, the mean and standard deviation of SUVmean obtained from OSEMjaw were 8.9 ± 1.4 for stage 1 lesions, 12.9 ± 4.1 for stage 2 lesions, and 13.8 ± 1.4 for stage 3 lesions. For OSEMcurrent, they were 5.4 ± 2.3 for stage 1 lesions, 8.3 ± 2.5 for stage 2 lesions, and 8.0 ± 0.9 for stage 3 lesions. The SUVmean obtained from OSEMjaw had a stronger correlation with clinical stage. Based on visual assessment, the quality of the SPECT images reconstructed by OSEMjaw (3.7 ± 0.9) was superior to that reconstructed by OSEMcurrent (2.9 ± 1.1). We developed a novel phantom and adapted it for technical evaluation. This study demonstrated the utility of the developed phantom.

BACKGROUND Medication-related osteonecrosis of the jaw (MRONJ) is a rare but serious reaction to anti-resorptive drugs (ARDs) in patients treated for osteoporosis and conditions related to cancer. Treatment for MRONJ consists of the use of non-operative therapies according to the evolution of the disease, which consist of the use of antimicrobial mouthwashes, systemic antibiotics, and operative therapies, such as debridement of necrotic bone, marginal or segmental resection, and bone reconstruction of the jaws in more advanced stages of the disease. CASE REPORT This is a case series of 11 female patients treated for MRONJ, with a mean age of 76.5 years. Patients with malignant diseases of the jaws or those undergoing head and neck radiotherapy were excluded. Nine patients were medicated for osteoporosis with oral bisphosphonates and denosumab, and 2 patients used zoledronate to treat metastatic breast cancer. MRONJ prevailed in the mandible, most patients were classified as stage 2, and the most frequent triggers were tooth extraction and prosthetic trauma. All patients initially underwent non-operative therapies and were operated according to MRONJ stage, but none required segmental resection. Adjuvant treatments were used in 5 patients, and mean treatment and follow-up periods were 5 and 18.3 months, respectively. There was complete resolution of disease in all patients, with only 1 relapse. CONCLUSIONS This case series suggests that it is possible to treat MRONJ with conservative therapies in the early stages of the disease and minimally invasive surgeries in more advanced stages of the disease, thus avoiding segmental jaw resections.

The mining industry of the Democratic Republic of the Congo (DRC) represents the most important sector of the country's economy, and the DRC belongs to the world top five diamond producers. Artisanal small-scale mining (ASM) of alluvial diamonds represents an important source of alternative income for subsistence farmers, but it also leads to several socio-environmental impacts: deforestation, river pollution, water resources exploitation, unhealthy, unregulated and sometimes dangerous work environments. We perform a data-driven comprehensive analysis of the impact of the diamond mining industry on natural resources and assess the potential relevance of these resources to the DRC food system. To this end, we evaluate land and water resources consumption associated with diamond mining from 2001 to 2018, cross-referencing high-resolution data on mines, land use and tree cover, and using a dynamic and spatially distributed agro-hydrological model. We leverage disaggregated agrological data to provide alternative resources allocation scenarios, and use subnational development indicators and spatially explicit conflict data to frame our analysis within the socio-economic context. We find that, despite the richness in natural resources of the DRC, the impact of diamond mining is relevant because of its effects on ecology, economy, and society. Resources and efforts currently put into the mining industry may have the potential to alleviate the malnourishment crisis in DRC if diverted towards the construction of a more structured and resilient food system. Phenomena such as the illicit trafficking of diamonds and their use to finance wars contribute to nullify the potential of mining as an alternative source of income for subsistence farmers.

The coronavirus pandemic has fundamentally shifted the way human beings interact, both as individuals and groups, in the face of such a widespread outbreak. This paper seeks to investigate the effects of COVID-19 on intergroup emotions and attitudes within an intractable intergroup conflict, specifically, through the lens of the Korean conflict. Using a two-wave, cross-sectional design, this study was able to track the profound psychological changes in intergroup emotions and attitudes both prior to the pandemic and during its onslaught. Results of these two wave representative samples show that South Korean citizens demonstrated higher levels of fear of their neighbors in North Korea after the outbreak of COVID-19 than before. In turn, this led to increased societal support of hostile government policies towards North Koreans. Conversely, the same participants exhibited higher levels of empathy towards North Koreans during the pandemic, which led to a higher willingness to collaborate with their outgroup. This dual effect on intergroup emotions within intractable conflicts brings forth new avenues from which societies may be able to restrain the destructive influence of the COVID-19 threat on intergroup relations - as well as harvesting its constructive potential for reconciling warring intergroup relations.

Detailed spatial understanding of levels and trends in under-5 mortality is needed to improve the targeting of interventions to the areas of highest need, and to understand the sources of variation in mortality. To improve this understanding, we analysed local-level information on child mortality across sub-Saharan Africa between 1980-2010. We used data from 82 Demographic and Health Surveys in 28 sub-Saharan African countries, including the location and timing of 3·24 million childbirths and 393 685 deaths, to develop high-resolution spatial maps of under-5 mortality in the 1980s, 1990s, and 2000s. These estimates were at a resolution of 0·1 degree latitude by 0·1 degree longitude (roughly 10 km × 10 km). We then analysed this spatial information to distinguish within-country versus between-country sources of variation in mortality, to examine the extent to which declines in mortality have been accompanied by convergence in the distribution of mortality, and to study localised drivers of mortality differences, including temperature, malaria burden, and conflict. In our sample of sub-Saharan African countries from the 1980s to the 2000s, within-country differences in under-5 mortality accounted for 74-78% of overall variation in under-5 mortality across space and over time. Mortality differed significantly across only 8-15% of country borders, supporting the role of local, rather than national, factors in driving mortality patterns. We found that by the end of the study period, 23% of the eligible children in the study countries continue to live in mortality hotspots-areas where, if current trends continue, the Sustainable Developent Goals mortality targets will not be met. In multivariate analysis, within-country mortality levels at each pixel were significantly related to local temperature, malaria burden, and recent history of conflict. Our findings suggest that sub-national determinants explain a greater portion of under-5 mortality than do country-level characteristics. Sub-national measures of child mortality could provide a more accurate, and potentially more actionable, portrayal of where and why children are still dying than can national statistics. The Stanford Woods Institute for the Environment.

Denosumab, an anti-resorptive agent, IgG2 monoclonal antibody for human Receptor activator of nuclear factor-kappa B ligand (RANKL), has been related to the occurrence of osteonecrosis of the jaws. Thus, the aim of this study was to review the literature from clinical case reports, regarding the type of patient and the therapeutic approach used for osteonecrosis of the jaws induced by chronic use of Denosumab. For this, a literature review was performed on PubMed, Medline and Cochrane databases, using the keywords "Denosumab" "anti-RANK ligand" and "Osteonecrosis of jaw". To be included, articles should be a report or a serie of clinical cases, describing patients aged 18 years or over who used denosumab therapy and have received any therapy for ONJ. Thirteen complete articles were selected for this review, totaling 17 clinical cases. The majority of ONJ cases, patients receiving Denosumab as treatment for osteoporosis and prostate cancer therapy. In most cases, patients affected by ONJ were women aged 60 or over and posterior mandible area was the main site of involvement. Diabetes pre-treatment with bisphosphonates and exodontia were the most often risk factors related to the occurrence of this condition. Systemic and local antibiotic therapy with or without surgical debridement was the most used treatment for ONJ resolution. It is concluded that the highest number of ONJ cases caused by the use of anti-RANKL agents occurred in female patients, aged 60 years or older, under treatment for osteoporosis and cancer metastasis, and the most affected region was the mandible posterior.

Bisphosphonates (BPs) are the first-line treatment to stop bone resorption in diseases, including osteoporosis, Paget's disease, multiple myeloma and bone metastases of cancer. However, BPs-related osteonecrosis of the jaw (BRONJ), characterized by local inflammation and jawbone necrosis, is a severe intractable complication. The cumulative inflammatory burden often accompanies impaired lymphatic drainage, but its specific impact on BRONJ and the underlying mechanisms remain unclear. The mouse BRONJ model was established to assess the integrity and drainage function of lymphatic vessels by tissue clearing techniques, injected indocyanine green lymphatic clearance assay, flow cytometry analysis and histopathological staining. RNA sequencing, metabolome analysis, transmission electron microscopy and Western blotting were utilized to analyze the impacts of Zoledronate acid (ZA) on endoplasmic reticulum stress (ERS) and function of lymphatic endothelial cells (LECs). By constructing Lyve1creERT; SIRT6f/f and Lyve1creERT; ATG5f/f mice, we evaluated the role of ERS-induced LECs apoptosis in the progression of BRONJ. Additionally, we developed a nanoparticle-loaded ZA and rapamycin (ZDPR) to enhance autophagy and evaluated its potential in mitigating BRONJ. The mouse BRONJ model displayed impaired lymphatic drainage, accompanied by significant local inflammation and bone necrosis. The prolonged stimulation of ZA resulted in the extension of ERS and the inhibition of autophagy in LECs, ultimately leading to apoptosis. Mechanistically, ZA activated XBP1s through the NAD+/SIRT6 pathway, initiating ERS-induced apoptosis in LECs. The conditional knockout mouse models demonstrated that the deletion of SIRT6 or ATG5 significantly worsened lymphatic drainage and inflammatory infiltration in BRONJ. Additionally, the innovative nanoparticle ZDPR alleviated ERS-apoptosis in LECs and enhanced lymphatic function, facilitating inflammation resolution. Our study has elucidated the role of the NAD+/SIRT6/XBP1s pathway in ERS-induced apoptosis in ZA-treated LECs, and further confirmed the therapeutic potential of ZDPR in restoring endothelial function and improving lymphatic drainage, thereby effectively mitigating BRONJ. Bisphosphonate-induced lymphatic drainage impairment exacerbates bone necrosis. Zoledronate acid triggers endoplasmic reticulum stress and apoptosis in lymphatic endothelial cells via the NAD+/SIRT6/XBP1s pathway. Novel nanoparticle-loaded Zoledronate acid and rapamycin enhances autophagy, restores lymphatic function, and mitigates bisphosphonates-related osteonecrosis of the jaw progression.

This article sets medico legal light on torture of three former child soldiers by comparing torture methods, consequences of torture and medical observations. It is focused on these child soldiers as representatives of the many abuses of children as soldiers in armed groups. The three persons were child soldiers during 12 years in The Democratic Republic of Congo (DRC) as members of three different armed groups. They were exposed to armed conflict events, experienced torture, and participated in atrocities, sexual abuse and traditional rituals during their role in armed conflict. They were psychologically distressed with unhealthy physical and mental states. The principles for working with child soldiers are described. The model addresses basic items: The confluence of the dimensions of the items will determine the specifics of medico legal evidence of torture in child soldiers, taking into consideration inputs that are required at the macro, community and individual levels. A primary goal is to prevent violence from occurring in child soldiers. Thus, much more deliberate effort is made to address the underlying causes of recruitment of children in armed groups in DRC and to invest more resources in conflict resolution before there is an outbreak of violence. Peace education tends to be introduced too late and does little to alleviate the use of children in armed conflict in DRC.

In autoimmune nodopathies, autoantibodies target the nodes of Ranvier, impairing saltatory nerve conduction. Understanding the impact of autoantibody binding on protein assembly is crucial for gaining insights into the pathogenicity of different autoantibodies. We investigated nodal, paranodal, and cytoskeletal axonal proteins in teased fibers from a sural nerve biopsy of a patient with anti-pan-neurofascin autoantibodies. Conventional diagnostic tools, including fluorescence microscopy, often miss subtle alterations at the ultrastructural level. We utilized direct stochastic optical reconstruction microscopy (dSTORM), a super-resolution fluorescence imaging technique, to assess the nanoscale architecture of nodal, paranodal, and cytoskeletal axonal proteins. While conventional fluorescence microscopy revealed severe paranodal and nodal damage in 14% of the nodes, with 86% appearing normal at first glance, the super-resolved images revealed a decreased neurofascin-155 and Caspr-1 density, but preserved colocalization of these adhesion proteins in paranodes that initially seemed normal. At the nodes, sodium channel density and distribution remained intact, but neurofascin-186 density was reduced. Axonal beta-IV spectrin was altered only in severely damaged nodes. This indicates that axonal integrity is largely preserved, with a potentially reversible decrease in paranodal and nodal adhesion proteins in patients with nodopathy revealing subtle alterations in nodal integrity that are not apparent with conventional imaging. These likely reversible changes may explain the rapid recovery seen in patients with anti-pan-neurofascin autoantibodies following autoantibody depletion. Conversely, the small percentage of severely and axonally damaged nodes may account for the residual symptoms experienced by most patients.

Medication-related osteonecrosis of the jaws (MRONJ) is a known complication of antiresorptive medications with surgical and nonsurgical treatment options. The aim of this study was to evaluate the effectiveness of nonsurgical therapy using local wound care on management of MRONJ lesions. The authors conducted a retrospective cohort study of patients who presented to the University of California-Los Angeles School of Dentistry Oral and Maxillofacial Surgery Clinic for evaluation and treatment of MRONJ. The primary predictor variable was wound care score; secondary predictors were demographics (age, gender), anatomic location, primary condition, and type and time of antiresorptive treatment. Outcomes assessed were disease resolution and time to disease resolution. Statistical analysis was carried out using the Spearman correlation for continuous and ordinal variables or the χ2 test for categorical variables. Time-to-event statistics and Cox proportional hazards models were calculated; a Kaplan-Meier plot was generated to assess time to healing. One hundred six patients with 117 MRONJ lesions were treated using local wound care; complete disease resolution was observed 71% of lesions, with an additional 22% of lesions undergoing disease improvement. Wound care score was statistically associated with disease resolution and time to resolution, whereas demographics, anatomic site, condition, and type and time of antiresorptive treatment had no effect on resolution. Local wound care increased the likelihood of MRONJ resolution and decreased the time to disease resolution. This strategy can be used in patients who cannot undergo surgery and should be implemented in all patients with MRONJ lesions who are managed nonsurgically.

This article introduces the Religion and Armed Conflict (RELAC) data, 1975 to 2015, which is a new data set suitable for analyzing the causes, dynamics, and resolution of religious conflicts. It contains information about key religious dimensions of conflicts: whether the issue at stake is religious, the actors' religious identity, and fine-grained data about the type and salience of religious claims. The article presents the major features of the data set and describes patterns and trends that shed new light on religious conflicts, for example, by demonstrating that conflicts over Islamist claims have become more prevalent. We also illustrate the utility of the data. For instance, we show that there is great variation in lethality across conflicts with different types of Islamist claims, thereby offering a more nuanced understanding of the deadliness of religious conflicts. RELAC should be a valuable resource for scholars, examining religious dimensions of intrastate armed conflicts.

Changes in fertility patterns are hypothesized to be among the many second-order consequences of armed conflict, but expectations about the direction of such effects are theoretically ambiguous. Prior research, from a range of contexts, has also yielded inconsistent results. We contribute to this debate by using harmonized data and methods to examine the effects of exposure to conflict on preferred and observed fertility outcomes across a spatially and temporally extensive population. We use high-resolution georeferenced data from 25 sub-Saharan African countries, combining records of violent events from the Armed Conflict Location and Event Data Project (ACLED) with data on fertility goals and outcomes from the Demographic and Health Surveys (n = 368,765 women aged 15-49 years). We estimate a series of linear and logistic regression models to assess the effects of exposure to conflict events on ideal family size and the probability of childbearing within the 12 months prior to the interview. We find that, on average, exposure to armed conflict leads to modest reductions in both respondents' preferred family size and their probability of recent childbearing. Many of these effects are heterogeneous between demographic groups and across contexts, which suggests systematic differences in women's vulnerability or preferred responses to armed conflict. Additional analyses suggest that conflict-related fertility declines may be driven by delays or reductions in marriage. These results contribute new evidence about the demographic effects of conflict and their underlying mechanisms, and broadly underline the importance of studying the second-order effects of organized violence on vulnerable populations.

Developmental dysplasia of the hip (DDH) is a painful orthopedic malformation diagnosed at birth in 1-3% of all newborns. Left untreated, DDH can lead to significant morbidity including long-term disability. Currently the condition is clinically diagnosed using 2-D ultrasound (US) imaging acquired between 0 and 6 mo of age. DDH metrics are manually extracted by highly trained radiologists through manual measurements of relevant anatomy from the 2-D US data, which remains a time-consuming and highly error-prone process. Recently, it was shown that combining 3-D US imaging with deep learning-based automated diagnostic tools may significantly improve accuracy and reduce variability in measuring DDH metrics. However, the robustness of current techniques remains insufficient for reliable deployment into real-life clinical workflows. In this work, we first present a quantitative robustness evaluation of the state of the art in bone segmentation from 3-D US and demonstrate examples of failed or implausible segmentations with convolutional neural network and vision transformer models under common data variations, e.g., small changes in image resolution or anatomical field of view from those encountered in the training data. Second, we propose a 3-D extension of SegFormer architecture, a lightweight transformer-based model with hierarchically structured encoders producing multi-scale features, which we show to concurrently improve accuracy and robustness. Quantitative results on clinical data from pediatric patients in the test set showed up to 0.9% improvement in Dice score and up to a 3% smaller Hausdorff distance 95% compared with state of the art when unseen variations in anatomical structures and data resolutions were introduced.

Following the April 2018 reemergence of Ebola in a rural region of the Democratic Republic of the Congo (DRC), the virus spread to an urban center by early May. Within 2 wk of the first case confirmation, a vaccination campaign was initiated in which 3,017 doses were administered to contacts of cases and frontline healthcare workers. To evaluate the spatial dynamics of Ebola transmission and quantify the impact of vaccination, we developed a geographically explicit model that incorporates high-resolution data on poverty and population density. We found that while Ebola risk was concentrated around sites initially reporting infections, longer-range dissemination also posed a risk to areas with high population density and poverty. We estimate that the vaccination program contracted the geographical area at risk for Ebola by up to 70.4% and reduced the level of risk within that region by up to 70.1%. The early implementation of vaccination was critical. A delay of even 1 wk would have reduced these effects to 33.3 and 44.8%, respectively. These results underscore the importance of the rapid deployment of Ebola vaccines during emerging outbreaks to containing transmission and preventing global spread. The spatiotemporal framework developed here provides a tool for identifying high-risk regions, in which surveillance can be intensified and preemptive control can be implemented during future outbreaks.

Cholera outbreaks contribute substantially to illness and death in low- and middle-income countries. Cholera outbreaks are associated with several social and environmental risk factors, and extreme conditions can act as catalysts. A social extreme known to be associated with infectious disease outbreaks is conflict, causing disruption to services, loss of income, and displacement. To determine the extent of this association, we used the self-controlled case-series method and found that conflict increased the risk for cholera in Nigeria by 3.6 times and in the Democratic Republic of the Congo by 2.6 times. We also found that 19.7% of cholera outbreaks in Nigeria and 12.3% of outbreaks in the Democratic Republic of the Congo were attributable to conflict. Our results highlight the value of providing rapid and sufficient assistance during conflict-associated cholera outbreaks and working toward conflict resolution and addressing preexisting vulnerabilities, such as poverty and access to healthcare.

The immunopathogenesis of autoimmune neurological syndromes (AINS) with antibodies against the 65 kDa isoform of glutamic acid decarboxylase (anti-GAD65 AINS) remains poorly understood. To elucidate underlying disease mechanisms and identify relevant cell populations, we performed single-cell RNA and immune repertoire sequencing of cerebrospinal fluid (CSF) and peripheral blood mononuclear cells (PBMCs) of eight anti-GAD65 AINS individuals compared to eight noninflammatory controls. In addition, PBMCs from 19 anti-GAD65 AINS individuals and 20 healthy controls were analyzed by multidimensional flow cytometry, and brain tissue specimens from four anti-GAD65 AINS individuals were examined histologically. We detected higher frequencies of stem cell-like memory T cells (TSCM) within the PBMCs and a marked enrichment and clonal expansion of activated CD4+ TSCM in the CSF of anti-GAD65 AINS individuals. Expanded T cells exhibited increased expression of proinflammatory genes. Histological analyses confirmed intraparenchymal CD8+ TSCM in three of four anti-GAD65 AINS individuals and rare meningeal/intraparenchymal CD4+ TSCM in one person. Although CSF B cell receptors (BCRs) displayed little to no clonal expansion, recombinant expression of 40 CSF BCRs revealed that 25% were GAD65-reactive with increased somatic hypermutations compared to non-GAD65-reactive BCRs. These findings further support the concept of an antigen-specific intrathecal immune response. In summary, we characterize the immune landscape of anti-GAD65 AINS at single-cell resolution and identify clonally expanded TSCM with cytotoxic properties as a hallmark of this disease.

Therapeutic strategies for patients with medication-related osteonecrosis of the jaw (MRONJ) remain controversial. The aim of the present study was to clarify the effectiveness and safety of teriparatide therapy in Japanese MRONJ patients based on a large number of case series with a multicenter retrospective analysis. Between January 2012 and December 2016, 29 patients who were diagnosed with MRONJ at 10 hospitals were treated with teriparatide. The medical records of these patients were retrospectively reviewed to assess the efficacy and safety of teriparatide therapy for MRONJ patients. Adverse events occurred in 17.2% of patients (5/29). One patient developed severe arthralgia and discontinued teriparatide therapy after 12 days, while others continued the treatment. Among 29 patients, the median period of administration of teriparatide was 14.0 months (range, 0.3-26 months), and treatment outcomes were evaluated as effective in 75.9% of patients with complete resolution in 65.5%. Among patients treated with oral bisphosphonates (BPs), 83.3% were effectively treated with teriparatide and 40% with intravenous BPs. The oral administration of BPs was associated with successful treatment outcomes with teriparatide (p = 0.062). Teriparatide therapy has potential as an effective treatment option for MRONJ.

To explore the perceptions of staff working in and referring to community-based intermediate care teams in Wales. Central and devolved governments have high expectations of intermediate care to promote independence and quality of life for older people and to solve the system pressures within the acute hospital sector. Developing an evidence base of the effectiveness of a model of care that is characterized by diversity and difference in practice is problematic. Fourth generation ethnographic evaluation involving focus groups, non-participant observations and semi-structured interviews with people working within and referring to intermediate care teams. PRELIMINARY FINDINGS: Strong evidence of interprofessional working demonstrated by shared responsibility, coordinated rather than parallel services, understanding of other organizations and recognition and resolution of conflict areas. This generated work which traditional measures would not identify. Evaluation is inherent in the work of healthcare professionals and managers. Managers need to aware of the systems and structures within which they are required to manage. This is important for intermediate care services as the heterogeneity contributes to the challenges encountered by managers when seeking to describe services and measure their effectiveness. Applying an appropriate evaluation framework will facilitate both.